Pox plan raises concerns for HIV-infected workers
Risk to health and threat of disclosure
Confidentiality and testing concerns about HIV-infected health care workers are starting to surface as the government moves ahead with its plan to offer smallpox vaccine to hospital staff. Those with HIV would be at risk of dangerous complications, including potentially fatal progressive vaccinia, if they receive smallpox vaccine.
While the process is designed to be voluntary and confidential, smallpox immunization programs in hospitals threaten the health and confidentiality of HIV-infected health care workers, warns Larry Gostin, JD, LLD, director of the Center for Law & the Public’s Health at Johns Hopkins University in Baltimore.
"This really puts them in a dilemma," he says. "First of all, there is the problem of those who don’t know they are infected and will be placed at risk [if vaccinated]. Secondly, hospitals — either because they fear liability or for policy reasons — may be much more aggressive at uncovering people with undiagnosed HIV infection, either by asking pointed questions or testing. Thirdly, for those who are known to be HIV-infected, the chances of that information being spread more widely across the hospital are significant. There is real potential for concern about health, discrimination, and breaches of confidentiality. It’s a real worry."
In addition, the American Hospital Association (AHA) in Chicago is asking the government to clarify its position on HIV testing for smallpox vaccination. Clarification is needed about whether pre-vaccination tests are necessary to screen out health care workers who should not receive the vaccine, Roslyne Schulman, AHA senior associate director for policy development, said recently at a smallpox meeting of the Institute of Medicine in Washington, DC.
"The Advisory Council on Immunization Practices has recommended against the need for mandatory screening tests prior to vaccination as long as a thorough medical history and interview are completed and people are informed of the risks," she said. "However, the Department and Health and Human Services has not officially adopted these recommendations. Further, the [Bush] administration has indicated that those persons who might have a contraindication for the vaccine should be referred to the local public health department or another health care provider for testing. However, there remain questions about who will pay for such testing. Again, clarity is needed."
Confidentiality and testing concerns about HIV-infected health care workers are starting to surface as the government moves ahead with its plan to offer smallpox vaccine to hospital staff. Those with HIV would be at risk of dangerous complications, including potentially fatal progressive vaccinia, if they receive smallpox vaccine.
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