"Once I was diagnosed with full blown AIDS, the administration of my hospital verbally and in

an unsigned and undated document immediately forbade me to continue performing any surgical
procedures, change dressings, draw blood, give injections, or do rectal exams. Any patient exam-
inations I did I would have to wear gloves. I was told that if I failed to agree to these conditions I
would be dismissed by the hospital."

Ladies and Gentlemen, words from

An American Urologist

Good ethical decisions begin with good facts.

As we deal with issues surrounding this very sensitive social concern, we are faced with mind-
boggling questions, with areas requiring extensive research and prime considerations, especially
on the LEGAL and ETHICAL side.

Indeed, how far can confidentiality go?

Friends from the novel profession of medicine, fellow medical students, our beloved doctors,
guests:

What does a medical practitioner with HIV/AIDS need to know and why?

My discussion is centred on addressing 3 key areas LPN: the limitations imposed, practice issues
and whether there is a need to disclose:

Limitations Imposed

For oneself, one needs to know the extent of the HIV infection.

Are there organs or systems affected?

What is the status of the immune system?
How can he/she expect this infection to affect him/her?
What are the indications for and the benefits and risks of treatment?

In this way, a medical practitioner is no different than others with newly diagnosed HIV in-
fection. But he/she is different in a significant way. He/She is a physician, and ones profession
and role impose a set of duties and obligations. These raise additional questions and concerns.

One has to accept the obligation to do no avoidable harm, be as skilled and knowledgeable
as one can be, recommend and do what is best for ones patients, and be honest with them. Be-
sides these duties of station one has assumed the responsibility and challenge of providing the
facts that her patients needs in order to give voluntary informed consent for him/her to perform
surgery or procedure on them.
Practice Issues
a. Should HIV infected Health Care Workers be allowed to practice?

For reasons of justice, one recognizes the right of patients to be free from identified risks of
infection, it also recognizes the rights of HIV positive health care providers to continue prac-
tice under the following conditions:

Strict observation of recommended infection control procedures (Universal

Precautions) that apply to all health care professionals.
Adherence to preventative steps that protect the public from any risk of infec-
tions.
Refraining from practices and procedures where a verified risk of transmis-
sion exists as identified by the Center for Disease Control - Department of
Public Health or other public health authorities.
Health care providers who are known to have chronic transmissible blood
borne infections should be advised to avoid procedures that have an epidemi-
ological link to the transmission of HBV or other blood borne infections.

The Need to Disclose

In general, according to case law and professional practice guidelines, health care workers
have a duty to inform patients or employers that they are HIV positive if they perform invasive or
"exposure-prone" procedures on patients. Specific guidelines are set out in the American Medical
Association's "Guidance for HIV-Infected Physicians and other Health Care Workers", 2011
with other legal implications provided by the speaker before me.
It is worthy to note in the journal that, Patient Care Duties: A physician or other health care
worker who performs exposure-prone procedures and becomes HIV-positive should disclose his/her
serostatus to a state public health official or local review committee. Hence, an HIV- infected physi-
cian or other health care worker should refrain from conducting exposure-prone procedures or per-
form such procedures without permission from the local review committee and the informed con-
sent of the patient."
Whether a physician should disclose his/her HIV status to her patients is the remaining ethi-
cal question. Because of the severity, fear, and uncertainty about transmission and the social
stigma associated with the debut of the AIDS/HIV epidemic, we treated this syndrome as excep-
tional and implemented different approaches to testing, confidentiality, counseling, and infection
control. It is time to incorporate that evidence into our ethical reasoning.

Lets take the case of a surgeon, for example

The risk of HIV acquisition from an infected surgeon appears much lower than the risk of
nosocomial bacterial infections, even those with lethal potential. These rates vary by surgeon and
institution. It is not the practice, at least not yet, for surgeons to disclose their personal complication
or postoperative infection rate to prospective patients.
Disclosure, may arouse anxiety unnecessarily and have no practical effect on risk reduction.
It may be that some patients would be more fearful of a low risk of perioperative HIV infection
than of a serious adverse drug reaction, postoperative hemorrhage, and the like. While there may be
an understandable reluctance to answer a patients pointed question about his or her surgeons HIV
status, medical ethics and respect for persons demand an honest answer, just as they would to a
question about training, experience, or complication rates.
 This case invites us to think, in a patient-centered and generic way, about the risks, real and
potential, that surgeons pose to patients and how they should be managed. Known serious risks
should absolutely be avoided.
Abstaining from surgery during such clinical infection is appropriate. Primary prevention
via immunization is an even better, more ethically appropriate, and efficient strategy. If the risk is
real, but much lower and not reducible by actions available to the surgeon, disclosure may be an
appropriate strategy.
Reasonable and truly informed consent remains a challenge, both as a process and as an out-
come. If a doctor clearly explains to her patients the medical indications, expected outcomes, rea-
sonably anticipated risks and adverse events, benefits, and alternatives, he/she will be doing not an
incompetent, but rather an ethically competent job and probably a better one than most of his/ her
colleagues.

Beyond that white coat is a human person

Beyond the stethoscope is a hero of countless times
Beyond the label is a person called to serve and touch many lives
Beyond the virus is a creation of God

Friends in the medical profession, future medical practitoners, will you disclose your status if you
got infected with HIV/AIDS?

Is it a yes, or a no?

"A policy which supports healthcare workers is more likely to be more effective than one which ex-
cludes and in effect punishes them,"