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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

HIV post-exposure care for health workers hindered by antiquated "stigma" laws

The aftermath of a needlestick is fraught with anxiety, but thanks to advances in HIV testing and treatment, health care workers can get swift and clear post-exposure guidance. A new drug regimen lowers the risk of contracting HIV, with fewer side effects.

But the mostly positive news about changes in post-exposure prophylaxis (PEP) is clouded by one drawback: Many states have neglected to update their HIV testing laws in light of new developments – laws that were mostly written in the 1990s when fear of HIV greatly exceeded our knowledge or ability to treat it.

“That was an era when the stigma of having HIV was enormous,” says Ronald H. Goldschmidt, MD, director of the national HIV/AIDS Clinicians’ Consultation Center at the University of California-San Francisco, which runs the PEPline advice call line for clinicians (1-888-HIV-4911). “There’s been such a societal and cultural shift that dealing with the stigma has become a lesser issue.”

In fact, in 2006, the Centers for Disease Control and Prevention recommended routine, universal testing of everyone ages 13 to 64 in health care settings, with an “opt-out” option, and annual HIV testing of people at high risk. With that policy, the HIV status of a source patient in an occupational exposure might already be known.

But can you reveal the HIV status to the health care worker who sustained a needlestick? That depends upon state law. “When the CDC came out with its 2006 recommendations, they really were at odds, to various degrees, with the laws of about 48 of the states,” says David M. Korman, JD, program manager for Special Projects at the Pennsylvania/MidAtlantic AIDS Education and Training Center at the University of Pittsburgh.

For example, many state laws required pre-test counseling, while CDC recommended HIV testing as a part of the general consent on admission to the health care facility.

--Michele Marrill

For more on this story see the August issue of Hospital Employee Health