AFTER A NEEDLE PRICK
The life after a needle prick resulting in an HIV infection will be the worst nightmare any health care worker can ever have. Even in United States of America where human rights are highly valued and reputed, the life after occupationally acquired HIV is a real misery. Any victim, however dedicated he was in his work, has to prove that the disease was really acquired because of needle prick itself and not by other reasons. The criteria to prove this is difficult and mostly the compensation provided is meager.

American journal of public health says in detail about the technical difficulties on compensation
for occupationally acquired HIV.


Even in America the compensation for occupational HIV is difficult .To become eligible one has to prove:
1) The extent of exposure to the disease or disease-causing agents during employment
2) The extent of exposure outside employment
3) And absence of the disease prior to the work-related exposure as shown by the employee's medical history

Definition of an occupational disease is so restrictive that infected health care workers are unlikely to qualify for benefits. For those who are able to meet the definition, compensation is often inadequate The following criteria were ordered by a court for an occupational disease, and these often create further difficulties in seeking compensation.
  • The disease must be actually caused by employment conditions that are characteristic of and peculiar to a particular occupation.
  • The disease must be actually contracted during employment in the particular occupation.
  • The occupation must present a particular hazard of the disease occurring so as to distinguish that occupation from usual occupations, or the incidence of the disease must be substantially higher in the occupation than in usual occupations.
  • If the disease is an ordinary disease of life, the incidence of such a disease must be substantially higher in the particular occupation than in the general public.
www.ncbi.nlm.nih.gov/pmc/articles/PMC1380991


The following rights are universally accepted as the rights of occupationally acquired HIV

Prohibition of Discrimination. – No person shall be subject to discrimination in any form by the State or any other person in relation to any sphere of public activity including:
  • Denial of, or termination from, employment or occupation unless in the case of termination
  • Unfair treatment in, or in relation to, employment or occupation
  • Denial or discontinuation of, or unfair treatment in, healthcare services
  • Denial or discontinuation of, or unfair treatment in, educational services
  • Denial or discontinuation of, or unfair treatment with regard to, access to, or provision or enjoyment or use of any goods, accommodation, service, facility, benefit, privilege or opportunity dedicated to the use of the general public or customarily available to the public, whether or not for a fee including shops, public restaurants, hotels and places of public entertainment or the use of wells, tanks, bathing ghats, roads, burial grounds or funeral ceremonies and places of public resort
  • Denial or discontinuation of, or unfair treatment with regard to, the right of movement
  • Denial or discontinuation of, or unfair treatment with regard to, the right to reside, purchase, rent, or otherwise occupy, any property
  • Denial or discontinuation of, or unfair treatment in, the opportunity to stand for or hold public or private office
  • Denial of access to, removal from, or unfair treatment in, a State or private institution in whose care or custody a person may be
  • Denial of, or unfair treatment in, the provision of insurance unless such unfair treatment is based on and supported by actuarial studies
  • Isolation or segregation of a protected person
  • HIV testing as a pre-requisite, for obtaining employment, or accessing healthcare services or education or, for the continuation of the same or, for accessing or using any other service or facility.

International council of nurses on occupational HIV and compensation for occupationally acquired HIV


While the type and extent of compensation and health care coverage may vary depending on the place of employment and employer, NNAs must:
  • Protect benefits and continued employment opportunities for HIV-positive personnel.
  • Negotiate employer-financed health care and disability insurance for work related infection from HIV/AIDS and other blood borne diseases.
  • Lobby for compensation benefits.
  • Negotiate job retraining opportunities for nursing/midwifery personnel whose physical ability may be compromised because of HIV, TB and other illness.
An adequate compensation policy will reinforce nursing/midwifery personnel's duty to care for all patients regardless of disease status. Although it may be tempting to provide 'risk allowance' for those providing HIV/AIDS care, any allowance or premium should be linked to quality and expertise in care, not to risk of any specific disease.

CONTINUED EMPLOYMENT

It must be emphasized that illness due to blood borne pathogens such as HIV/AIDS, HBV and HCV and TB infection is not a cause for discontinuation of employment, whether the infection was acquired on the job or not. Thus as with any other illness, HIV-positive nursing/midwifery personnel should be allowed to work as long as they are fit, provided they practice universal precautions for infection control.

It is worthwhile to remember that the services provided by trained HIV-positive professionals outweigh the extremely low risk of HIV transmission to patients/clients. In line with this affirmative thinking, NNAs, nurse managers and employers should:
  • Promote access to confidential voluntary HIV testing, counseling and appropriate follow-up care.
  • Support flexible approaches that allow the assignment of nursing/midwifery personnel with HIV/AIDS to be modified on the basis of their ability to perform tasks and avoid infections, e.g. tuberculosis.
  • Promote policies that treat health care workers with HIV/AIDS the same as people with other serious illnesses.
If their ability to work is limited, health care personnel with AIDS should be provided with suitable alternative work arrangements and a supportive occupational setting.

WORKPLACE ISSUES

Even nursing/midwifery personnel may not be immune from irrational and emotional responses when working with HIV-positive colleagues. To address such negative responses, NNAs, nurse managers and employers should develop policies that:
  • Protect the confidentiality and privacy of HIV-positive nursing/midwifery personnel.
  • Prevent social isolation of HIV-positive personnel by co-workers.
  • Keep HIV-positive personnel in a supportive occupational setting as long as possible.
  • Provide a peer support system involving health care workers including those living with HIV.
  • Educate all employees, management and union leaders about the rights and care of HIV positive health care workers.
To combat discrimination and isolation of nursing/midwifery personnel living with HIV/AIDS, educational programmes must be targeted to reach managers, supervisors, union leaders and all employees.

NNA SERVICES

Depending on the stage of the disease and the resources available, HIV-positive nursing/ midwifery personnel require a package of services which can include27:
  • Negotiating with employers, managers and insurance agencies not to discriminate against HIV-positive personnel
  • Providing support, legal assistance and referrals;
  • Fostering networking with other HIV-positive health workers;
  • Counseling on career change and job retraining opportunities;
  • Advising about continued practice and disclosure of HIV status;
  • Developing and disseminating position statements on issues such as mandatory testing, ethical obligations of HIV-positive personnel and disclosure of information; and
  • Providing up-to-date and accurate information about compensation benefits, occupational risks and follow-up care.
Nursing/midwifery personnel have a long tradition of providing care without discrimination. It would be indeed unfortunate if they are themselves discriminated against because of HIV status. The challenge for NNAs, nurse managers and employers is to ensure that nursing/ midwifery personnel with HIV/AIDS are treated with dignity and afforded appropriate care and compensation benefits.

LOBBYING FOR PUBLIC POLICY

A starting point for NNA work in influencing public policy on HIV/AIDS care, ethics and human rights, is to review existing practices, policies and legislation in their countries to determine what needs to be changed or introduced. Using ICN guidelines and references, NNAs must then lobby for introducing or changing existing regulations and legislation to ensure that people with HIV/AIDS are treated like any other group with a health problem. Policies, practices and legislation should:
  • Ensure that health care settings have infection control policies.
  • Oppose mandatory HIV testing of patients and of nursing/midwifery personnel.
  • Ensure confidentiality and prevent disclosure of personal information about HIV status.
  • Clarify criteria for definition of 'occupational exposure'.
  • Make occupationally acquired HIV/AIDS a compensable disease, like other occupational diseases and disabilities.
  • Ensure comprehensive HIV-related employment regulations, including provision of HIV prevention education and protection against discrimination in the workplace.
  • Clarify professional ethical norms and obligations in regard to health care and HIV/ AIDS.
  • Allow continued practice for HIV-positive personnel depending on their ability to perform.
www.who.int/entity/occupational_health/activities/1icnguid.pdf

The government of south Africa has developed and published guidelines regarding compensation for occupational HIV
Compensation for occupationally acquired HIV infection
The following information is from a series of consultations with the Compensation Commission (formerly known as the Workmen’s Compensation Commission) and other relevant role players on the issue of compensation for occupationally acquired HIV exposure and HIV infection. It must be noted that the final decision as to whether there is a entitlement to compensation for any particular injury will rest with the Compensation Commission and each case will be judged on its own merits and on the facts of the case. It should further be noted that some of the rules and regulations and the approach to assessing compensation may change over time and this policy may therefore need to be updated from time to time.

1.0 Occupationally acquired HIV infection from an injury in the workplace is a compensatable injury.

1.1 It is the duty of the employer to provide for the necessary procedures and costs for the management of occupational HIV exposure in the pre-sero-conversion phase. This may include the HIV tests, the medical consultations, other laboratory tests, post exposure prophylaxis, and counseling.

1.2 The Compensation Commission will consider compensation only from the time of sero- conversion (this may include the HIV test which documented the sero-conversion).

1.3 For compensation purposes, the employee must prove a link between the injury on duty and the HIV infection. For this reason it is important to document the HIV status of the employee and the source patient. knowledge of the source patient’s HIV status will strengthen the claim. To support an application for compensation for an occupationally acquired HIV infection the employee must demonstrate an HIV negative status at the time of the injury and the source patient should have a documented HIV positive test result.

1.4 In the absence of the source patient’s HIV status, the employer must be able to demonstrate that every effort was taken to assess the HIV status of the source patient and that this was refused by the source patient. Other relevant clinical information on the source patient must also be documented for the claim. A sero-conversion within 3 months of the injury is considered to be reasonable evidence that the sero-conversion was as a result of the injury, provided all other necessary information is provided. If the source patient or the employee is considered to be in the window period then PCR testing should be considered.

1.5 Each claim will be assessed on its merits. Employees and employers should ensure that documentation of occupational exposures are kept on record and that claims are submitted within 11 months from the time of the injury. The CC will provide compensation for reasonable care at reasonable cost for a successful claimant, and any claims for disability will be assessed in the usual manner.

1.6 The CC will not provide compensation for treatment to reduce mother-to-child HIV transmission in cases of occupationally acquired HIV infection in the mother.

www.doh.gov.za/aids/docs/management.html