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5.5.6 HIV

RELATED CHAPTER

Blood Borne Viruses


Contents

  1. Purpose
  2. Background
  3. Context
  4. Legislation
  5. Recruitment and Employment
  6. Health and Safety
  7. Working with People with HIV
  8. Confidentiality
  9. Consent to Disclosure
  10. Recording Information
  11. Support and Counselling
  12. Staff Development and Training
  13. Providing Services
  14. Monitoring

    Appendix A: Corporate Policy HIV
    Appendix B: HIV/Aids Consent Form


1. Purpose

The purpose of this document is to outline the Departmental policy and procedure regarding the management of staff and the provision of services to people in respect of HIV.

This document should be read in conjunction with the corporate policy - HIV which is attached as Appendix A: Corporate Policy HIV.


2. Background

The Corporate Policy HIV, published in 1996 encompasses a number of key areas common to all departments, and sets out general principles which employees are expected to adhere to in carrying out their jobs and providing the Council's services.

The key points of the policy are summarised below:-

  • The Council is committed to equality of opportunity in its service delivery and employment practices. It also recognises and values the diversity of its communities and workforce. This includes people with HIV;
  • The Council therefore is committed to ensuring that people affected by HIV either directly or indirectly, do not experience discrimination in employment or through using council services;
  • The Council will challenge any prejudicial connotations associated with the origin and transmissions of the virus;
  • It is the policy of the Council not to test for HIV, and therefore no employee or applicant will be required to take the HIV antibody test as a condition of employment;
  • There is no obligation upon an employee to inform management if they have HIV;
  • All of the services of the Council are available to all residents of the Borough including people with HIV. No one will be denied a service for which they meet the eligibility criteria solely because they have HIV;
  • The Council does not require people with HIV to disclose this information in order to obtain a service;
  • Information relating to any person's HIV status, regardless of how it is acquired, must be held in confidence. Information must not be shared, recorded, stored or used in any other way without the consent of the person with HIV;
  • In recognising that the potential for fear and prejudice about HIV exists, the Council will produce and publicise rational and logical information to overcome negative reactions;
  • The Council is committed to supporting positive initiatives designed to prevent the further spread of HIV.

The corporate policy required each Department of the Authority to draft and implement its own policy and procedural documentation relevant to the work it undertakes in order to build on the Corporate Policy.


3. Context

HIV has been a significant issue in health and social care provision since the early 1980's. The unpredictable nature of HIV disease means that an individual's circumstances can change rapidly, requiring quick responses to a constantly changing pattern of needs.

Advances in the treatment and care of people with HIV disease have increased both the quality and length of life. Changes within the health care system mean that people now receive more care at home.

This policy and procedural document has been written in line with the Strategic Framework and throughout reflects many of the values and aims of the framework.


4. Legislation

Legislation and guidance that has an impact on all aspects of Authority's responsibilities and practices is contained in the Corporate Policy - HIV.

Specific legislation that relates to the Departments responsibilities towards people with HIV is contained in the following Acts.

  • The National Assistance Act 1948, places Social Services under a duty to make arrangements to provide "residential accommodation to persons who by reason of age, infirmity or any other circumstance are in need of care and attention which is not otherwise available to them", and a duty to make arrangements to promote the welfare of persons who are "blind, deaf or dumb, or who suffer from mental disorder of any description and other persons who are substantially and permanently handicapped by illness, injury or congenital deformity";
  • The Chronically Sick and disabled Persons Act 1970 places Social Services under a duty to provide specified welfare services which are required in their opinion to meet the needs of persons covered by the National Assistance Act 1948, above. Individuals also have the right to services under certain circumstances;
  • The Disabled Persons Act 1986 makes new provision for the assessment of service needs under the Chronically Sick and Disabled Persons Act and imposes a duty to have regard to the ability of a carer;
  • NHS and Community Care Act 1993 confers responsibility on Social Service Departments to ensure that social care services are provided to those in need;
  • Disability Discrimination Act 1995 states that discriminating against a person because of a disability will be illegal. Employers of more than 20 people will be legally obliged to make "reasonable adjustments" so people who are disabled can work for them. "Infection by HIV" has been included in the Act to indicate "progressive conditions" which should be covered by these provisions. However, the Social Security Minister, Alistair Burt MP, said "People with HIV will be covered.............only if they meet all the requirements..............that is, not until the first effect on normal day to day activities manifests itself. As the great majority of people with HIV infection are asymptomatic, they would not be covered".


5.  Recruitment and Employment

These issues are dealt with in full in documentation produced by the Central Personnel Unit, and should be read in conjunction with that document.


6. Health and Safety

The risk to staff contracting the virus in a workplace setting is extremely low, and there are no confirmed cases of infection this way.

Even in situations where (health care) workers have contracted HIV through infected blood, this has usually been as a result of a needle stick injury, and infection through this route is low.

However, while the occupational risk from HIV is low, staff should also be aware of the risks from other more infectious illnesses such as Hepatitis B.

Infection control procedures are designed to protect staff and should be adhered to at all times and in all situations. Copies of the Councils Infection Control Procedures are available from the Occupational Health Unit.


7.  Working with People with HIV

The Council required all staff to work with and provide services to all people, regardless of their HIV status, without discrimination or prejudice.

Refusal to do so, or evidence of any other form of discrimination, will be regarded as a serious matter and may result in disciplinary action being taken against them.

It is recognised though that fear of infection may arise through misinformation or the lack of opportunity to explore other issues, and this can heighten feelings of anxiety or prejudice. Staff are recommended to attend the Basic HIV Awareness Training Course, which will give them the opportunity to dispel common myths, gain up to date information and discuss other issues in a safe and supportive environment.


8. Confidentiality

The principles of confidentiality are outlined in the Corporate Policy HIV (Appendix A: Corporate Policy HIV) and considered in full in the Confidentiality Procedure. However there are a number of issues pertinent to HIV and these are dealt with below and should be considered in conjunction with the relevant procedures mentioned above.

There may be occasions where individual circumstances challenge the principle of confidentiality. However case law has shown that these situations are rare and would have to be severe before the principle could be overridden.

There are though some instances when information relating to a person's HIV status might influence the eligibility for a specific service or have an impact on the level or type of care they receive. This is deemed as a "need to know" situation and only exists where a decision to provide or deny a service or alter the level or type of care hinges on this specific information only.

In such a "need to know" situation, consent of the client must be sought. If the client is unwilling to consent to the sharing of information, then access to, or provision of services can only be made on the information available.

For children and young people under the age of sixteen where the Council shares Parental Responsibility, the consent of the parent/s or guardian/s must be sought. The young person should be involved depending upon their age and maturity.

For children and young people under the age of sixteen where the Council has sole Parental Responsibility, the decision whether or not to share information will rest with the Director of Social Services.


9. Consent to Disclosure

Before information about an individual's HIV status is disclosed or shared to a third party, the written consent of the person concerned must be obtained.

Consent should always be informed and understood. For consent to be informed, it is necessary to discuss with the person concerned why there is a need to share information, with whom, and what are the likely consequences of their agreeing to or not agreeing to disclosure.

In some instances non-disclosure could mean that the person's need for a service would not be identified. It is important to be honest about this and to acknowledge the person's right to decide.

The person should be advised of how and whether the information about their status may be recorded and who may have access to it. People are not always clear about the extent to which information needs to be shared in large organisations and this too must be explained.

In all situations a consent form, such as that attached at Appendix B: HIV/Aids Consent Form should be used.


10. Recording Information

If a service user, or member of staff decides to disclose information regarding their HIV status a number of points need to be considered and conveyed to the person in question.

  • Is knowledge of their status relevant?
  • Does the individual wish their status to be recorded or not?
  • It should be explained what the possible consequences are of either recording or not recording the information;
  • It should be remembered that when information is recorded it becomes the responsibility of the Council and not the member of staff concerned;
  • Explain how the information will be recorded (i.e. manually, on a computer or both), how the information will be stored (in a filing cabinet or on a database);
  • Explain who else on a normal (day to day) basis will have access to the information, i.e. other team members, administration staff etc;
  • Information about a persons HIV status must not be shared other than for statistical purposes, outside the team to another individual, team, department or agency without first seeking the written consent of the individual.


11. Support and Counseling

Managers are responsible for ensuring that staff receive an adequate level of care and support to share both professional and personal concerns and worries. This should at first be achieved through the normal methods of supervision, however in some cases it may be necessary to refer individuals on to specialist support, such as the Staff Welfare Officer or the HIV Coordinator.

In some circumstances individuals may require specialist counselling, in which case they will be referred to appropriate counselling services provided either through the Council or by external agencies.


12. Staff Development and Training

Managers are responsible for ensuring that staff receive adequate and appropriate training to enable them to carry out their duties properly and effectively.

This includes identification and discussion of learning needs in relation to HIV that should be recorded using the Learning Needs Analysis process. Where specialised training is required contact should be made in the first instance with the HIV Coordinator and the HIV Trainer.

Existing members of staff should be encouraged to attend the one day HIV Basic Awareness Course. New staff to the Department will have HIV information included as part of their induction process.

Staff who are likely to have contact with people with HIV will be expected to attend the two day HIV Advanced Course.

A variety of specialist courses are available to staff where appropriate.


13. Providing Services

The Department does not provide specific specialised services for people with HIV. People with HIV can access all the services of the Department in the normal manner and will be assessed according to their needs.

Living with HIV or a diagnosis of AIDS is not regarded as a need in itself, and services will not be provided solely for this reason.

However it should be stressed that the health of someone with HIV can change rapidly and therefore we need to respond as quickly as possible to meet their needs. Also clients will need to be reassessed/reviewed on a regular basis to ensure that the services being provided are still appropriate, and changes made where necessary.

It is not uncommon for a person with HIV to also be a carer (including young carers) for another person with HIV. Staff should be aware of this possibility and carry out the relevant assessments to meet all their needs in both capacities.

It is important that the rights of a person with HIV to retain full control over decisions made about their care and support is both acknowledged and maintained.

All staff should be aware of relevant sources of information, advice, counselling, and other services to clients. Such information is available from the HIV Coordinator.

People with HIV often have increased living costs, while also living on a reduced or insufficient income. Staff should therefore be aware of the relevant State Benefits applicable, and ensure that individuals claim those benefits appropriate to their situation. Further advice can be sought from the Departments Welfare Rights Service.

13.1 Services for Children

No child or young person will enter statutory care solely on the grounds of having HIV.

No young person under 16 in statutory care may be subjected to a HIV test without the agreement of the Director of Social Services.

A request to carry out a HIV test will not be accepted solely on the grounds of lifestyle or sexuality of the child or young person, or the lifestyle or sexuality of the parents.

A request to carry out a HIV test will only be considered by the Director if a baby, child or young person displays symptoms that may be associated with HIV disease. In such cases the responsible Social Worker should seek confidential medical advice and should such advice result in a medical recommendation that a HIV test be undertaken, this should be referred to the Director for decision.

In the event that an agreement to carry out a HIV test is given, the Social Worker will be responsible for ensuring that both pre-test and post-test counselling (appropriate to age and understanding of the child) is given by an adequately trained and qualified health visitor. An appropriate person should also be present, subject to age, understanding and consent of the child.

It is recognised that in certain circumstances adoptive parents may seek guarantees that a child is free from HIV, even though there is no evidence to suggest that the child may have been at risk from or have contracted HIV. Such requests involving HIV testing are not acceptable for the reasons outlined above. Also for clinical reasons it is not possible to effectively establish a child's HIV status before they are 2-3 years old.

If it is known that a child who is to be Looked After by the local authority has HIV, then the residential carers or foster parents will only be informed when the health care and management of the child may be adversely affected otherwise.

As a general principle carers of children in short term placements will not normally be informed, while carers of children in long term or permanent placements are more likely to be informed.

However it should be recognised that no two cases are the same, and a decision whether or not to inform residential carers or foster parents will depend entirely upon the circumstances and health of the child concerned. This is deemed as a "need to know" and discussed in full at Section 8, Confidentiality.

Disclosure of a child's HIV status by a carer or foster parent to another person, department or agency (such as school teachers) should be regulated by a "need to know" which is discussed in full at section 8.


14.  Monitoring and Review

The effectiveness of this policy will be monitored through a variety of means, including customer complaints and disciplinary records.

This policy will be reviewed on at least a three yearly basis, or as and when changes in relevant legislation occur.


Appendix A: Corporate Policy HIV

1. Purpose
2. Introduction
  2.1 Definitions
  2.2 Incidence
3. Context
  3.1 Relevant Legislation and Guidance
  3.2 Healthy Environment
  3.3 Equal Opportunities
4. The Policy
  4.1 Schools Maintained by the LEA
  4.2 A Positive Approach
  4.3 Confidentiality
  4.4 Support and Counselling
  4.5 Recruitment
  4.6 Employment
  4.7 Health and Safety
  4.8 Service Provision
  4.9 Training, Education and Information
5. Implementation
6. Monitoring and Review


1. Purpose

The purpose of this report is to define the Authority's policy in responding to the impact of HIV. This will cover the role of the local authority as an employer, as a provider and enabler of services and in fulfilling the Authority's wider remit in relation to it being a major influence within the community.


2. Introduction

2.1Definitions

Throughout this policy the phrases "People with HIV" and "Living with HIV" will be used to describe both people living with HIV infection or HIV disease. HIV disease by definition will include those living with AIDS.

Given the potential for misunderstanding it is important to be clear about the terminology in this area. The following terminology is currently used:

  • HIV DISEASE is a term used to cover all medical conditions and illnesses related to HIV infection. Many people with HIV infection can be ill without a diagnosis of AIDS;
  • HIV stands for Human Immuno Deficiency Virus. HIV damages the body's immune system reducing its ability to fight infections. A HIV test detects antibodies to HIV. When such antibodies are found, a person is said to be HIV positive or HIV antibody positive;
  • AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is not an illness or disease, it is a collection (syndrome) of illnesses and infections. A person is diagnosed as having AIDS when they experience one or a combination of certain opportunistic infections. Many of these illnesses can be successfully treated, and many people living with AIDS are usually well, with only occasional acute episodes of illness.

2.2 Incidence

HIV has become one of the most significant challenges to world health in the latter part of this century. It is officially classed as a pandemic in that it relates to the whole population, by the World Health Organisation and has reached epidemic proportions in some countries.

There are estimated to be 13-15 million people worldwide living with HIV. Approximately 4% of cases of HIV have occurred in Europe, with the United Kingdom having one of the lowest rates of incidence of all European countries.

Within the United Kingdom, to the end of March 1995, almost 24,000 people had been diagnosed as having HIV. Of these over 7,000 have already died.

Of the eight health regions in England, the North West region has the 5th highest incidence of HIV.

Local statistical reports show that there are less than 30 people (to the end of December 1994) currently known to be living with HIV resident in the Borough.  However, there may well be a substantial number of people who are not aware of their HIV status, or choose not to take a HIV test. Therefore the true number of people with HIV may be substantially more than the known figure.


3. Context

The need for a specific HIV policy is a complex matter owing to the diverse range of issues that it raises at many different levels. These need to be effectively coordinated and consistently applied.

Many of the issues it raises, such as equal opportunities and health and safety are already the subjects of corporate policies. These policies have been reviewed and are considered to be both appropriate and sufficient in dealing with matters relating to HIV. General good practice represented by existing policies provides staff with sufficient protection. However there are issues that need special consideration and these are the subject of this policy.

3.1 Relevant Legislation and Guidance

i. General

Legislation of a general nature that has an impact on other employment practices but is particularly relevant to HIV includes the following Acts:

  • The Access to Personal Files Act 1987 gives the user of services and any other living person about whom an authority holds personal information, the right of access to personal information about themselves. There are separate Regulations for Housing and Social Services;
  • The Data Protection Act 1984 enables an individual who believes that personal information relating to themselves is being electronically stored, to apply to discover if the information is being stored and if so, to have access to it.

These acts are especially important given the significance of maintaining confidentiality of people with HIV.

ii. Specific

Legislation relating in particular to HIV is contained in the following Acts.

  • The Public Health (Control of Diseases) Act 1984, enables a local authority to order the compulsory medical examination, removal to and detention in hospital of a person with a notifiable disease. By definition AIDS is considered a notifiable disease;
  • The NHS Trusts and Primary Care Trusts (Sexually Transmitted Infections) Directions 2000 provide that every NHS trust and Primary Care Trust shall take all necessary steps to secure that any information capable of identifying an individual obtained by any of their members or employees with respect to persons examined or treated for any sexually transmitted infection shall not be disclosed except-
    1. for the purpose of communicating that information to a medical practitioner, or to a person employed under the direction of a medical practitioner in connection with the treatment of persons suffering from such disease or the prevention of the spread thereof;and
    2. For the purpose of such treatment or prevention.
  • Government advice, contained in the publication "AIDS and the Workplace: a Guide for Employers" states:

    "HIV infection alone does not affect peoples ability to do their job until they develop illnesses that make them unfit.......If they later become ill, they should be treated like anyone else with a life threatening illness. Only if their illness affects their ability to do the job should their employer seek medical advice"

    and

    "Dismissal purely on the basis that an employee is infected with HIV could be held to be unfair under legislation"

3.2 Healthy Environment

It is accepted that some employees will work with and provide services to people with HIV (often unknowingly) and managers are responsible for protecting the health of employees in so far as is reasonable under the relevant Health and Safety Guidelines.

The fear of becoming infected through ordinary social or work contact is unfounded. HIV can only be passed on via specific routes and cannot be contracted by, for example, sharing use of crockery or utensils, toilets, holding or hugging.

There are no known cases of anyone in a non-clinical situation having contracted HIV through their work.

3.3 Equal Opportunities

The Council is committed to equality of opportunity in its service delivery and employment practices. It also recognises and values the diversity of its communities and workforce. This includes people with HIV.

The Council therefore is committed to ensuring that people affected by HIV, either directly or indirectly do not experience discrimination in employment or through using Council services.

The Council, through its positive approach, will challenge any prejudicial connotations associated with the origin and transmission of the virus.

4. The Policy

The policy encompasses a number of key areas common to all departments and sets out general principles, which employees are expected to adhere to in providing the Council's services.

4.1 Schools Maintained by the LEA

In recognition of the unique relationship between the Authority and schools it is not possible to instruct the adoption of this policy. However copies of the policy will be disseminated to all Boards of Governors of Schools maintained by the Local Education Authority. It is to be recommended to them that unless they have their own HIV policy, individual schools should adopt this document as a model of good practice.

4.2 A Positive Approach

The Council through its positive approach recognises that:

  • It has a major role to play in responding to the challenge that HIV presents, both in terms or the services that the Council provides to residents of the Borough, and also as a major employer;
  • It has a role to play in raising awareness, correcting misinformation, challenging discrimination and prejudice and dispelling fear, through example and best practice; and
  • It is committed to working with the District Health Authority, and with the voluntary sector, to ensure that adequate resources and support are provided in accordance with this policy and within available resources to best meet the needs of those affected.

All appropriate opportunities will be taken to maximise the allocation of available resources.

4.3 Confidentiality

Information relating to a persons HIV status, regardless of how it is acquired must be held in confidence.

Any person holding such information must not:-

  • Divulge it to a third party;
  • Record the information, either manually or on computer; or
  • Use that information in any other way;

    without the consent of the person with HIV.

    There may be occasions where individual circumstances challenge this principle. However case law has shown that these situations are rare and would have to be severe before the principle could be overridden.

    Before information about an individual is recorded, disclosed or shared, their written consent must be obtained. They should understand why, for what purpose or to whom that information is to be recorded, disclosed or shared. See Appendix C - to follow.

4.4 Support and Counselling

The Council recognises the benefit of support and counselling for those members of staff working with people with HIV, or staff who are affected by HIV. In such circumstances the line manager or supervisor should offer appropriate support and guidance.

Individuals requiring counselling will be referred to appropriate counselling services, provided either through the Council or by external agencies.

4.5 Recruitment

The council will not discriminate during the recruitment and selection process, against any applicant on the grounds that they are living with HIV. Applications for employment will be dealt with in the normal manner.

Applicants will not be refused an offer of work solely on the grounds of having HIV. Fitness and suitability for employment will be judged in the normal manner that applies to all staff.

Terms and conditions of employment will be no different to other members of staff.

4.6 Employment

It is the policy of the Council not to test for HIV, and therefore no employee, or applicant will be required to take the HIV antibody test as a condition of employment.

There is no obligation upon an employee to inform management if they have HIV.

However it is expected that they take reasonable steps in recognising the need to protect both themselves and others.

If it becomes known that an employee is living with HIV the Council will take reasonable steps to provide adequate support and make reasonable arrangements to enable continued employment or facilitate early retirement on medical grounds.

The Council expects employees to work with and provide services to people with HIV without prejudice or discrimination.

4.7 Health and Safety

Observations of and adherence to existing Health & Safety, Infection control procedures and COSHH (Control of Substances Hazardous to Health) Guidelines will provide sufficient protection from the risk of contracting HIV in a workplace setting.

All necessary equipment, such as clothing and cleaning materials are available and should be used as required by the above policies.

4.8 Service Provision

All services of the Council are available to all residents of the Borough, including people with HIV in accordance with its general duties, responsibilities, priorities and eligibility criteria.

No one will be denied a service for which they meet the eligibility criteria solely because they have HIV.

The Council does not require people with HIV to disclose this information in order to obtain a service.

Practices within each department will be reviewed to ensure that all users of services and all employees are adequately protected from risk of HIV infection.

4.9 Training, Education and Information

In recognising that the potential for fear and prejudice about HIV exists, the Council will adopt a positive approach to develop, produce and publicise rational and logical information in order to overcome negative reactions.

The Council is committed to supporting positive initiatives designed to prevent further spread of HIV, such as Safer Sex, Safer Drug Use campaigns (including needle exchange schemes) and any relevant events generated by World Aids Day.

All members of staff should have the opportunity to attend a HIV basic awareness training course. Some members of staff will require additional specialised training relevant to their work. The exact nature and content of any training will be determined as a result of a detailed assessment and will be carried out by appropriately experiences and qualified staff or trainers.


5. Implementation

As this policy only covers common key areas relating to HIV, it cannot address fully or meet the issues relevant to individual departments within the council.

Therefore each Department will draft its own Departmental Policy and Procedural Document, which will reflect and build upon this policy in order to fully address the issues relevant to that Department.

It is intended that this policy is presented to all services committees for them to adopt and for individual departments plans to be based upon this general policy.

A leaflet summarising the key points of the policy, and individual responsibility in carrying it out will be distributed to all existing and new members of staff. A copy of the leaflet is attached as Appendix D - to follow


6. Monitor and Review

This policy will be reviewed on at least a three yearly basis and any changes will be reported back to Committees.


Appendix B: HIV/Aids Consent Form

Click here to view Appendix B: HIV/Aids Consent Form

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