Dentists with HIV face 'unfair' treatment

When Allan Reid was told in 2007 he was HIV positive, he kept it a secret. Three months later, he saw his name and picture splashed across the Sun newspaper, criticised in the tabloid for sparking a "major health alert after treating thousands of patients – without telling them he was HIV positive".

Under guidelines adopted by the Department of Health 20 years ago, and revised and republished in 2007, health workers who carry out certain procedures are banned from working as soon as they are diagnosed as HIV positive. These are all interventions known as "exposure-prone procedures" (EPPs), which the UK Advisory Panel for healthcare workers infected with blood-borne viruses (UKAP) defines as having a "risk that injury to the worker may result in exposure of the patient's open tissues to the blood of the worker".

Most procedures in dentistry fall into this category, so as soon as dentists are found to be HIV positive, they are banned from working.

Around 10 dentists and trainee dentists a year are thought to be affected by this ruling, although there is no official record of how many dentists with HIV have been banned from working, according to the indemnity provider Dental Protection.

Knowing and very much fearing this fate, Reid, who worked at a dental practice in south London, decided to keep his diagnosis a secret. "I continued to practise for some months after finding out my status. I knew it would be the end of my career. I just couldn't cope with that happening to me," says the 41-year-old.

It was the realisation that if he lived elsewhere, he could have carried on working that influenced Reid's decision to hide the truth. In all, there are more than 20 countries where dentists with HIV can practise, including America, Israel and a number of countries in Europe.

In France, dentists can practise if they are clinically well and have had an undetectable viral load for at least three months. In America, it differs from state to state. Some American states allow dentists with HIV to continue practising provided they follow infection control procedures and their condition is monitored regularly by a doctor. In others, dentists have to inform patients of their HIV status.

In Israel, a dentist with HIV can practise, providing they are taking HIV treatment and they maintain an undetectable viral load and follow infection control procedures. Reid says he felt "extremely confident" in his cross-infection control measures, and felt he never put his patients at risk. "After being aware of my status, I fully reassessed my working practices and felt 100% sure that by continuing to work I was not putting any patient's safety in jeopardy.

"I was also very much aware that I was not the only HIV-positive healthcare worker who kept the same secret. I personally knew of several other EPP-performing healthcare workers, including dentists, who did the same."

However, his plan to keep his status secret was wrecked when he was exposed by the Sun. He was told by Lewisham primary care trust (PCT) to stop working and summoned before the General Dental Council (GDC) professional conduct committee. In one day, his career was gone as well as his livelihood. Unable to pay the mortgage, his house was repossessed.

It is nearly three years since Reid was forced to put away his dental tools after 17 years as a dentist. The GDC suspended Reid for 12 months for not disclosing his HIV positive status to Lewisham PCT. Last July, he was fully restored to the dentists' register so if the guidance were changed in future, he would be able to practise again.

"The committee accepts that the risk of transference of the HIV virus (from infected dentist to patient) is regarded by contemporary medical opinion as negligible, provided appropriate safeguards are in place," the GDC concluded at the time.

Dennis Sugarman (not his real name), who lost his job after being diagnosed HIV positive, says what hurt most was his mother saying, "you were the only thing we could be proud of. You used to be a somebody, now you're a nobody."

He had been practising as a dentist for 20 years before discovering that he was HIV positive. After informing his PCT, he lost his contract and so he was not eligible for long-term sick pay. "The contract termination was backdated to the day after I received the diagnosis, so I received no sickness payments at all, although they did allow me to take early retirement on medical grounds," says Sugarman.

As dental training is so specialised, it is hard for ex-dentists to use their skills elsewhere. For Sugarman, not only has cashflow been a considerable problem, he also has a "gaping hole" in his life that used to be occupied by going to the surgery. He now spends one day a week making dentures for people too remote to access a dental surgery, and works part-time as a dental tutor and peripatetically as an auditor for the PCT.

The British Dental Association (BDA) says the ruling is "unfair and unlawful" and wants the legal guidelines changed. Peter Ward, its chief executive, says: "Dentistry, in general, does not involve situations where blood from clinician and patient mixes. In the small number of instances where open wounds mean that there could be blood exposure, the requirement to wear gloves makes the possibility of any blood contact negligible." The BDA has officially endorsed the Beijing Declaration drawn up in 2009 at the Sixth International World Workshop on Oral Health and Disease in Aids, by scientists from 30 different countries including the UK.

No risk of transmission

This states that dentists with HIV do not pose a risk of transmission to dental patients and can continue working as long as they act appropriately, are receiving treatment and following standard infection control.

"Understanding of HIV transmission and the ways that good treatment can prevent this has moved on in recent years and the UK regulations haven't kept pace with those changes," says Catherine Murphy, head of public affairs at the Terrence Higgins Trust. "HIV treatment can reduce the likelihood of HIV transmission to almost nothing. When this is combined with the kind of safety and infection control procedures essential in dentistry, patients should be at little or no risk. It is a crying shame that highly skilled professionals are being lost to the health service entirely unnecessarily."

UKAP, the Expert Advisory Group on Aids and the Advisory Group on Hepatitis are currently reviewing DH guidance. A DH spokesman says: "We will be considering the working group's advice carefully and expect it to be published in the next few months."

But for now, Reid and many dentists like him are in limbo, still keeping up to date with developments and going on dental courses, but unable to practise. "HIV is a virus and not an illness in itself. It is a risk factor for disease certainly, but one where, with the advances of HIV treatment in recent years, the risks of illness have been significantly reduced. Yet it is still such a stigmatised condition. To lose your job over HIV when all the emerging evidence states that there is no need to, just seems so wrong in this age," says Reid.