Discrimination in health care

Published: 05 August 2010

There is evidence that people with HIV are particularly likely to experience discrimination from healthcare providers. This may be because people are more likely to disclose their HIV status to healthcare workers than to others (healthcare workers have a legitimate reason to ask questions about a person’s health status and should follow strict rules of confidentiality).

In a large survey of people with HIV in London, one third of people reported discrimination because of their HIV status. Of those reporting discrimination, half said it had come from a healthcare worker: 26% from a dentist, 18% from a GP and 10% from hospital staff (usually outside the HIV clinic).1

In fact, at least one court case concerning refusal of medical treatment to a person with HIV has been won. This is the only case concerning discrimination in the provision of goods and services related to HIV that has come to the media’s attention and which we are aware of. (Other cases have been settled out of court and others may not been reported by the media.)

Staff at Craigavon Area Hospital in Northern Ireland refused to perform an endoscopy on a patient. He was subsequently informed by letter from the Southern Health and Social Care Trust that the procedure had been denied on the basis of his HIV status. With the support of Equality Commission for Northern Ireland, he took the trust to the county court for breach of the Disability Discrimination Act. The trust settled for £4000 damages, apologised for the distress and injury to his feelings, and agreed to review its policies.

Tony Bell, the patient concerned, commented: “The denial of this procedure, and the length of time involved in my treatment, created a great deal of anxiety and distress for me. It was a period that caused me great worry about the state of my health. The hospital has confirmed to me that they have the facilities and appropriate procedures in place to perform endoscopy on HIV patients and I believe that they should have followed those procedures in my case and respected my dignity as a patient in their care. Thankfully my treatment has now been completed but I wouldn’t want other HIV patients to go through a similar experience.”2

Dentists

In relation to dentists, two other recent UK studies suggest that people with HIV are more likely than other people to have had difficulties accessing dental care or not to be registered with a dentist. It is common for people with HIV to report differential treatment after having disclosed their HIV status to dental staff (for example, being given the last appointment of the day).3,4

Also, in a ‘mystery shopper’ exercise conducted in west London, 15 of 73 (20%) of dentists who had initially said they were accepting new NHS dental patients subsequently said they would not be able to treat someone with HIV. Others requested that the patient take the last appointment of the day (to allow for additional sterilisation) or said the charge would be higher than the usual NHS rates.5

Such problems are of particular concern as people with HIV often experience specific oral health problems, such as oral candidiasis, oral hairy leukoplakia, Kaposi’s sarcoma, recurrent periodontitis and gingivitis.

The General Dental Council (the regulatory body, equivalent to the General Medical Council) requires that dentists do not discriminate against patients because of their health, disability or lifestyle. Dentists are required to “treat patients fairly and in line with the law”, promote equal opportunities and protect the confidentiality of patients’ information.6

The British Dental Association (BDA, the professional association for dentists, membership of which is voluntary) states that it is unethical to refuse care to patients with an infectious disease. People with HIV “who are otherwise well” may be treated routinely in primary dental care settings.

The BDA’s guidance on infection control points out that, although dentists should obtain a thorough medical history from all patients, this will not identify all carriers of infectious diseases. “This means that the same infection control procedures must be used for all patients.”7

The document also notes: “Dental clinicians have a general obligation to provide care to those in need and this should extend to infected patients who should be offered the same high standard of care available to any other patient... It is unethical to refuse dental care to those patients with a potentially infectious disease on the grounds that it could expose the dental clinician to personal risk. It is also illogical as many undiagnosed carriers of infectious diseases pass undetected through practices and clinics every day. If patients are refused treatment because they are known carriers of an infectious disease, they may not report their conditions honestly or abandon seeking treatment; both results are unacceptable. Those who reveal that they are infected are providing privileged information.”

Refusal of care because a patient has HIV would be unlawful under the Equality Act. It is possible that insisting on a patient taking the last appointment of the day would also be unlawful (it is a worse quality of service), but this has not been tested by the courts.

References

  1. Elford J et al. HIV-related discrimination reported by people living with HIV in London, UK. AIDS and Behavior 12:255-64, 2008
  2. Disability Action Disability cases highlight need for change. www.disabilityaction.org/news/item/8/disability-cases-highlight-need-for-change/, 30 April 2009
  3. Steedman NM et al. Is being HIV-infected a barrier to accessing dental care? HIV Medicine 10 (supplement 1), abstract P11, 2009
  4. Levett T et al. Access to dental care for HIV patients: does it matter and does discrimination exist? Intl J STD AIDS 20: 782-784, 2009
  5. PPI Forum for Ealing PCT Survey into Access to NHS Dentistry in the London Borough of Ealing for People with HIV-positive status. www.lx.nhs.uk, February and March 2007
  6. General Dental Council Standards for dental professionals. www.gdc-uk.org, 2005
  7. British Dental Association Infection control in dentistry, England. BDA Advice sheet A12, 2009
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.