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PRINCIPLES REGARDING HUMAN IMMUNODEFICIENCY VIRUS (HIV)

 AND HIV-RELATED ILLNESSES

The American Medical Student Association:

1.             In regard to patient rights to health care:

a.             BELIEVES that patients with known or suspected HIV infection or related illness(es) maintain their right to obtain health care at all levels of the health-care system, including, but not limited to:  emergency medical services, outpatient and emergency room treatment, inpatient treatment, home nursing care, nursing-home care and hospice care; (1988)

b.             BELIEVES that patients with known or suspected HIV infection or related illness(es) have a right to the same quality of care as would be provided to a patient not suffering from a known or suspected HIV infection or related illness, at all levels of the health-care system; (1988)

c.             BELIEVES that patients with known or suspected HIV infection or related illness(es) deserve to be treated with the same degree of compassion as would be afforded to patients not suffering from a known or suspected HIV infection or related illness, at all levels of the health-care system; (1988)

d.             OPPOSES any policy/policies which would jeopardize a patient with known or suspected HIV infection or related illness(es)’s ability to access the health-care system or to receive quality, compassionate care as outlined above. (1988)

2.             In regard to discrimination:

a.             OPPOSES discrimination based upon known or suspected HIV infection or related illness(es) in the areas of providing: (including, but not limited to) hospital admissions, diagnostic and/or therapeutic procedures (including nonelective surgery), and emergency medical services; (1988)

b.             OPPOSES discrimination based upon known or suspected HIV infection or related illness(es) in the areas of: (including, but not limited to) housing, employment (including health-care employees seropositive to anti-HIV antibodies), insurance eligibility and coverage, education and travel. (1988)

3.             In regard to physician responsibilities:

a.             BELIEVES that physicians have the following responsibilities regarding HIV and HIV-related illnesses:

1.             to provide quality medical care to patients with known or suspected HIV infection or related illness(es), including but not limited to:  diagnosis, treatment, cure and education; (1988)

2.             to refer patients with known or suspected HIV infection or related illness(es) to another medical professional in the event that the primary physician is unable to provide quality medical care to a patient due to lack of expertise or resources on the part of the physician; 

3.             to provide society with factual education regarding HIV infection and related illness, including but not limited to:  how HIV is and is not transmitted, the signs and symptoms of HIV infection and related illnesses, the use of screening tests for HIV infection (i.e., HIV test or testing), and the methods of preventing HIV transmission; (1988)

4.             to allay undue fears and change misconceptions in society about HIV infection and related illness through education and appropriate medical and psychological referrals, if necessary; (1988)

5.             to provide factual education to medical students, residents, attending physicians, and all other health-care professionals and students regarding HIV infection and related illnesses, treatments and prevention strategies; (1988)

6.             to ensure that responsible measures, as outlined in the CDC guidelines, are taken in the workplace to prevent the transmission of HIV; (1988)

b.             BELIEVES it to be unethical for physicians to refuse to treat or refer patients with known or suspected HIV infection or related illness(es) based solely upon personal attitudes regarding such patients, their illness (actual or perceived), or their lifestyles. (1988)

4.             In regard to HIV testing:

a.             SUPPORTS the use of the HIV test to screen donated blood products and donors of sperm, organs and tissues as a precondition for acceptance or use in transfusions, insemination and transplants; (1988)

b.             SUPPORTS the rights of blood, sperm and organ banks to refuse donations from individuals who refuse to consent to an HIV test; (1988)

c.             BELIEVES that individuals who are donating blood products, sperm, organs or tissues for use in transfusion, insemination, or transplant should be advised that they will be tested for the presence of anti-HIV antibodies, be required to give informed consent for such testing; (1988)

d.             OPPOSES mandatory HIV testing for any purpose other than as described above, and specifically OPPOSES mandatory testing of health-care workers as a breach of confidentiality; (1988)

e.             SUPPORTS the rights of individuals to choose to have the HIV test performed in a voluntary, anonymous and confidential manner free or at minimal cost; (1988)

f.              BELIEVES that such testing should only be performed when the patient has provided informed consent; (1988)

g.             OPPOSES any use of an HIV test as a precondition for receiving health-care services; (1988)

h.             BELIEVES that persons undergoing HIV testing should receive pretest education regarding the nature of the test, the possible interpretations of the results and ways to reduce the risk of HIV transmission through behavioral changes; (1988)

i.              BELIEVES that persons undergoing HIV testing should receive post-test counseling and education regarding their HIV status, its implications for personal physical and mental health, ways to reduce the risk of transmission through behavioral changes, available help for voluntary follow-up of any sexual and/or I.V. drug use partners who may have been exposed to HIV; (1988)

j.              SUPPORTS programs to assist anti-HIV antibody seropositive individuals to perform voluntary contact tracing and notification of individuals who may be at risk of HIV exposure; (1988)

k.             SUPPORTS the reportability of seropositive HIV test results with nonidentifying information such as age, sex, race, city and state of residence, risk factor(s) for infection and current signs/symptoms of HIV-related illness. (1988)

l.              OPPOSES mandatory reportability of names of persons registering a positive anti-HIV antibody status, or the maintenance of any registry of anti-HIV antibody seropositive individuals; (1988)

m.            SUPPORTS the inclusion of HIV test results under separate cover in medical records to safeguard the confidentiality of the patient; (1988)

n.             RECOGNIZES the uncertain meaning of a positive anti-HIV antibody status, and the stigma attached to anti-HIV antibody seropositivity, that mandatory testing is not a viable public health strategy for preventing HIV transmission; (1988)

o.             SUPPORTS the availability of free, confidential and voluntary HIV testing and counseling in the event of a parenteral exposure to HIV in the work place by a health-care worker; (1988)

p.             OPPOSES mandatory HIV screening of applicants for permanent residency in the United States ; (1990)

q.             OPPOSES the requirement of HIV serologic status documentation of foreign visitors; (1990)

r.              SUPPORTS the rights of adolescents to choose to have the HIV test performed without consent of a legal guardian. (1995)

s.             SUPPORTS mandatory legislation surrounding maternal-fetal HIV transmission including:

1.             Requiring health-care providers and facilities to counsel and offer all pregnant wormen HIV testing at least once during pregnancy; (2005)

2.             Requiring labor and delivery units to offer rapid HIV testing to women in labor who do not have documentation of HIV results during time of pregnancy; (2005)

3.             Requiring labor and delivery and nursery units to have medications available for both mother and child in the case of a positive HIV test result. (2005)

5.             In regard to education:

a.             SUPPORTS the recommendations of the Surgeon General contained in the Surgeon General’s Report on Acquired Immune Deficiency Syndrome; (1988)

b.             BELIEVES that education regarding HIV, HIV related illnesses and risk elimination/reduction practices are currently the most promising public health options to control the spread of HIV; (1988)

c.             SUPPORTS efforts to achieve widespread public education regarding all aspects of HIV, HIV related illnesses and risk elimination/reduction practices; (1988)

d.             BELIEVES that additional resources should be committed at the federal, state and local levels of government to provide educational resources about HIV, HIV related illnesses and risk elimination/reduction practices to all individuals, with particular emphasis on reaching minorities and individuals at greatest risk of infection with HIV; (1988)

e.             SUPPORTS the education about HIV and HIV-related illnesses beginning with the grammar school curricula.  Such education should address topics appropriate to the ages of the students involved, be factual in nature, and be presented in a professional and nonjudgmental manner, including discussion on sexuality, drug abuse and condoms; (1988)

f.              URGES the medical community to become actively involved in public education efforts addressing HIV and HIV-related illnesses; (1988)

g.             OPPOSES guidelines which restrict the content of educational materials, making them ineffective for the intended audience; (1992)

h.             URGES guidelines to develop educational materials which are sensitive, culturally appropriate and effective as determined by members of the population targeted by the materials. (1992)

6.             In regard to support services:

a.             BELIEVES that adequate support services to assist with medical needs, food, shelter and personal care should not be denied to individuals with HIV related illnesses, regardless of ability to pay, a position AMSA takes regarding all debilitating illnesses; (1988)

b.             URGES the development of a system of coordinated volunteer and government agencies at the local level to assess the support needs and financial resources of individuals with HIV related illnesses, to create and develop such services and to coordinate the disbursement of all support services deemed appropriate; (1988)

c.             BELIEVES that individuals should not be denied admission to nursing homes or hospice care facilities on the basis of either a known or presumed HIV infection or related illness and OPPOSES any policy that would have such an effect; (1988)

d.             URGES the development of alternative living situations for individuals with HIV related illnesses who do not have adequate housing. (1988)

7.             In regard to HIV research:

a.             URGES research into the following topics integral to addressing the HIV/AIDS crisis:

i.              continued research defining the epidemiology of HIV infection in the population and the impact of HIV infection; (1988)

ii.             continued research into woman-controlled methods of protection against HIV.  AMSA in particular strongly supports increased funding and coordination of microbicide research as a prevention tool against HIV; (2005)

iii.            increased research efforts into the development of pediatric formulations for HIV-positive children; (2005)

iv.            increased research efforts to develop low-cost methods of rapid HIV testing, CD4 count measurements, and viral load testing that can be easily used in resource-poor settings; (2005)

v.             increased research efforts to develop treatments for the HIV infection, including:

1.             a cure for HIV infection (1988)

2.             an HIV vaccine  (2005)

vi.            increased research into the various strains of HIV, and SUPPORTS the development of separate diagnostic tests for each strain discovered such that the principle added be numbered appropriately. (1988)

b.             URGES strict enforcement of confidentiality guarantees provided to individuals participating in research studies of HIV and HIV-related illnesses and that access to identifying information within such files should be limited to those individuals requiring such information for legitimate research purposes (1988)

8.             In regard to infection control policies:

a.             SUPPORTS and URGES the following measures to control the spread of infectious diseases in every health-care facility in the United States :

i.              Mandatory adherence to Hepatitis B infection control guidelines (i.e., universal precautions) by all health-care facilities and personnel for every patient, regardless of known or suspected infection with Hepatitis B and/or HIV; (1988)

ii.             Employee and patient education programs in every health-care facility regarding HIV, HIV-related illness, risk of HIV transmission and techniques to minimize such risks; (1988)

iii.            Implementation in every health-care facility of disciplinary procedures for any individual found to be routinely and/or intentionally disregarding standard infection control policies; (1988)

iv.            Adoption of the Occupational Safety and Health Administration Guidelines for the Control of Blood-Borne Infections within all clinical settings; (1992)

b.             URGES infection control education for all health-care related professionals and pre-professionals.  This includes:

i.              mandatory education concerning infection control guidelines for all health-care workers at the time of employment in a health-care facility, and on a yearly basis (minimally) thereafter; (1988)

ii.             timely updates regarding changes in recommended CDC and/or local infection control policies at all health-care facilities to all health-care facility employees; (1988)

iii.            infection control education for all health-care related students as part of their standard curriculum. (2005)

c.             SUPPORTS AND URGES harm reduction principles in the education and treatment of drug users.  In these cases, harm reduction would include, but not be limited to, the following measures:

i.              Communities with injection drug users to adopt needle exchange programs in conjunction with substance abuse treatment and prevention and addiction treatment programs.  In particular, access to drug treatment programs, methadone maintenance, bleach, and pilot needle exchange programs in prisons should be implemented to ensure the health of prisoners and halt the epidemic of HIV and Hepatitis C in prisons across the US . (2005)

ii.             The creation of methadone maintenance programs in states that do not currently have these types of drug treatment programs, and urges increased funding to meet the demand of those already in operation. (2005)

iii.            Educating drug users about safe injecting practices, Hepatitis C and HIV transmission, and overdose treatment. (2005)

9.             In regard to federal policy:

a.             ENCOURAGES the development and adoption of a comprehensive national policy setting priorities and goals for confronting and controlling the current HIV epidemic; (1988)

b.             URGES passage of legislation by Congress making it illegal to discriminate against any individual on the basis of a presumed or known HIV infection or related illness, extending to such individuals full protection of their civil rights; (1988)

c.             URGES the allocation of increased funding for all aspects of HIV-related programs, including research, education, social services and health-care delivery; (1988)

d.             URGES that the Presidential Advisory Commission on HIV and AIDS be expanded to include more healthcare workers with direct clinical expertise on AIDS and representatives from the following groups: people infected with AIDS, specifically including women, gay/bisexual men, transgender people, people of color, recovering injection drug users, adolescents and the sexual partners of persons infected with HIV. (2006)

e.             URGES that current FDA guidelines for testing new drugs/treatments should be reviewed, and that procedures should be developed and implemented to shorten the time required to test, approve and make available any drugs/treatment that are shown to be effective against HIV and HIV-related illnesses.  Such new procedures should not sacrifice reasonable evaluations of safety and efficacy; (1988)

f.              URGES that the CDC and FDA establish research protocol guidelines which maintain scientific autonomy from social-political bias and which are humane and expedite the availability of new treatments; (1991)

g.             URGES the U.S. federal government to remove HIV and AIDS from the list of diseases which excluded foreigners from traveling to the United States ; (1993)

h.             URGES that the federal government lift the ban on federal funding of needle exchange programs. (1999)

10.           In regard to HIV infected health-care providers:

a.             SUPPORTS the right of physicians and health-care workers with known or suspected HIV infection or illness to continue working in their chosen profession and that each seropositive physician or health-care worker should be under competent medical care with a provider who is aware of the changing management of HIV infections.  It is suggested that medical care should not be obtained from a provider located in the same workplace; (1988)

b.             ENCOURAGES physicians and health-care workers with a debilitating illness (including HIV infection or illness) to voluntarily refrain, either temporarily or indefinitely, from providing patient care at any time when their physical and/or mental capacities become impaired.  Physicians and other health-care workers with AIDS and opportunistic infections must conform to the same infection control guidelines applicable to those infections that would apply to any practitioner; (1988)

c.             SUPPORTS the creation at each health-care facility of a mechanism to evaluate the ability of physicians and health-care providers to provide competent medical care.  Such mechanisms shall maintain the individual’s confidentiality and right to due process guaranteed to any potentially disabled employee.  Each institution should develop personnel policies concerning HIV testing and diseases, taking into account the above recommendations and circulate these to all employees and staff; (1988)

d.             SUPPORTS the reassignment to non-patient care duties any physician or health-care provider with known HIV infection or illness when: (1988)

1.             such reassignment is requested by the individual, or

2.             the individual’s continued direct involvement in providing patient care would present an identifiable and real risk to the health of either the patient or the individual.  Such determinations should be made in accordance with paragraph c above. (1988)

e.             BELIEVES that a student with a known infectious disease and/or illness not otherwise covered by legal statute to include HIV/AIDS, should be allowed to complete his or her medical education, including residency program, provided: (1993)

1.             his/her health allows his or her active participation in the classroom or clinic and (1993)

2.             any student who feels he or she is being discriminated against based on their HIV status must have the opportunity to have the final decision regarding their medical education be determined by a committee at that student’s medical school created specifically to make such a determination.  This committee will include at least one ethicist and at least one licensed infectious disease specialist, preferably one with clinical experience treating patients with HIV disease.  The student maintains the option of appointing advocate(s) to the committee.  In order to maintain confidentiality the student also has the option of appointing a representative to speak to the committee on their behalf, thus maintaining anonymity. (1993)

3.             URGES any such medical school committee, set up specifically to determine whether an HIV-positive medical student may continue his/her medical education, to allow such students to continue their education unless, and only unless, that individual has active tuberculosis or other contagious opportunistic infection, an open wound, or physical or mental impairment which would adversely affect that student’s ability to interact with and care for patients. (1993)

f.          OPPOSES the actions of federal, state, or local regulatory bodies requiring disclosure of physician HIV status to patients, RECOGNIZING that such actions violate physician’s personal rights to privacy without any medical justification. (1988)

11.           URGES the United States to give increased financial and personnel support and other contributions to small and large, private and public international organization efforts aimed at controlling the spread of AIDS in less developed areas that have limited resources. (1988)

12.           RECOGNIZES that human rights abuses are integral to the possible human rights catastrophe surrounding HIV/AIDS and includes but is not limited to violations of the right to be free from discrimination, the right to personal protection, the right to information, the right to health and the right to life.  (2002)

13.           URGES the United States as a donor country to contribute to the Global Fund to Fight AIDS, Tuberculosis and Malaria at the level recommended by the Secretary General of the United Nations. (2002)

14.           SUPPORTS legislation mandating that HIV positive children be informed of their status at an early age. (2006)