At the Dentist

A lovely friend of mine on Twitter, @alanlaw, messaged me a little upset yesterday.  He had some justification.  He had been handed the following form of fill out at a dentist he's been visiting all his life:

"People who share needles, haemophiliacs and homosexuals endure a higher risk of contracting blood borne viruses such as AIDS and hepatitis.  Do you fall into such a category? Yes/ No"

Okay, let's look at this step by step:

• AIDS (Acquired Immune Deficiency Syndrome) is a disease not a virus.  It is caused by a virus, called HIV.  Even my dog knows this much and he doesn't even have any GCSEs.
• "Homosexuals" also covers gay women (remember women? Oh yeah: 50% of the world's population).  There have in fact been remarakably few cases of lesbian HIV infections over the years.  They therefore cannot be said to "endure a higher risk" in this context.  Try "gay men"?
• Over 50% of new HIV infections in the UK are however in fact in straight people.
• New cases of haemophiliac infection have been minimal since effective blood screening measures were introduced in the 80s.
• The questionnaire does not say why it seeks this information.  It may be valid (see below) or it may be, as many would reasonably suspect, that it is on the grounds of risk to the dentist.
• If that is the case, the statement entirely ignores the fact that those on HIV medication, who have undetectable viral loads, almost certainly cannot transmit the virus (click on link)
• The last point has been upheld by the Court of Appeal in Geneva in a reckless sexual transmission case; and I understand subsequently also in the Canadian courts.
• I love the neutral use of the word "endure"

So, there are certain issues with the way the question is drafted... such as... you'd expect a sodding health care professional to get the medical term right.  Okay *draws breath*...  now onto the law.

The Law!

Under the Equality Act 2010, according to both the Terrence Higgins Trust and NAM (National Aids Map) charities, it is illegal for dentists to refuse to treat anyone with HIV: this covers both NHS and private dentists.  Apparently some dentists often ask an HIV+ person to take the last appointment of the day in order to sterilize instruments better.  Although this has not be challenged yet, the view of the THT legal team is that this too is probably illegal as indirect discrimination is covered by the Act.

If the question is being asked to exclude you from treatment that would therefore be illegal and should be reported both to the Police and to the British Dental Association.

NAM quite sensibly points out "Normal hygiene procedures in a dental surgery are enough to protect both you and the dentist/ dental nurse from the risk of any infections."

 Dental Profession

Well, what does the dental profession have to say?  The British Dental Association comments it is both "unethical and illegal to refuse to treat patients who are HIV positive."  The BDA in fact refers its practitioners to a resource pack prepared by the National Aids Trust which "raises awareness of discriminatory practices and provides advice and practical tools to help healthcare workers address and avoid stigmatising behaviour towards people living with HIV."  The pack has also been endorsed by the Royal College of General Practioneers and the Royal College of Nurses.

The sensible attitude of the dental profession as a whole would therefore seem to suggest this particular questionnaire would not be endorsed by them: far from it.  This might explain why my dentist does not ask this type of thing at all.

And it goes further: it seems Britain is one of the few Western countries still to keep a ban on HIV+ dentists themselves from practising.  Yep, surprise... Britain is behind the times on discriminatory practices and our Government is refusing to change them!

In October 2010 a leading indemnity provider for dentists (Dental Protection) demanded, on behalf of the profession, that the Department of Health stop its discriminatory rule that prevents HIV+ dentists from practising in the UK.  Dental Protection comments:

"It is 20 years since the draconian rules were introduced preventing dentists from providing treatment to patients.  Initially introduced as a precautionary measure after the mysterious case of Dr Acer, a dentist in the USA who was thought to have infected six patients with the AIDS virus, there has never been any recorded transmission of the disease in a dental setting [Peter's note: in the world, either from dentist to patient or vice versa]."

The situation is so clear cut it seems that the "Beijing Declaration" after the 6th World Workshop on Oral Health and Disease in AIDS in April 2009 specifically highlighted the outdated stance currently adopted by the UK Department of Health.  One might suppose that all it would take is one brave HIV+ dentist to go to court on this and it would seem the profession would pretty much be behind him or her.

The Mysterious Case of Dr Acer

Yes, let's deal quickly with Dr Acer.  He apparently infected six patients with HIV in the 80s.  He died in 1990.  It was the time of all the hysteria and the vicious stigmatisation of both HIV sufferers and gay people in general.  The CDC in Atlanta did tests which "established" that the strain of those patients were the same.  Legal cases since have since proven that it is incredibly difficult to prove an actual source of infection.  Several medical journals have discredited this early and, for HIV medicine, out of date finding.

Back to the Questionnaire

Well it's bloody offensive.  It offends me on its poor drafting, its unnecessary and illiberal probing into people's sexuality and private lives; it is offensive to HIV- gay men (by suggesting if you're gay you probably have HIV or will get it soon); it seems to run squarely in the face of BDA guidelines on avoiding stigmatising behaviour towards positive people; and it also manages to offend haemophiliacs whilst it is at it.  It is wholly unnecessary if the purpose is to warn the dentist s/he "might catch something" - which is the era that this type of question comes from.

There *may* be a justifiable need to answer the simple neutral question: "have you been diagnosed with HIV?" purely for the purpose of making dentists look out for oral related health problems which can crop up for positive people.  However, if they were doing their job properly (as I'm sure they do as a profession) they would presumably notice these in any case.  They're busy sticking sundry things in your gob with a bright light on above your head, for heaven's sake.

I would make a fuss about this at my surgery.  A big fuss.  Why should an 18 year old who is coming out be told by some shitty questionnaire that he "endures" a risk of blood borne diseases?  Why should my friend?  It is stigmatising, offensive and belongs back in the 80s with the absurd ban on HIV+ dentists practising.

*gets off soap box*