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Compendium March 2008 (Vol 30, No 3)

Guest Editorial: HIV/AIDS and the Veterinary Practitioner — Making a Difference

by Radford Davis, DVM, MPH, DACVPM

    Of the many diseases that vie for the top spot in causing global human suffering and death, few, with perhaps the exception of now-eradicated smallpox, can match the effect of HIV/AIDS. The fourth leading cause of death worldwide, HIV/AIDS has claimed the lives of more than 22 million people, and nearly 40 million people are living with infection, including more than 1 million in the United States.1 And while the AIDS pandemic does show signs of slowing, its full impact has yet to be felt in many areas. What does HIV/AIDS have to do with veterinary medicine? The short answer: more than most people think.

    HIV/AIDS is only one of the many immunocompromising diseases and conditions that afflict humans, but it is unique and demands veterinary attention for several reasons. Its many routes of transmission, the high susceptibility of people with AIDS to recurrent opportunistic infections and demonstrable zoonotic threats, the enduring myth of animal transmission, and the unique liability issues surrounding exposure and confidentiality are but a few. In the future, demonstration of HIV/AIDS education may become part of state licensing requirements for veterinarians, as it is already in Washington State.

    Thanks largely to new medications, people with HIV/AIDS are living longer— today, the life expectancy of someone with HIV under medical care is 24 years—which means that veterinarians are more likely than ever to have HIV-infected individuals as clients, coworkers, and employees. These individuals may or may not choose to disclose their status, or they may not know their status: 25% of those infected in the United States don't know they are infected.2 Those with AIDS, the immunosuppressed and later stage of HIV infection, face significant health risks from zoonotic pathogens, more so than immunocompetent individuals. Veterinarians are considered experts on zoonotic diseases and, in keeping with our public health commitment, should be addressing the needs of clients with HIV/AIDS through proper education and communication. Educational measures could include explaining how clients can reduce their risk of exposure to certain zoonoses, discussing pet retention or adoption, or dispelling myths about HIV transmission: a recent survey showed that 22% of Americans still believe HIV can be transmitted by sharing a drinking glass. Sometimes, communication duties must include speaking to the physician of an HIV-infected individual to assuage concerns about the risks of owning a pet or to reverse unjust recommendations, such as getting rid of a pet.

    As veterinarians and public health professionals, we must also oversee the running of a safe, threat-free workplace. HIV/AIDS in the workplace is an issue that requires a proactive approach on the part of the clinic owner and management to limit liability and protect the health of clients as well as employees. Dog bites and needlestick injuries are not uncommon in a veterinary practice setting. How many workers in your clinic are certified in human first aid? They all should be. Clients and employees who are bitten can put others at risk for exposure to bloodborne pathogens such as HIV and hepatitis B and C. Veterinarians and their staff need to know how to prevent their own exposure to these pathogens while addressing the immediate medical needs of the victim. Understanding and implementing the federal standards governing protection against exposure to bloodborne pathogens (29 CFR 1910.1030) as well as the Centers for Disease Control and Prevention's universal precautions is critical.3,4 Implementing training and developing standard protocols within your clinic to prevent infection of veterinary staff with zoonotic diseases is also of paramount importance, regardless of HIV concerns. Publications are available to help you accomplish these tasks.5

    Allaying staff fears surrounding HIV/AIDS and ensuring that those with HIV/AIDS do not face discrimination or harassment in the workplace are other essential aspects of addressing HIV in the veterinary clinic. People with HIV are protected under the Americans with Disabilities Act (ADA). Employers must provide those covered under the ADA with "reasonable accommodations" and maintain the confidentiality of their medical information. Suspending, reassigning, firing, or denying employment to a person with HIV brings with it serious legal ramifications that few employers can defend in a court of law.

    Addressing HIV/AIDS is a nontraditional role for most veterinarians, but it is one well within our purview. What can you do to meet it? I have a few suggestions:

    • Take time to learn more about HIV/AIDS so that you can discuss it intelligently with clients when approached.
    • Keep HIV/AIDS brochures and posters on the topic of pets and zoonoses in your waiting room.
    • Add a line to the new client form that allows the client to discreetly ask for more information about HIV and the risks of pet ownership.
    • Train your staff in human first aid, universal precautions, and zoonosis prevention.

    Unfortunately, seminars on HIV/AIDS in relation to veterinary medicine are rare, but go to them when you have the opportunity.

    More than 25 years since it was first identified, HIV/AIDS is more than a health care issue, more than a disease. It affects families, communities, nations, and economies, has generated millions of orphans, and casts a shadow of fear everywhere it is found. In some countries, such as Botswana, the rate of infection is as high as one in four. As veterinarians, we can make a difference in helping those with HIV lead happier, healthier, safer lives. Veterinarians must reach out to clients with HIV/AIDS and make an effort to educate themselves on what is arguably the most important disease of our time. Our role in public health demands it.

    1. Centers for Disease Control and Prevention. Twenty-five years of HIV/AIDS—United States, 1981-2006. MMWR Morb Mortal Wkly Rep 2006;55:585-589.

    2. Centers for Disease Control and Prevention. Epidemiology of HIV/AIDS—United States, 1981-2005. MMWR Morb Mortal Wkly Rep 2006;55:589-592.

    3. Occupational and Safety Health Administration. Bloodborne Pathogens and Needlestick Prevention. Accessed September 2007 at www.osha.gov/SLTC/ bloodbornepathogens/index.html.

    4. Centers for Disease Control and Prevention. Universal Precautions for Prevention of Transmission of HIV and Other Bloodborne Infections. Accessed September 2007 at www.cdc.gov/ncidod/dhqp/bp_universal_precautions.html.

    5. National Association of State Public Health Veterinarians. Compendium of Veterinary Standard Precautions: Zoonotic Disease Prevention in Veterinary Personnel. Accessed September 2007 at nasphv.org/documentsCompendia.html.

    References »

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