To expect to be told if a patient of mine is HIV positive

[NCISaddict]

If I have asked them if they have any medical conditions I should be aware of?
I am aware that it is very difficult to catch and that they may have encountered judgemental attitudes in the past, which is totally unacceptable but if your condition could put your HCP at some risk (even though it would be small) then surely you should inform them?

I wouldn't've thought you COULD catch HIV from vomiting so perhaps wouldn't mention it.

It also depends on the patient's situation.

In a hospital I would assume everyone within earshot is trained medical professional with confidentiality firmly in place.

If you picked me up in the street, I wouldn't want to tell you about my (fictional) HIV status because perhaps my boss/ cousin/ whoever is walking past and they hear.

I'm not HIV+ but the people I have known who are often have good reason to conceal and/or be selective with the information.

I.e., in case it wasn't clear, the difference in situation is why they might confide in A&E staff but not you.

IMO it's one thing to not offer up the information, it's quite another to lie about it if asked. I would expect a HCP to take the relevant precautions regardless on account of the fact someone could have any number of conditions and may be unaware of them.

But that being said, someone with HIV will presumably be on varying medications/ARV drugs etc which may, for all they know, be contra indicated with medications that the paramedic may administer as part of initial treatment. So on that basis it would be a bit stupid IMO to not disclose a medical condition.

Just for addition info.

When a Patient has their levels done, CD4 count, Viral Load etc they can be found to have less than 5% HI Virus in their Blood Cells, many will carry virtually 0%, in some cases they won't carry the Virus at all outside of their Blood, so if they know their levels (and they generally will), there is even less need to declare their Status, or limit what they do, in any way.

The chances of contracting anything by vomit going in your mouth is ridiculously low. Unless there's blood in it and you have an open cut in your mouth. The chances are if they're diagnosed and following treatment they will have an undetectable viral load which makes the chances even lower. Like minutely, virtually zero levels of low. Not that I'm saying you should go around sticking your hands in vomit of people with HIV but unless there's visible blood in it, I don't think you would have to be told.

""I wouldn't've thought you COULD catch HIV from vomiting""

You can't at all. I've done personal care as part of my 'Buddy' role, especially during Immune Reconstitution and cleaned up etc after people with High Viral Loads.

Wannabe, there isn't any drugs that a Paranedic would administer that would contraindicate.

It tends to be ongoing Liver and Heart medications that are the biggest risk.

Again, Patients have a good working knowledge of this. Part of my role was to support those with LDs/Understanding issues, to help with reading the bumf that comes with the Meds.

Most people at the start of the journey have to have Meds for Thrush, Chest Infections, Genersl Infections, Skin Issues and become experts in their own bodies and their Meds.

I'm really surprised that this very issue is not addressed specifically in paramedic training. Should you not be asking one of your supervisors rather than Mumsnet?

It seems that you feel aggrieved because the patient told doctors but not you, thus making you feel like a second-class citizen. Surely you can't expect ill people to have equality, truth and fairness at the heart of everything they say?

You do an amazing job but it sounds like you perhaps need to develop a slightly thicker skin?

"", it's quite another to lie about it ""

Just to make it clear, they are told by their Consultants that they don't have to declare, non disclosure isn't lying.

The onus is on you as a paramedic to minimise your risk of exposure, not the patient to disclose their HIV status.

This really!

BUT!

This case seemed different as the patient told the A&E staff immediately and quite openly (which was how I found out) whereas I, who had been holding their vomit bowl and clearing up the vomit didn't seem to warrant being told.

I totally get why you are upset.

Difficult to get vomit in your eye, Op. Though I did hear of a Gynae Dr who got a clamydia infection in the eye from being a bit cack-handed taking a vaginal swab! Oops.
No, a patient is not obliged to tell you they have HIV if they choose not to.
I would suggest you need to discuss the difference between 'aseptic technique' and standard (universal) precautions and how they apply to your role with your IPC team.
DinoSnores absolutely right in what you say, except you mean 1:3 risk of Hep C, not Hep A which is oro-faecal transmission and not BBV.

faded, yes, you are completely right. Thank you.

YABU and your employer seems to have been incredibly negligent in your training. It's pretty much impossible for HIV to be transmitted outside of the body/a hypodermic needle, as it can't survive contact with air. The main risk to health professionals is needle stick injuries, and even then the risk is tiny, especially as most people who are aware of their HIV status have a tiny viral load.

Trouble is, with the way the NHS handles information these days, I am reluctant to tell any NHS staff anything, as you do not know what the NHS is going to do with that information, or how it is going to be shared.

Just to make it clear, they are told by their Consultants that they don't have to declare, non disclosure isn't lying.

What?

"Do you have x?"

"No I do not."

You might consider it a justified lie. It might be a lie sanctioned by a consultant. But it IS still a lie.

I'm a doctor. I don't like when patients do not tell me they have underlying conditions (of any description) because it can result in them getting inappropriate treatment or treatment which interferes with their HIV treatment (for example).

Sorry, but meant to add they do have the right not to disclose and I assume everyone has the potential to pass on a communicable disease.

YABU, and I'm a bit worried about whether your training is up to date if you think Universal Precautions are the same as aseptic technique.

Aseptic technique reduces the risk to the patient not to the provider.

WiseUp Of course I don't and yes I do realise that risks are incredibly low and it's not something I lose sleep over. I realise they don't have to as in there is no legal reason why they should but in this particular case it seemed odd.
A patient is happy to tell nurses/doctors immediately and in public but not me in the privacy of their own home and with only me there.

But, fidel, OP asked this patient about any medical conditions I should be aware of - not "are you HIV+".

I would have thought it's weird to ask a patient whether they're HIV+ except in specific circumstances where a major treatment was on the cards - and bloods would be done by then, surely?

Mrs Devere I have changed a details of the treatment, rest assured it involved blood.

NCIS, isn't it likely the patient was too shocked & scared to think straight at that point? I'm guessing you gave emergency response. Patient may even have been terrified you'd withhold treatment if disclosed.

I can understand your feeling miffed, though.