In 1986 the Tufts University AIDS Task Force prepared a document entitled AIDS Guidelines at Tufts University, outlining general university policies relevant to students. This document is intended to provide guidelines relevant to faculty and medical students who are actively involved in the clinical care of patients. Our medical students and our faculty are involved in patient care at a number of our affiliated hospitals. Faculty and medical students are responsible for being familiar with and following the policy and guidelines of this document, as well as any policy of the affiliated institution in which they are taking care of patients. All students are required to attend annually a mandatory session concerning HIV infection that is presented to all medical students at Tufts University School of Medicine.
AIDS is the most severe clinical expression of infection with HIV, a human retrovirus. Current evidence supports the interpersonal transmission of this virus by means of (a) intimate, sexual contact, (b) the sharing of contaminated needles by parental drug abusers, (c) accidental contamination via needle sticks from an infected individual, (d) transfusion of blood or certain blood products (for example, plasma, cell fractions and factor concentrates)*, and (e) vertical transmission from infected mothers to their offspring at or before birth. A very low risk of nosocomial transmission has emerged from numerous studies, and overwhelming evidence supports the conclusion that this viral infection is not acquired through casual contact with infected persons. This singular fact underlies many of the recommendations, which follow.
Any response to HIV infection should be guided by the very best contemporary knowledge of this potentially devastating infection. Unnecessary, ill-conceived and possibly discriminatory actions should not be undertaken. However, it is essential that the potential infectivity of the human body fluids or tissues processed in any laboratory be recognized. Education concerning what does and what does not constitute a risk of HIV transmission is the most effective means available for containing the epidemic.
Given this introduction, the following specific recommendations are provided to guide the administration, faculty, students and staff of Tufts University School of Medicine.
1. Students infected with HIV, whether they have active AIDS, AIDS-related conditions, or who are simply seropositive for viral antibodies, will not be excluded from their educational program, unless medically-based judgments in individual cases establish that exclusion or restriction is necessary for the welfare of the individual or for the welfare of patients or members of the medical center community. In this connection, it is important that the facts about AIDS be publicized in order to help dispel ignorance and misinformation about risks posed by the presence of HIV-infected persons.
2. Students engaged in patient care activities who know or have reason to believe that they are infected with HIV are urged to share that information, on a confidential basis, with the Dean for Students so that the University can respond appropriately to their health and educational needs. The University needs such information so that every reasonable effort can be made to assure that infected persons are fully informed about the nature and consequences of their condition, for the protection of themselves and of other members of the community. This is similar to the requirements for several other potentially communicable diseases.
3. HIV-infected medical students will be provided with supportive and individualized health, educational and career counseling. The Dean for Students will be responsible for coordination of such counseling.
4. Students who know, or have reasonable basis for believing, that they are infected with HIV are expected to seek expert advice about their health circumstances and are obligated, ethically and legally, to conduct themselves responsibly in accordance with such knowledge, for the protection of patients and other members of their community.
5. Students should aid in the provision of competent and humane care to all patients, irrespective of their known or suspected HIV status. Medical students should follow guidelines promulgated by the US Public Health Service* which have been distributed to all students. Students, faculty and staff should follow these guidelines to protect themselves and to decrease the risk of HIV transmission. Medical students, faculty and staff are expected to adhere to the guidelines promulgated by the U.S. Public Health Service. Copies of these guidelines are available in the Office of Student Affairs, and have been sent to every department chairman.
6. HIV antibody testing should only be used in situations where it will directly benefit the individual or where it will be of public health benefit. Confidentiality of results of such tests and of AIDS-related diagnosis is essential. Beyond mandated reporting requirements to public health authorities or as otherwise may be required by law, results of tests for anti-HIV antibody should not be communicated to any party other than the individual who has been tested. Since such results will become part of the individual's medical record, all personnel should accord the medical record the degree of confidentiality it deserves. Only those with a need to know should read or have knowledge of the medical record, unless specific consent to divulge such information to others is granted by the patient.
7. All research and laboratory directors of principal investigators should recognize their responsibility for protecting laboratory workers from hazards incumbent in handling human blood, secretions and tissues. This includes education of laboratory personnel where necessary. All laboratories should strive to adhere to safety guidelines established by the US Public Health Service for the handling of blood and other body fluids and secretions.
8. Students who are at high risk for infection because of their immune status, due to HIV or any other reason, will be encouraged to discuss their work responsibilities with their personal health care provider. If the health care provider determines that there are certain rotation assignments the student should not accept, this should be communicated to the Dean for Students.
Consideration for assignment based on the risk of any individual developing an opportunistic infection will be reviewed since patients with AIDS are known to excrete viruses such as CMV and Varicella, and also have a high incidence of Tuberculosis. Students who might be at risk include those:
- presently or frequently receiving large doses of cortico-steroid drugs;
- with known HIV infection or with other immunodeficiency diseases such as
- Lupus Erythematosus, Agammaglobulinemia, and Hodgkin's Disease;
- who are receiving or have not achieved immunologic or hematologic recovery;
- receiving any immune-suppressive medications;
- who are pregnant
Modifications of these recommendations may be warranted as additional information becomes available concerning HIV infection, or with the national implementation of alternative policies for control of the epidemic.
+Exposure to the HIV virus in non-medical situations is addressed in University Guidelines.
*Hepatitis B plasma-derived vaccine (Heptavax-B), heat-treated albumin, and immune globulin preparations have no apparent risk of HIV transmission.
*Recommendation for Prevention of HIV Transmission in Health Care Settings. Morbidity and Mortality Weekly Report August 21, 1987, Vol. 36, No. 25. U.S. Department of Health and Human Services, Centers for Disease Control.