Download Good News: HIV Is Not a Communicable Disease

V I E W P O I N T
Good News:
HIV Is Not a
Communicable Disease
John Hardie BDS, MSc, PhD, FRCD(C)
I
t is an incontestable fact that
the single most significant
health condition of the last 30
years has been the Acquired
Immune Deficiency Syndrome.
AIDS stimulated a billion dollar
industry devoted to its cure and
prevention. By some accounts the
USA has spent $344 billion on
HIV/AIDS since 1981. By raising a number of complex legal
and ethical issues, AIDS redirected traditional approaches to
informed consent, confidentiality
and the clinical testing of experimental drugs.
In the mid-1980s the fear and
suspicion surrounding this new
condition lead to a believe that
the transmission of HIV/AIDS
could occur during the routine
practice of dentistry. Although
this thought was never substantiated, its presence resulted in
a revolution in dental infection
control recommendations and
practices. Recent pronouncements by the USA Centers for
Disease Control question the validity of the dramatic changes
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that have occurred and are continuing to occur in dentistry’s
approach to the prevention of
disease transmission.
HIV-THE FINAL RULE
Until the end of 2009, an individual with HIV infection could not
enter the USA. Based on a current appreciation of the epidemiology and transmission of HIV
within the US, on November 2,
serious health condition, it is not
a communicable disease that is
a significant public health risk
for introduction, transmission,
and spread to the US population
through casual contact.”1 The
final rule has been effective as of
January 4, 2010.
Is this an admission by the US
government that HIV is not infectious? At present, it is probably
...through a process of fear, ignorance and intimidation it continues to support recommendations
that are based on political and regulatory
expediency rather than on scientific merit
2009 the Department of Health
and Human Services (HHS) and
Centres for Disease Control and
Prevention (CDC) published a final rule that removed HIV infection from the list of diseases that
can keep people who are not US
citizens from entering the United
States. This final rule stated
that, “While HIV infection is a
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impossible to answer that question. However, what is passing
strange is the apparent failure of
any of the popular media to publicize the final rule. Indeed, it is
only recently that it was brought
to the attention of the author.
DENTISTRY AND THE FINAL RULE
As part of the explanation supwww.oralhealthgroup.com
V I E W P O I N T
porting the Final Rule the CDC
noted that, “Any risk posed by
HIV-infected people is not a result of their nationality, but is
based on specific behaviors such
as unprotected sex or needle
sharing with someone infected
with HIV.”1 Neither of these activities has the remotest association with the practice of dentistry. When this consideration
is combined with relegating HIV
infection to a non-communicable
status within a public health environment, it is evident that the
transmissibility of HIV during
dental care has been subjected to
gross exaggeration.
A rational approach to preventing disease transmission depends on identifying its cause,
understanding how, why and
when its transmission occurs
www.oralhealthgroup.com and implementing proven methods of transmission prevention.
Dentistry did not adopt this approach with HIV/AIDS. Instead
through a process of fear, ignorance and intimidation it continues to support recommendations that are based on political
and regulatory expediency rather
than on scientific merit.
The pressures of regulatory
authorities are such that the
Final Rule is unlikely to have
any effect on how dentistry approaches HIV/AIDS. However,
the realization by the CDC that
within a public health environment HIV is a non-communicable condition, might give some
colleagues the courage to demand that a cautious, measured
and scientifically justified approach must be taken by the
profession when it faces its next
infectious threat.
Acknowledgement
The author wishes to thank Mr.
David Crowe and the Alberta
Reappraising AIDS Society
website for bringing his attention to the Final Rule.
Dr. Hardie was intimately involved in the development of the
RCDSO 1996 evidence-based
guidelines.
Oral Health welcomes this original article.
REFERENCE
1. D epartment of Health and Human Services,
Centers for Disease Control and Prevention.
Medical Examination of Aliens—Removal of Human
Immunodeficiency Virus (HIV) Infection From
Definition of Communicable Diseases of Public
health Significance. Federal Register Vol 74, No 210/
Monday, November 2, 2009/Rules and Regulations.
September 2012
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