General HIV Policy
Since all USUHS medical students are active duty military officers, each person should recognize their responsibility to follow the guidance of each individual military service. On a regular basis the student body will receive a briefing on the entire subject of AIDS in contemporary society. This briefing provides a full educational experience to include medical and psychological issues, prevention, safe sex practices, deployment issues and all personal health and mental health services.
All students are tested for HIV according to the instructions provided by their parent military service. This testing provides the opportunity for early identification and treatment.
Aside from the required testing process, some individuals may learn they are HIV positive by some other means. Any student placed in this situation should immediately report this finding to their personal physician in the Family Health Center and to the proper military official in their military chain of command. This will ensure prompt evaluation, re-testing and treatment if necessary.
Students who are HIV positive will be required to observe restrictions in clinical settings as established by the command structure of each individual military hospital. The Office for Student Affairs and the Commandant following the professional medical position of the Family Health Center will dialog with the command structure in settings where HIV positive students may work to insure that communication, treatment, support and protection of patients are made a priority.
HIV positive status may have an important affect on the length of time a student may remain on active duty. Each student must address these issues with the Commandant.
Medical students, physicians, and all other health care professionals have a fundamental responsibility to provide care to all patients in a sensitive and compassionate manner without regard to the patient's diagnosis or the nature of the illness involved. At the same time, however, health care personnel must be aware of their potential exposure to certain diseases because of their occupation and take appropriate precautions to protect themselves from such exposure.
Although many diseases may be transmitted through contact with biological materials or fluids such as feces, urine, genital secretions and blood, two serious and potentially fatal viral infections must be emphasized in particular-- namely those caused by Hepatitis B and HIV that causes AIDS. The Hepatitis B virus causes an inflammatory disease of the liver that may be asymptomatic or manifested by jaundice and other symptoms of acute liver injury. Approximately 25% of patients become jaundiced, but only 3-5% requires hospitalization. Although a significant number of patients go on to develop chronic liver disease, less than 1% of patients die of their disease. On the other hand, HIV typically causes an indolent disease and usually remains asymptomatic for many years during which time the patient's immune system is progressively impaired. Eventually, patients develop various symptoms of AIDS-- a chronic wasting disease with many manifestations, including multiple infections not usually found in patients with a normal immune system. Unfortunately, almost all patients succumb to their disease.
Both of these infections are transmitted primarily through sexual contact or through contamination with infected blood products, and neither are transmitted through simple casual contact. Therefore, Hepatitis B and HIV are transmitted in the health care setting primarily through handling infected blood or through a needlestick injury wherein an individual drawing blood from an infected patient accidentally injects that blood into himself or herself.
The Hepatitis B virus appears to be more easily transmissible than HIV, and the relative risks of becoming infected from a single needlestick injury with infected blood are estimated to be 10-35% for hepatitis B but only 0.32% for HIV. Nevertheless, when drawing or obtaining a blood sample, it is vital that all health care personnel, including medical students, (1) recognize that any patient may be infected with Hepatitis B or HIV and (2) always take the appropriate precautions to avoid a needlestick injury, including wearing gloves when drawing blood. Furthermore, since the Hepatitis B vaccine is highly effective in protecting against subsequent Hepatitis B infection, it is equally vital that health care personnel avail themselves of this vaccine. Accordingly, all uniformed medical personnel are required to be vaccinated against Hepatitis B, and our University Health Center will ensure that all of our students receive a full course of immunizations.
Since the University and all of the military hospitals have strict control procedures and a designated infection control officer, the following guidelines are reiterated here to remind you of the procedures to be followed in the event that you sustain a needlestick injury.
- Assume that your patients may be infected with Hepatitis B, HIV or both.
- Wash the site of injury with soap and water.
- Become a patient instantly and immediately report your exposure to the infection control officer, or the emergency room physician if the former is unavailable, so that you may receive expert counseling and advice.
- Your physician will take a pertinent history from you, examine you, discuss the situation with you, and make recommendations for appropriate diagnostic tests and treatment.
- Don't panic! Talk about the situation with your physician and with others as you see fit, and continue to talk about it.