September 1, 2012
by John Hardie BDS, MSc, PhD, FRCD(C)
It 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 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, 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 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 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 supporting 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 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.
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.
1. Department 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.