6.1 All matters arising from and relating to the employment of HIV infected health care workers should be co-ordinated through a specialist occupational health physician

6.2 The HIV physician providing the necessary regular care to an infected worker, with their consent, should liaise with the occupational health physician and preferably they should jointly manage the case.

6.3 Occupational health services which do not employ a specialist occupational health physician should refer individuals to such a physician in another unit. The Association of National Health Service Occupational Physicians (ANHOPS) has issued guidance to its members and has given a list of specialist occupational physicians who can be contacted by those working in occupational medicine in the field (see Annex D). The close involvement of occupational health departments in developing local procedures for managing and supporting HIV infected health care workers is strongly recommended.

6.4 If such arrangements do not exist, the Faculty of Occupational Medicine or ANHOPS will also put independent contractors and other non-NHS staff in touch with a specialist occupational health physician. Alternatively, the physician looking after the worker may contact UKAP for advice.

6.5 While the occupational health physician has responsibility for occupational medical management and assessment, if a physician is not immediately available, some infected health care workers may initially seek advice from an occupational health nurse. The nurse should make every effort to arrange for the health care worker to see the occupational health physician as soon as possible. If necessary the occupational health nurse should seek confidential advice directly from the UKAP. As for any other referral to the UKAP, identification of the worker should be avoided.

6.6 HIV infected health care workers should remain under regular medical and occupational health supervision in accordance with good practice. Occupational health physicians should consider the impact of HIV positivity on the individual's resistance to infection when advising on suitability for particular posts, especially if the duties involve exposure to known or undiagnosed TB.

6.7 Patient safety and public confidence are paramount and dependent on the HIV infected, or potentially infected, health care worker observing their duty of self-declaration to an occupational health physician. Employers should promote a climate that encourages such confidential disclosure. It is extremely important that HIV infected health care workers receive the same rights of confidentiality as any patient seeking or receiving medical care. Occupational health practitioners, who work within strict guidelines on confidentiality, have a key role in this process, since they are able to act as an advocate for the health care worker and adviser to the employing authority. They should adopt a proactive role in helping health care workers to assess if they have been at risk of HIV infection and encourage them to be tested for HIV, if appropriate (see Paragraphs 4.6-4.9).

6.8 Occupational health records are held separately from other hospital notes and can be accessed only by occupational health practitioners, who are obliged ethically and professionally not to release records or information without the consent of the individual. Conversely, occupational health practitioners do not have access to hospital notes. There are occasions when an employer may need to be advised that a change in duties should take place, but HIV status itself normally would not be disclosed without the health care worker's consent. However, it may be necessary in the public interest for the employer and the DPH to have access to confidential information where patients are, or may have been, at risk.

6.9 Occupational physicians are well placed to act as advocates for the worker on issues of retraining and redeployment, or, if indicated, medical retirement. Occupational health departments have a key role to play in developing local policies for the management of infected health care workers' future employment.

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