Leading Article: Ignorance and fear of HIV

THE SCENES of mayhem at two hospitals in Kent at the weekend are a reminder of how ignorant and frightened people still are of Aids. The hospitals have been flooded with calls from 10,000 patients who feared that they might have been infected with HIV by a gynaecologist recently diagnosed as carrying it. Nearly 300 terrified patients rushed round in person, demanding to be tested for the virus immediately.

Yet the chances of contracting HIV from a surgeon while on the operating table are near to nil. No case has ever been recorded for sure; and experts believe that, since it is patients' blood that tends to be spilt in quantity, patients are more likely to put surgeons at risk than the other way around. The HIV- positive Florida dentist who passed on the virus to five of his patients in 1987 may actually have done so simply because he failed to sterilise his instruments.

That said, the British public needs to be reassured that both doctors and health administrators are doing all they should to protect patients. Even one avoidable death by HIV infection from a doctor would provoke a sharp loss of confidence in the entire health system; and the terrible consequences of failure or incompetence can be seen easily from the scandal in France about HIV-infected blood in the transfusion service.

A predictable cry for the compulsory testing of all doctors and dentists has already gone up in the tabloid press. Yet testing doctors compulsorily would make no sense (nor be fair) while their patients remained untested. And a once-off test would be little use: as the tests now used look not for the virus itself but for the antibodies that the body secretes to attack it, infected patients often test negative for the first three months.

What, then, needs to be done? With a family doctor or physician who talks to patients only from behind a table, the answer is nothing. Patients have little more chance of catching HIV from them than they do from the local librarian or bank manager. There is therefore no reason to demand anything special of such doctors who find they have the virus, other than that they behave as responsibly as any other HIV carrier should.

More tricky is the question of doctors and medical staff who perform 'invasive' medicine such as surgery, internal examinations, or anything else that might draw blood or other bodily fluids. The General Medical Council has rightly published guidelines telling doctors that they should be tested if they think they might be HIV-positive, and should take advice on how to curtail the invasive areas of their medical practices. But while the GMC says it is unethical to carry on practising against the advice, it is at pains to avoid saying that doctors must tell their hospitals if they find they have the virus.

This is mistaken. HIV-positive doctors, like others who have just been told they have the virus, may not be in a position to take decisions about their practices themselves; and it is expecting too much of those they consult to report them if they do the wrong thing. Doctors should therefore be required by their contracts to tell their employers, in confidence, if they become infected or if they think they might be. Unless the weekend's scenes of panic are to be repeated, hospitals and health authorities need that early warning. They have a right to demand it.