Education And Debate

Reducing the risk of nosocomial HIV infection in British health workers working overseas: role of post-exposure prophylaxis

BMJ 1998; 316 doi: (Published 11 April 1998) Cite this as: BMJ 1998;316:1158
  1. Charles F Gilks (, senior lecturera,
  2. David Wilkinson, specialist scientistb
  1. a Division of Tropical Medicine, Liverpool School of Tropical Medicine, Liverpool L3 5QA,
  2. b Centre for Epidemiological Research in Southern Africa, Medical Research Council, Hlabisa, South Africa
  1. Correspondence to: Dr Gilks
  • Accepted 16 January 1998

Nosocomial HIV transmission is a particular worry for many doctors, medical students, and nurses who seek work experience in low income countries. Firstly, the prevalence of HIV infection among the patients they care for in poor countries is high. Secondly, these health workers are often relatively inexperienced—their technical skills may not be well practised and hence they are likely to be exposed to blood and other body fluids. Thirdly, many developing countries with a high prevalence of HIV lack the resources to implement universal precautions adequately. Finally, poor or inadequate equipment and facilities are more often encountered overseas and can increase the risks of exposure. These occupational risks are clearly additional to the risks from unprotected sex, for which separate preventive measures apply.

Although the risk of infection per exposure may be low, the cumulative risk with repeat incidents increases and seroconversion does occur.1 Devastating personal and professional consequences may then ensue, as recently described by Sandy Logie in the BMJ.2 These issues, always a concern but rarely discussed openly, are now to the fore because effective prophylactic treatment after exposure to HIV is available.3 This is now the standard of care in the United Kingdom but is rarely recommended or available in underdeveloped countries.4 This raises several important issues for those who go overseas to work, as well as for those who employ them or are their sponsors or educators.

Summary points

British health workers seeking work experience in underdeveloped countries are at risk from nosocomial transmission of HIV

Although the risk of infection per exposure may be low, the cumulative risk with repeat incidents increases and seroconversion does occur

Availability of effective post-exposure prophyl axis raises important moral and legal issues for those who go overseas to work and those who employ, sponsor, or educate …

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