Intended for healthcare professionals

Rapid response to:


Host should also protect students on electives from HIV

BMJ 2003; 326 doi: (Published 08 February 2003) Cite this as: BMJ 2003;326:338

Rapid Response:

Education concerning HIV & elective attachments is the responsibility of Medical Schools


Tai and Nielson’s trauma unit should be commended for their efforts
to protect foreign students from HIV during their elective attachments.
They describe an induction package for students concerning needle-stick
injuries as well as 24 hour support from an HIV specialist nurse and
immediate availability of HIV post exposure prophylaxis. It is useful for
foreign students to know the support that will be available to them during
their elective attachment in the trauma unit at Johannesburg General
Hospital. (1)

However, their argument that the above measures should be regarded as
a minimum for any institution hosting elective medical students is
unrealistic at present. This needs development over time.

Whilst it may be possible for larger institutions to have such
procedures and measures in place, smaller rural host hospitals may find it
difficult or impossible to comply with Tai and Nielson’s recommendations.

Many students undertake electives in rural communities and hospitals
where such comprehensive education packages and post-exposure support may
not be fully available. These communities may not have availability of
post-exposure prophylaxis for their own permanent staff, or anti-
retroviral therapy for patients in the local community. If the lack of
these measures were to deter medical students from completing their
elective attachments in such communities then extremely valuable
experiences will be lost.

Tilzey and Banatvala describe updated medical school policies
concerning HIV protection on electives. (2)

Medical schools sending students on elective attachments should
ensure that, prior to departure, students are fully informed about the
management of needle stick injuries and post exposure prophylaxis as well
as many other issues concerning electives in foreign countries, including
malaria and other tropical diseases, personal safety, high-risk surgical
procedures and responsibilities of students, who are not yet fully
qualified doctors, to recognise their limitations in a foreign

Planning for the elective attachment should be an integral part of
any medical school curriculum. Despatching medical schools have a
responsibility to ensure that students are as well prepared as possible
prior to their elective attachments. This must not be devolved to the host
institutions unless a clear education and support package exists for
students in their new environment.

(1) Tai NRM, Nielson S, Boffard K. Host should also protect students
on elective from HIV. BMJ 2003;326:338 (8 February)

(2) Tilzey AJ, Banatvala JE. Protection from HIV on electives:
questionnaire study of UK medical schools. BMJ 2003;325:1010-1 (2

Competing interests:  
None declared

Competing interests: No competing interests

10 February 2003
Andrew G Rowland
Senior House Officer in Paediatrics
Royal Manchester Children's Hospital, Hospital Road, Pendlebury, Manchester M27 4HA, UK