No One Knows How Many
Foreign Nurses Have HIV

By Anthony Browne
The Times - London

The recruitment of health workers from Africa, many of whom have been found to be HIV-positive, has been under review by the Department of Health for more than a year.
The problem came to light in January 2001 when Wolverhampton University School of Midwifery and Nursing recruited 180 students from sub-Saharan Africa, principally Zimbabwe, and discovered that at least five were HIV-positive. It was decided to treat them then place them in hospital jobs across the country.
Jane Eminson, the chief executive of the Wolverhampton Health Authority, said at the time in a press conference that they would be valuable NHS employees and posed no danger provided that they were not involved in procedures where there was a risk of patients being exposed to their blood. She said that the African nurses were just some of a number of HIV-positive staff working in the NHS under strict government guidelines.
The nurses complained that they were victims of racist hysteria. One said: "We are being targeted because we are African. There are students here from all over the world. You can get HIV anywhere."
Gisela Stuart, who was then a Health Minister, backed Wolverhampton Health Authority's policy of letting HIV-positive nurses stay, saying: "Just because someone has HIV doesn't mean they develop Aids. The authority is taking a very responsible attitude." (Note - Most physicians consulted on this subject disagree with Ms. Stuart's assertion. The 'gestation' period for symptoms can be as long as 10-12 years...all the while the patient is infectious. AIDS is commonly broken down into three stages, the first being: infected but asymptomatic. -ed)
The authority admitted that it had no idea how many of the trainee nurses were HIV-positive. The test for HIV was voluntary and, the authority did not know how many had been tested or how many were infected.
There is no evidence that any patient in Britain has been infected by an HIV-positive healthcare worker. The Department of Health says that guidelines banning HIV-positive staff from working in operating theatres and giving injections prevents any risk. But since hospitals have little idea of which staff are HIV-positive, they cannot be certain of who should be subjected to the restrictions.
By hiring overseas nurses who require lifelong treatment, the NHS could be adding to its problems rather than solving them. The nurses, recruited to help to relieve staff shortages in the NHS, would need treatment that adds at least £10,000 a year to the cost of employing them.
As returning to Africa could cost them their lives, they are likely to stay in Britain, probably needing treatment costing the NHS several hundred thousands of pounds. There is also the risk of transmission to sexual partners in Britain.
After the events at Wolverhampton, the Department of Health reviewed the way in which nursing schools admit overseas student nurses. Since then, there have been periodic expressions of concern about HIV-positive NHS workers.
At Hull and East Yorkshire NHS Hospitals Trust and at Raigmore Hospital in Inverness, hundreds of patients were offered blood tests after being exposed to HIV-positive staff who had conducted procedures that involved a risk of transmission.
Last year the Government was so alarmed by the repeated outbreaks of "excessive public concern that it ruled that patients would no longer automatically be told when an HIV-positive worker had performed a risky procedure on them. Each case would be reviewed on its merits, it said.
But since January 2001 the number of HIV-positive nurses recruited from overseas has increased to the extent that it is not "unusual as the Government said, but common. Hospitals across the country are recruiting increasing numbers of nurses from sub-Saharan Africa. Despite accusations of racism, the Africa connection matters because its rates of HIV are higher than anywhere else. The NHS recruits most overseas nurses from the Philippines, but the United Nations rates HIV infection there at less than 0.1 per cent.
By contrast, the number of nurses drafted from South Africa, where one in five adults has HIV, has increased from 599 in 1998 to 2,114 in 2001. Recruitment from Zimbabwe, where one third of adults are HIV-positive, has risen from 52 in 1998 to 473 last year.
Botswana is the country most ravaged by Aids, cutting life expectancy to just 27 years. Yet nursing recruits from there have risen 25-fold, from four in 1998 to 100 in 2001.
The Government has been repeatedly criticised for taking nurses from countries that can ill afford to lose them but it says that they approach the NHS and it does not actively seek them. The Government does not even have estimates for the numbers of HIV-positive nurses it drafts; the Royal College of Nursing says that intakes are low.
But if nurses have HIV in proportions similar to the general populations they come from, then the NHS recruited 737 HIV-positive nurses from overseas last year - of which 727 came from Africa, eight from India, one from Australia and one from America. In contrast, the NHS recruited 14,000 British nurses last year, of which data would suggest 14 to be HIV-positive. Epidemiologists who have examined the figures say that it is a reasonable estimate. It could even be an underestimate.
Nurses from Africa tend to be women from cities aged 20-30, the peak group in Africa for HIV infection. One study in South Africa showed that half the student nurses in Johannesburg were HIV-positive. If that figure holds for nurses across the country, then Britain last year took about 1,000 HIV-positive nurses from South Africa alone.
The broad recruitment of HIV-positive nurses from Africa is part of the new pattern of the HIV epidemic in Britain.
The Times revealed last week that the number of diagnosed HIV cases among African immigrants last year had overtaken those among gay men.Many other countries such as America and Australia, require HIV tests before people are allowed to immigrate. Canada began insisting on HIV tests for immigrants this year. Britain is planning the same for medical staff hired by the NHS.,,2-362032,00.html


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