Unit 5: AIDS Manifestation in the Mouth and Ethics

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HIV/AIDS Training for the Dental Health Worker:

HIV/AIDS Training for the Dental Health Worker Developed by Theresa Allyn Based on Washington State HIV AIDS Curriculum Sponsored by the WSDA Unit Five

HIV/AIDS Manifestation in the Mouth and HIV/AIDS Ethical Issues Unit Five :

HIV/AIDS Manifestation in the Mouth and HIV/AIDS Ethical Issues Unit Five Developed by Theresa Allyn Based on Washington State HIV AIDS Curriculum Sponsored by the WSDA

A Note from your Instructor:

A Note from your Instructor This next unit is a whole lot shorter than Unit Four so you should just move right through it. Although the unit is on ethical issues I am beginning the unit with a brief tutorial on what HIV and AIDS looks like in the mouth. This information is currently not covered in the Washington State HIV/AIDS curriculum, but as dental worker it is important information for us to be familiar with. This unit will give you a visual idea of how HIV/AIDS manifests in the mouth. To fully enjoy all this presentation has to offer don’t hesitate to try the links for more information as well as for videos that will enrich your learning experience. Remember to make sure that you have your internet connected and you are in full screen view. Remember that you can pause the audio component when you go out on the internet and simply press play when you are back in the presentation. Most of this material is based on the AIDS What you Must Know Washington State Curriculum. 3 Copyright 2/2008

Unit Five Overview:

4 Unit Five Overview What mouth conditions are specific to and HIV AIDS diagnosis? What are the reporting requirements for HIV/AIDS? What are the confidentiality requirements? What disability and discrimination guidelines are established? What behaviors could be endangering the public and how are they dealt with? Copyright 2/2008

HIV/AIDS in the Mouth: Kaposi's Sarcoma on the Palate:

HIV/AIDS in the Mouth: Kaposi's Sarcoma on the Palate 5 Copyright 2/2008

Kaposi's Sarcoma Tumour:

Kaposi's Sarcoma Tumour 6 Copyright 2/2008

Lesions and Tumors in the Mouth:

Lesions and Tumors in the Mouth 7 Copyright 2/2008

Kaposi's Sarcoma in the Gums:

Kaposi's Sarcoma in the Gums 8 Copyright 2/2008

Kaposi's Sarcoma Gums Continued…:

Kaposi's Sarcoma Gums Continued… 9 Copyright 2/2008

Kaposi's Sarcoma in the Gums Continued…:

Kaposi's Sarcoma in the Gums Continued… 10 Copyright 2/2008

HIV Related Thrush:

HIV Related Thrush 11 www.aids-images.ch Copyright 2/2008

HIV Related Thrush:

HIV Related Thrush 12 Copyright 2/2008

HIV Related Gingivitis:

HIV Related Gingivitis 13 Copyright 2/2008

Ethical Issues of HIV and AIDS :

Ethical Issues of HIV and AIDS AIDS (medically diagnosed) and symptomatic HIV infection have been reportable conditions in Washington since 1984 and 1993 respectively. In 1999, asymptomatic HIV infection also became reportable. Reporting of HIV and AIDS cases assists local and state officials in tracking the epidemic. It also allows for effective planning and intervention to be provided in the effort to reduce the transmission of HIV to other people. 14 Copyright 2/2008

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15 Ethical Issues of HIV and AIDS Copyright 2/2008

What Does Reportable Mean?:

Reporting on diagnosis: In the case of HIV or AIDS, providers who diagnose a person must submit a confidential case report to the local health jurisdiction within 3 days. Positive HIV results obtained through anonymous testing are not reportable. However, once a patient with positive results seeks medical care for conditions related to HIV or AIDS, the provider is required to report the case to the local health departments. What Does Reportable Mean? Reporting on seeking medical treatment: 16 Copyright 2/2008

Spousal Notification:

Spousal Notification Federal Public Law 104-146 (1996) requires that states take action to require that a "good faith effort" be made to notify all spouses of HIV-infected persons. A "spouse" is defined as anyone who is or has been the marriage partner of an HIV infected individual within 10 years prior to the HIV diagnosis. 17 Copyright 2/2008

What does Notification Mean?:

What does Notification Mean? Notification" means that if the test result is positive, the individual testing positive will be counseled about the importance of notifying spouses and partners 18 Copyright 2/2008

Confidentiality:

It is the law All medical records are confidential and must be maintained in a manner that protects that confidentiality. There are special requirements around HIV and AIDS, found in WAC 246-101 and RCW 70.24.105. Confidentiality of medical information means that a person’s medical information (including HIV testing and HIV results) may not be disclosed to anyone unless the individual signs a release of information form. Confidentiality What does Confidential mean? 19 Copyright 2/2008

Confidentiality Continued…:

Information can be shared When it is given from one health provider to another health care provider for related on-going medical care of the patient In a life or death emergency To a third party payor (insurance provider) In the case of reporting notifiable conditions to the local health jurisdiction or the DOH Violation of the confidentiality laws is a misdemeanor and may result in civil liability actions for reckless or intentional disclosure up to $10,000 or actual damages, whichever is greater. It is the responsibility of the county's health officer to investigate potential breaches of confidentiality of HIV identifying information and report those to the DOH. Confidentiality Continued… Violations 20 Copyright 2/2008

Why is there Confidentiality Protections for HIV and other Selected Records?:

Why is there Confidentiality Protections for HIV and other Selected Records? Some areas of the medical record have additional confidentiality requirements because disclosure of the information to the wrong person or agency could mean additional harm to the patient. It has been determined that there exists a level of prejudice, fear and discrimination directed at people with these medical conditions. Therefore, there is a balance between civil protection and information access. 21 Copyright 2/2008

Disability and Discrimination:

Disability and Discrimination People with AIDS and HIV are also protected by federal law under Title II of the Americans with Disability Act of 1990 (ADA) and Section 504 of the Federal Rehabilitation Act of 1973, as amended. In Washington State, the Washington Law Against Discrimination (WLAD) regulates "disabled“ status and explicitly prohibits discrimination on the basis of HIV and Hepatitis C Infection. RCW 49.60.174. The WLAD is enforced by the Washington State Human Rights Commission. Persons with HIV infection and/or AIDS who feel discriminated against on the basis of their disease may file a complaint with the Office for Civil Rights (OCR) of the U.S. Department of Health and Human Services, or the Washington State Human Rights Commission. WSHRC jurisdiction information can be found on its website, www.hum.wa.gov. The WSHRC does not investigate anonymous complaints, and may have to release a complaint under the State’s Public Disclosure ACT. In certain circumstances, OCR will not disclose a complainant’s identity. 22 Copyright 2/2008

The areas Covered in the Law are::

The areas Covered in the Law are: These laws mean that it is illegal to discriminate against people who have AIDS or are HIV infected, on the basis of their medical condition. It is also illegal to discriminate against someone who is ‘believed’ to have AIDS or HIV infection, even though that person is not, in fact, infected. 23 Copyright 2/2008

Employers may not Discriminate against Persons with HIV/AIDS in::

Employers may not Discriminate against Persons with HIV/AIDS in: Employment Recruitment Hiring Transfers Layoffs Terminations Rate of pay Job assignments Leaves of absence, sick leave, any other leave or fringe benefits available by virtue of employment Note that state and federal laws do not cover all employers. For example, state law does not cover employers with fewer than eight employees, religiously controlled non-profits, and Indian tribes. 24 Copyright 2/2008

Reasonable Accommodation:

Reasonable Accommodation 25 Copyright 2/2008

An Employee with a Disability must Self-Identify:

An Employee with a Disability must Self-Identify The employer must engage in an interactive process with the requestor. The reasonable accommodation grant may not be exactly the same one as requested by the employee, but can be equally effective. The employer does not have to change the essential nature of its work, or engage in undue hardship or heavy administrative burdens. The essential functions of the job must be accomplished, with or without reasonable accommodations. 26 Copyright 2/2008

Slide 27:

27 Copyright 2/2008

The Process for Discrimination Issues:

The Process for Discrimination Issues If someone is in a situation in which they feel they are being discriminated against, they should first document the discrimination, speak with their supervisor, and follow the entity’s internal process to file a discrimination charge. However, it is not necessary to follow an internal grievance process. If these remedies do not work, a person should contact the Office for Civil Rights or the Washington State Human Rights Commission. An aggrieved person can also file directly in state court. A complaint must be filed within 180 days of the alleged discriminatory incident. http://www.hum.wa.gov/ 28 Copyright 2/2008

Potentially Prejudicial Information:

When a person goes for a job interview or is hired: It is best practice for an employer to not ask questions directed at the perception or presence of HIV infection or AIDS unless the employer has obtained a “bona fide occupational qualification” (BFOQ) from the Washington State Human Rights Commission. It is best practice for an employer to not ask “lifestyle” questions such as inquiring about an applicant’s religion, living arrangements, sexual orientation, or gender identity. Potentially Prejudicial Information Appropriate Questions: 29 Copyright 2/2008

Washington Law:

Washington Law Chapter 49.60 RCW, the Washington Law Against Discrimination, prohibits discrimination based on age, creed, religion, race, color, national origin, sex, sexual orientation and gender identity, HIV and Hepatitis C status, whistleblower retaliation, marital status (housing and employment), families with children (housing), or the presence of any sensory, mental, or physical disability or the use of a trained dog guide or service. Exceptions to this are applicants for the U.S. military, the Peace Corps, the Job Corps, and persons applying for U.S. citizenship, under federal law, which supersedes state law. santacruz.indymedia.org/.../18806/index.php To view this photo at its original site and see more on discrimination click or visit the following link: 30 Copyright 2/2008

Behaviors Endangering the Public Health:

Public health protection Washington State law (RCW 70.24) and rules (WAC 246-100 and 246-101) gives state and local health officers the authority and responsibility to carry out certain measures to protect the public health from the spread of sexually transmitted disease (STD), including HIV. The local health officer is the physician hired to direct the operations of the local county's health department or health district. Included in the broad responsibilities of the health officer is the authority to: Interview persons infected with an STD Notify sexual or needle-sharing partners of exposure to disease Order persons suspected of being infected to receive examination, testing, counseling or treatment Issue orders to cease and desist from specific conduct that endangers the public health of others Court enforcement of these orders can be sought. State law delineates the standards that must be met before action by the health officer may be taken. Behaviors Endangering the Public Health Authorities & responsibilities of the Health Officer 31 Copyright 2/2008

Behaviors Endangering the Public Health Continued…:

Behaviors Endangering the Public Health Continued… For HIV, Washington State law permits an additional step – the detention of an HIV-infected person who continues to endanger the health of others. After all less restrictive measures have been exhausted, the law allows for a person to be detained for periods up to 90 days after appropriate hearings and rulings by a court. This detention must include counseling. 32 Copyright 2/2008

Reporting Non-Compliance:

Reporting Non-Compliance By state law and rule, health care providers are required to provide instruction on infection control measures to the patient who is diagnosed with a communicable disease. They are also required to report certain information to the local health officer where there are either impediments to or refusal to comply with prescribed infection control measures. 33 Copyright 2/2008

Reporting Cont…:

Reporting Cont… When a health care provider has knowledge that a specific patient is failing to comply with prescribed infection control measures (e.g., acquisition of a new STD, sex without disclosure of HIV status prior to sexual partners, failure to disclose HIV status to needle-sharing partners, or donating or selling HIV-infected blood, etc.) they should contact the local public health officer to discuss the circumstances of the case and to determine if the name of the person should be reported for investigation and follow-up. The health officer or other authorized representative will investigate the case if credible evidence exists that an HIV infected person is engaging in conduct endangering the public health. There are also other laws and regulations concerning behaviors endangering and occupational exposures. These may be specific to professions and to the jurisdictions of public health officers. For more specific information, talk with public health officials in your area, call the Washington State Hotline at 1-800-272-2437, or ask a knowledgeable person to provide their 1nformation to your group. 34 Copyright 2/2008

Unit Five Quiz Directions:

Unit Five Quiz Directions Directions: Get a piece of paper and pen and write your answers to the following 10 questions. When finished check your answers on the following answer slides. Keep each self quiz as proof that you have completed the unit. 35 Copyright 2/2008

Quiz for Unit Five:

Quiz for Unit Five True or False: Reporting new HIV/AIDS infected patients is not mandatory for health care workers due to patient confidentiality laws. True or False: If I know I have HIV and deliberately infect someone I could go to jail. True or False: Kaposi Sarcoma only creates skin lesions. True or False: Confidentiality of medical information means that a person’s medical information (including HIV testing and HIV results) may not be disclosed to anyone unless the individual signs a release of information form. True or False: Violation of patient confidentiality regarding HIV status could result in a misdemeanor and may result in civil liability actions for reckless or intentional disclosure up to $10,000 or actual damages. 36 Copyright 2/2008

Quiz for Unit Five Continued…:

Quiz for Unit Five Continued… True or False: People with AIDS and HIV are also protected by federal law under Title II of the Americans with Disability Act of 1990 (ADA) and Section 504 of the Federal Rehabilitation Act of 1973, as amended. True or False: Some state and federal laws do not cover all employers in regard to disability and accommodation for an HIV positive patient. True or False: Employers are required to provide and maintain a working environment free of discrimination. True or False: Employers are not responsible for providing reasonable worksite accommodations for an HIV employee due to the expense and burden to the employer. True or False: Persons with HIV infection and/or AIDS who feel discriminated against on the basis of their disease may file a complaint with the Office for Civil Rights. 37 Copyright 2/2008

Answers For Quiz Five:

Answers For Quiz Five True or False : Reporting new HIV/AIDS infected patients is not mandatory for health care workers due to patient confidentiality laws. True or False: If I know I have HIV and deliberately infect someone I could go to jail. True or False: Kaposi Sarcoma only creates skin lesions. True or False: Confidentiality of medical information means that a person’s medical information (including HIV testing and HIV results) may not be disclosed to anyone unless the individual signs a release of information form. True or False: Violation of patient confidentiality regarding HIV status could result in a misdemeanor and may result in civil liability actions for reckless or intentional disclosure up to $10,000 or actual damages. 38 Copyright 2/2008

Answers for Quiz five Cont…:

Answers for Quiz five Cont… True or False: People with AIDS and HIV are also protected by federal law under Title II of the Americans with Disability Act of 1990 (ADA) and Section 504 of the Federal Rehabilitation Act of 1973, as amended. True or False: Some state and federal laws do not cover all employers in regard to disability and accommodation for an HIV positive patient. True or False: Employers are required to provide and maintain a working environment free of discrimination. True or False: Employers are not responsible for providing reasonable worksite accommodations for an HIV employee due to the expense and burden to the employer. True or False: Persons with HIV infection and/or AIDS who feel discriminated against on the basis of their disease may file a complaint with the Office for Civil Rights 39 Copyright 2/2008

Congratulations!:

Congratulations! You have completed Unit Five of HIV/AIDS online learning course. You will now move on to Unit Six the very last unit. The last unit will deal with Psychological issues involving HIV/AIDS. 40 Copyright 2/2008

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