Stigmatizing surveillance: blood-borne pathogen protocol and the dangerous doctor

Abstract

HIV and hepatitis B and C are viruses that have been unduly set apart from other infectious diseases in terms of the symbolic pull they exert and the anxiety they produce. This is reflected in health care policy and protocol. Hospitals, health care regions and colleges of physicians and surgeons create guidelines and procedures that single out HIV or hepatitis B and C as requiring special attention. This paper examines such surveillance and stigma in blood-borne pathogen protocol, using the example of recently refined policies in Newfoundland, Canada. We argue that policies distinguishing HIV and hepatitis B and C as requiring special treatment are produced by a combination of four factors: (1) the ideological and political function of risk discourse, and how this overshadows actual measures of probability, (2) the historical association of HIV and hepatitis B and C as belonging to ‘deviant’ bodies, (3) the normalizing function of health surveillance mechanisms and (4) the contradictory image of the ‘sick’ doctor. It is crucial that health professionals be critical of bylaws that single out HIV and hepatitis B and C as these guidelines are unjust and may impede efforts to control the disease.

Keywords:

• Healthcare policy
• HIV
• hepatitis B
• hepatitis C
• stigma
• risk

Acknowledgements

This paper was written in the context of a graduate seminar on Critical Theory (Faculty of Medicine, Memorial University) taught by Professor Brunger. The authors wish to thank their classmates for the lively discussions that contributed to some of the thinking in this article. The authors also wish to thank the reviewers of this article whose insightful comments and appreciation for the central thesis have made this a much stronger manuscript.

Disclosure statement

The authors have no conflicts of interest, personal or institutional, with the subject matter discussed in this manuscript.

Notes

1. Exposure-prone procedures, during which transmission of HBC, HCV or HIV from a health care worker to a patient is most likely to occur, include repair of major traumatic injuries, major cutting or removal of any oral or perioral tissue, the presence of the health care worker’s fingers and a needle together in a confined anatomic site, and so on.

2. Average risk of HCV infection between patient and healthcare worker is estimated at 0.5%, but is considered null if exposure was to non-viremic (virus not present in the blood) patients. Risk of HIV infection is estimated at <0.3% (Deuffic-Burban, Delarocque-Astagneau, Abiteboul, Bouvet, & Yazdanpanah, 2011).

3. The term ‘Routine Practices’ has replaced the former common term, ‘Universal Precautions’, and includes a much broader scope of measures.