Association of Anatomical Pathology Technology


HIV and post-mortems

NAT (National AIDS Trust) HIV-related discrimination within the pathology profession

By Sally Thomas

The UK’s HIV epidemic has been characterised by a rapid change in attitude and increased understanding of the virus over the last thirty years. We have gone from the panic and mourning at the height of the AIDS crisis, to the present day - where HIV, if diagnosed early, is a perfectly manageable long-term condition. This has presented challenges for all professions in public life to keep their policies and approach to HIV in line with the current evidence.
By and large, the pathology, mortuary and funeral professions have done so; however, it seems that there are still some working within these professions displaying attitudes and an understanding of HIV more in line with the 1980s than with 2013. In recent months, NAT has heard of some worrying accounts from families, or partners, of people with HIV who have died who have been denied a post-mortem examination, simply on the basis of their loved-ones’ HIV status.
In one instance the widow of an HIV positive man who died never had his cause of death officially ascertained. She believes he committed suicide, possibly via overdose, but the mortuary concerned refused to conduct a post mortem examination, citing “infection risk to staff” as the reason.  This has left her unable to grieve properly or close such an upsetting chapter in her life. We’ve also had evidence from HIV support workers in the field that some mortuaries are refusing to carry out post mortem examinations on HIV positive patients. “Even the consultant microbiologist hasn’t had any success in challenging this”, one colleague writes.
All of this is not only discrimination, it is totally unnecessary; the Royal College of Pathologists Guidance clearly advises that universal precautions are sufficient for examining HIV-positive individuals. No one should be refused a post mortem examination because of their HIV status. Indeed, effective HIV treatment can reduce infectiousness by up to 96% - so someone diagnosed with HIV, whose status the post mortem team finds out about, is likely to be far less of an infection risk than someone with undiagnosed HIV. Universal precautions should be sufficient to protect all staff from the risk of infection.
In this country today, very few people actually die from HIV or AIDS, but everyone dies eventually, and those with HIV – and those who care for and love them – deserve to be treated with the same dignity and respect as everybody else. That is not only a matter of basic human compassion, but it is what the scientific evidence says too. 
To read NAT’s brief for the pathology profession on HIV issues click here

AAPT are pleased to be one of the major stakeholders along with RCPath in the updating of HSE Guidance regarding mortuaries and handling of the deceased. National Aids Trust (NAT) are strong supporters of this important review of guidance.

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