The evolution of a public health policy: Health care providers and the transmission of HIV

The single known instance of transmission of HIV from a health care provider to a patient raised issues concerning the responsibility of clinicians to their patients, and sparked debate over policies to prevent the spread of HIV in health care facilities. The intensity and politicization of the debate were reflected in revision of the Centers for Disease Control guidelines to control the spread of infection at health care facilities, and in legislation proposed in Congress. The guidelines and proposed legislation provoked responses by public health and medical organizations, several of which considered the measures to be unnecessarily restrictive and too costly in terms of potential benefits. This article describes the events and responses that took place during 1991-1992 after the public was made aware of the case involving transmission from provider to patient. The author examines the situation in the context of public health efforts to control the spread of HIV.