AMA (NSW) opposes Mandatory Disease Testing Bill

Mandatory disease testing doesn’t make sense clinically or ethically, said AMA (NSW) President, Dr Danielle McMullen, who is scheduled to appear at the Law and Justice Committee hearing on Mandatory Disease Testing today. 

The hearing is being held as part of the Law and Justice Committee’s Inquiry into the Mandatory Disease Testing Bill, which would enforce mandatory disease testing on individuals whose bodily fluids have come in contact with frontline workers. 

“While the risk of transmission is extremely low, we acknowledge the seriousness of blood-borne viruses and the depth of concern that exists among frontline workers about the risk of potential exposure,” Dr McMullen said. 

“However, there is no clinical rationale for mandatory disease testing.” 

Clinical evidence shows that the risk of Hepatitis B, Hepatitis C and HIV transmission from a known positive source through blood and saliva to unbroken skin and skin-to-skin contact is zero. There have been no published cases of spitting causing HIV transmission. There have been no published cases of HIV transmission in Australia through spitting or biting. 

Hepatitis B can be transmitted when bodily fluids come in contact with the blood stream of another person. The prevalence of Hepatitis B, at 0.9%, is low by international standards, with Australia implementing a universal infant vaccination in 2000. Furthermore, police officers and paramedics are required to have a Hepatitis B vaccine upon recruitment. 

Hepatitis C generally requires a large exposure to blood for transmission, with no infections reported with mucous membrane or intake skin exposure. 

“In circumstances where there is a risk of transmission, emergency services personnel should follow potential bloodborne virus exposure management protocols,” Dr McMullen said. The Australian Society for HIV Medicine has produced guidelines for the management of individuals who have been exposed (or suspect they have been exposed) to HIV in non-occupational and occupational settings. 

“High-quality, clear clinical guidelines already exist for managing exposure, and these specifically state that while seeking the source infection status can be helpful if voluntary, it is not necessary,” Dr McMullen said. 

If significant exposure such as a needle stick injury or blood splash to broken skin, mouth or eyes has occurred, it is critical that urgent clinical review occurs, to consider Post Exposure Prophylaxis (PEP) treatment. Treatment, if required, should not be delayed pending the results of diagnostic tests. 

“There is a window period during which an infection may not be detected in the acute stage of the disease. Therefore, testing the source person isn’t conclusive and the results should not change the treatment protocol. 

“Testing the source person should not alter initial treatment and management,” Dr McMullen said. 

“Emergency responders should be offered immediate assessment, treatment and counselling. Our fear is that by emphasising mandatory testing – a process that could take up to three weeks to complete – the frontline worker may miss out on the treatment they need. 

“Testing the source person is not conclusive and could potentially cause further distress to emergency worker or even false security. 

“We also strongly oppose conducting a medical procedure on someone without their consent. Privacy of health information should also be paramount. 

“Furthermore, mandatory disease testing has the potential to contribute to the stigma and discrimination of people living with HIV, Hepatitis B and C. This has the downstream effect of limiting the ability of health services to engage with people at risk of or living with blood borne viruses.”  

Mandatory disease testing laws are not supported by global health bodies such as UNAIDS and the World Health Organisation. 

“We especially do not support mandatory testing of juveniles under the age of 18,” Dr McMullen said. 

“The prevalence of blood borne viruses in this group is extremely low, and the ethical ramifications of coercing a child into a blood test which has no therapeutic benefit for them is severe.” 

Only four people under the age of 19 were diagnosed with HIV in 2019. Similarly, very low prevalence of Hepatitis B and C is noted in this age group. 

“The real gap is not the lack of mandatory testing, it is the lack of counselling and health resources for those exposed. Appropriate discussion, testing and PEP where indicated, in combination with greater awareness and support for those exposed, would provide a significantly greater health benefit than mandatory testing,” Dr McMullen said. 

Media Contact:  Andrea Cornish – 0450 129 502