Communicable Diseases Policy
THE UNIVERSITY COMMITTEE ON COMMUNICABLE DISEASES
The University Committee on Communicable Diseases is responsible for promulgating policies, ensuring the provision of educational programs and adjudicating questions relevant to the prevention of and response to communicable diseases within the University community of employees and students. Certain units of the University such as those on the Health Sciences Center Campus or the Madrid Campus may require additional or different policies in response to regulatory agencies or governmental status; in such instances, the individual unit shall have jurisdiction in the promulgation and enforcement of those policies. The Committee on Communicable Diseases is appointed by the President of the University.
ACQUIRED IMMUNE DEFICIENCY SYNDROME
HIV disease is causing a world-wide health crisis of tragic proportions. As one of the countries with a significant incidence of HIV, the United States continues to evidence an alarming increase in HIV infection and in the illnesses and death associated with this disease. Unfortunately, the health crisis caused by HIV has been compounded by the ignorance and discrimination that has characterized the response by some segments of our society to the people suffering from this disease. As a result, physical and psychological suffering are often accompanied by prejudice, recrimination, rejection, isolation, injustice and condemnation.
The tragedy of HIV has touched and will continue to touch the Saint Louis University community. As a Catholic University in the Jesuit tradition, Saint Louis University believes that it can express its personal care of students and employees by providing operational procedures which manifest justice and compassion in matters relating to HIV disease. The University recognizes and affirms its responsibility to:
Respond to its students and employees with HIV in a manner consistent with the best medical and scientific information available.
Provide educational programs about the medical aspects of the disease and legitimate ways of preventing it in a manner consistent with its Catholic Jesuit identity and in ways that are appropriate for the diverse populations of our university community.
Stand in solidarity with and reach out with compassion and understanding to those with HIV disease and their loved ones, especially if they are members of our university community or people in the care of our professional schools and clinics.
Respect the rights of persons with HIV that flow from our human dignity.
Discrimination against persons with HIV is unjust and immoral, and it will not be tolerated at Saint Louis University.
In the words of the American Bishops in their document, Called to Compassion and Responsibility: A Response to the HIV/AIDS Crisis (November 30, 1989):
Our response to persons with AIDS must be such that we discover Christ in them and they in turn are able to encounter Christ in us. Although this response undoubtedly arises in the context of religious faith, even those without faith can and must look beyond suffering to see the human dignity and goodness of those who suffer.
SECTION I. INTRODUCTION
Human immunodeficiency virus is a transmissible viral agent which primarily infects the human species and usually results in a gradual progression of manifestations of impaired ability to resist infection. After initial acquisition of the agent, there is a spectrum of manifestations from being infected without recognizable disease (sero-positive) to having manifestations of HIV infection without a serious complicating unusual infection or cancer (acquired immunodeficiency syndrome related complex-ARC) to having manifestations of more severe immune deficiency characterized by unusual infections or cancers (AIDS).
HIV - human immunodeficiency virus - the name given to the viral infectious agent which is responsible for the acquired immunodeficiency syndrome (AIDS). The term immunodeficiency refers to the manifestations of the viral infection. Other terms are AIDS virus, lymphadenopathy virus (LAV), and human T-cell lymphtrophic virus III (HTLV-III).
Seropositivity - the laboratory condition in which a person who is infected with HIV has a blood test which demonstrates acquisition of an infection with HIV. People infected with HIV can be symptom free or have manifestations due to HIV, including fever, swollen glands, and weight loss.
AIDS - (acquired immune deficiency syndrome) - the presence of a complicating unusual infection or cancer in a person infected with HIV and a marker of significant immune suppression (the body's inability to fight off infection).
2.0 Mode of Transmission and Prevention:
HIV has been demonstrated to be transmitted by the exchange of blood and other body fluids from infected individuals to uninfected individuals. The major identified routes of transmission include sexual contact (both homosexual and heterosexual), sharing intravenous drug equipment, transfusion of infected blood or blood products, and mother to child (either prior to or at birth). In addition, health care workers have acquired infection due to work related accidents. There are presently no data to support transmission of HIV by casual contact.
As noted in the Preface, the University affirms its responsibility to provide education about AIDS to members of the University Community. Such education may be included in the orientation program routinely offered for new students and new employees, and special education programs may be scheduled as needed to provide the latest information to all students and employees.
Orientation programs for new undergraduate students, including the AIDS education component, are the responsibility of the Office of Student Life. Additional programs may be offered for residence hall students through the office of the Director of Housing, and for International Students by the Director of International Student Services.
The Dean/Director of each undergraduate, graduate and professional school or Center within the University shall be responsible for ensuring that his/her students and faculty have access to an orientation program as well as to any special AIDS education programs that may be relevant.
The University's Department of Human Resources is responsible for Employee Orientation Programs, including the AIDS education component, and shall ensure that all University employees have access to periodic AIDS update sessions.
SECTION II. GENERAL POLICIES
1.0 Applicability and Basis
1.1 This policy applies to all University staff, faculty and students. Vendors/contractors operating University functions and using University facilities shall be in compliance with the law.
1.2 Health Sciences Center academic, research, and service units, or other University units significantly at risk, may develop more specific policy statements to address the special needs of their students and personnel.
1.3 Saint Louis University policy shall be based upon current recommendations from the Centers for Disease Control, from the U.S. Public Health Service, from the American College Health Association, and from documents of the United States Catholic Conference and other resources of Catholic moral teaching on AIDS. This policy should be reviewed annually by the University Committee on Communicable Diseases, and changes should be proposed according to the latest available information.
2.0 Disabling Conditions: Persons with HIV infection are considered as disabled under federal and state laws and the University will take such action as is necessary to insure the protection of their legal rights.
3.1 People known or suspected to have HIV infection, whether or not they have symptoms of illness, have sometimes been victims of discrimination and physical or psychological abuse. The potential for discrimination and mistreatment of these individuals, or of persons thought to be at risk of infection, requires that confidential information concerning any aspect of HIV infection be handled with extraordinary care. Therefore, information concerning the existence and/or identity of a student, faculty member or staff member with HIV infection shall not be divulged, except to the extent required or permitted by law. The number of persons to be so advised shall be kept to a minimum and shall be limited to those with a need to know.
3.2 There is no medical or other reason for institutions to advise students living ina residence hall of the presence there of students with HIV infection
3.3 To preclude the accidental disclosure of personal health information, employee and student health records of any kind may not be kept in publicly accessible University files. Personal health information belongs to the individual and may be released with the permission of that individual, subject to the limited exceptions set forth in subsection 3.1, above.
3.4 All inquiries from the public or media regarding the presence of HIV infected individuals in the Saint Louis University community shall be referred to the President's Office.
4.0 HIV Antibody Testing
4.1 The University shall not mandate the testing of its students, faculty or staff for the presence of antibody to HIV. Those desiring HIV antibody testing, however, are encouraged to contact the student or employee health services or the Employee Assistance Program for information about the availability of such testing services in the St. Louis Area. All requests for information and referrals for testing are to be held confidential.
4.2 Missouri law requires that "all physicians, hospital, or other persons authorized by the department of health who perform or conduct HIV blood sampling...shall report to the department of health the identity of any individual confirmed to be infected with HIV," subject to exceptions for research projects, anonymous testing sites and testing solely for the purposes of assessing fitness for insurance purposes.
5.0 Health Care Service
5.1 Student Health Services Screening for HIV infection is available for all students through the Student Health Service located in Marchetti Towers East, 3518 Laclede and the Doctors' Offices/Saint Louis University Health Sciences Center. Diagnosis and referral for treatment are also available for individuals who are seropositive for HIV, or who have AIDS. Medical and psychological counseling is given to any individual presenting to the Student Health Service requesting screening or diagnosis of HIV related disease. Counseling is available regarding HIV infection and transmission through the Counseling Center on Frost Campus.
Information regarding the student and diagnostic information is maintained confidentially in the medical record system at the Student Health and Counseling Center, per established policy but subject to the requirement of state law referred to in Sub-section 4.2 above, that the identity of any individual confirmed to be infected with HIV be reported to the Department of Health. A consent to undergo serologic testing is obtained prior to diagnostic testing, during the medical counseling session. Information about anonymous testing sites is also available. These health care services are performed within the scope of the Student Health Center. These services are available on a discounted fee-for-service basis. Payment for services may be cash at the time of service, or billed to the student's insurance. It should be noted, however, that charges billed to an insurance company require release of diagnostic information. Medical students, and graduate students of the Medical School, receive comprehensive medical services through the Saint Louis University Health Plan, a pre-paid self-insurance plan of the Medical School organized as a staff-model H.M.O. HIV counseling, screening, diagnosis, and treatment are covered benefits of this Plan. Care is provided at Saint Louis University Health Sciences Center, and confidentiality is maintained as per the Student Health Center.
5.2 Employee Health Service. Screening for HIV infection and associated medical counseling is available for all University employees who might have acquired HIV infection through their work on a Saint Louis University campus. These services are provided at Healthline/Occupational Health located on the Health Sciences Center campus. Employees who are considered "at risk" include biomedical researchers, clinical laboratory personnel, janitorial staff at facilities where bodily fluids and/or HIV are handled, physicians, nursing staff, and health care students (Allied Health, Nursing, Orthodontic, Medical, etc.). Initial screening and counseling are provided as part of the occupational benefit of the University. Employees are followed by Employee Health, as well as referred for specialty care in the event they develop HIV infection. Further counseling is also available through the Employee Assistance Program of the University.
Record of potential exposure is maintained in employees' files, as well as documentation of referral to Employee Health. All subsequent records are maintained by Healthline/Occupational Health per established policy. All records are subject to the requirements of confidentiality set forth in Subsection 3.1 above.
6.0 Responsibility of Infected Individuals
Individuals who are infected with HIV or who have a reasonable basis for believing that they are infected must conduct themselves responsibly for their own protection and that of other members of the University community.
7.0 Safety Precautions and Procedures
Each School, College and Department of the University should become familiar with the safety guidelines proposed by the CDC for the handling of human blood and body fluids. These safety guidelines apply to blood and blood -containing fluids of all persons, not just persons known to have HIV infection. Body fluids such as tears, vomitus, urine, and feces are thought to confer very low or no risk or HIV infection unless they contain apparent blood. However, when in doubt, use gloves when handling or disposing of such materials. Although exposure to blood should be rare outside of the Health Sciences Center Units, certain laboratories, and the Athletic Department; accidents or injuries resulting in the shedding of blood or other body fluids can happen anywhere. Each School, College, and Department should have procedures in place for responding to such accidents and injuries in a manner consistent with the CDC's recommendations. The most basic of these recommendations is that surfaces contaminated by human blood or other body fluids should be cleaned with detergent and disinfected with commercial disinfectant solutions or with 1 part household bleach freshly diluted with 9 parts water. Individuals engaged in cleaning and disinfecting these surfaces should wear either latex or plastic gloves. Students enrolled in laboratory courses requiring exposure to human blood, such as biology courses, should use appropriate barrier techniques and disposal equipment. Lancets and other blood-letting devices must not be re-used or shared. For additional information and guidance, contact:
Frost Campus: Risk Management
Health Sciences Center Campus: Director of Safety
SECTION III. SPECIFIC POLICIES - STUDENTS
The University will not deny admission to an HIV-infected applicant on the basis of his or her HIV infection unless the University has concluded, on the grounds of sound medical and scientific evidence, that the applicant's HIV infection would prevent him or her from completing essential program requirements, and that no reasonable accommodation could be made that would enable the applicant to complete such requirements.
2.0 Access to Campus Facilities
Infection with HIV, per se, will not restrict a student's access to campus dining facilities, student centers, recreation or sports centers or fields, swimming pools, or other common areas.
3.0 Residence Halls
3.1 Decisions about housing for students with HIV infection must be made on a case-by-case basis. The best currently available medical information does not indicate any risk to those sharing residence with infected individuals. In some circumstances, however, there may be reasonable concern for the health of students with immune deficiencies (of any origin) when those students might be exposed to certain contagious diseases, such as measles or chickenpox, in a close living situation. Single-occupancy rooms are therefore recommended for those students with immune deficiencies, for their own protection.
3.2 Room Changes. This policy shall be consistent with that stated in the Residence Hall Guide, in the "Room Change" policy, which states that a room change must be approved by the Assistant Director of Housing.
3.3 Residence hall staff shall receive education about AIDS and related concerns as part of their regular annual training prior to the arrival of students.
4.0 Classroom Attendance
Individuals with HIV infection, whether symptomatic or not, should not be restricted from regular classroom and laboratory attendance so long as they are physically and mentally able to attend class.
5.0 Athletic Facilities and Activities
Individuals should not be restricted from participating in the University's intercollegiate, intramural, recreation or physical education programs because of HIV infection as long as from a medical perspective they are able to do so. Such individuals are encouraged to seek medical advice before participating in programs requiring vigorous physical activity to ensure that such activity will not be deleterious to their health.
6.0 International Students
In general, the provisions of the University's Policy on Aids will apply to international students in the same way they apply to American students. The International Student Services Office, located in DuBourg Hall on Frost Campus is available to foreign students as an additional source of information and support.
Nonimmigrant aliens in this country on foreign student visas are entitled to remain for the period they are pursuing a full course of studies. The regulations specifically provide that the student's visa status is not affected if illness or a medical condition interrupts or reduces the course of study, so long as full course of study is resumed upon recovery.
7.0 Health Sciences Center Students
Health Sciences Center Students are subject to these general University policies as well as any specific policies promulgated by the Health Sciences Center. If there are any inconsistencies between this University-wide policy and the Health Sciences Center policy, the Health Sciences Center policy shall control with respect to students, employees and activities within the Health Sciences Center.
SECTION IV. SPECIFIC POLICIES -EMPLOYEES
1.1 The University will not deny employment to an HIV-infected applicant on the basis of his or her HIV infection unless the University has concluded on the grounds of sound medical and scientific evidence, that the applicant's HIV infection would prevent him or her from performing essential job duties and that no reasonable accommodation could be made that would enable the applicant to perform such duties.
1.2 Faculty and staff with HIV infection should not be restricted from regular employment activities and shall be evaluated like all other employees.
1.3 Current medical evidence indicates that there is no danger to employees who work with HIV infected individuals under ordinary working conditions. If an employee expresses fears or concern, the supervisor will refer that employee to an appropriate source for education to allay fears. Requests for transfer will be handled on an individual basis with the understanding that employees do not have a right to reassignment. Refusal to work with a person with AIDS does not excuse an employee from fulfilling assigned duties.
2.0 Sick Leave and Disability
Sick days and leaves of absence will be granted to all eligible employees with illnesses, including AIDS, in accordance with the University's regular policy on leaves of absence and sick leave as summarized in the Staff Handbook and Faculty Manual. Long Term Disability benefits are provided for full-time employees with one year of service as described in the Summary Plan Description.
3.0 Health Sciences Center Employees
Health Sciences Center faculty and staff, including resident physicians and fellows, are subject to these general University policies as well as any specific policies promulgated by the Health Sciences Center. If there are any inconsistencies between the this University-wide policy and the Health Sciences Center policy, the Health Sciences Center policy shall control with respect to students, employees and activities within the Health Sciences Center.