I. Statement of Principles

The recommendations and guidelines included in this document are based on the "General Statement on Institutional Response to AIDS" issued by the American College Health Association (ACHA) on December 2, 1985, and "A Position Paper on Dealing with School-Age Children and School Staff Who Have Contracted AIDS" issued by the State of Michigan Board of Education in April, 1986. They reflect the best currently available medical information and recommendations of the Public Health Service and the Centers for Disease Control. It must be recognized, however, that these recommendations and guidelines may require change as advances are made in medical knowledge.

THE PRIMARY RESPONSE OF COLLEGES AND UNIVERSITIES TO THE AIDS EPIDEMIC MUST BE EDUCATION. Because there is no specific therapy for AIDS or AIDS-related conditions, the most important goals for institutions will be those of increasing awareness and providing education to prevent further spread of the disease. The organization and completion of effective educational programs about AIDS should be an activity of priority for Macomb Community College. Such programs must address all degree credit and non-degree credit students as well as AIDS education for institutional employees.

Such educational programs will address the major intervention currently possible in limiting the consequences of AIDS, which is primary prevention. They may also be of paramount importance in discharging Macomb's responsibility to protect its student body and staff from the transmission of AIDS. Since the current medical evidence indicates that no actual safety risks are created in a normal academic or employment setting, the administration of effective AIDS education and training programs provides the best way for Macomb to render enrollment or employment safe and healthful. The AIDS epidemic raises issues of liability that are of great concern to College administrators; the most effective means of addressing these issues at present is to educate students and employees about AIDS and to take reasonable precautions such as are suggested herein.

THE AMERICAN COLLEGE HEALTH ASSOCIATION RECOMMENDS THAT INSTITUTIONS NOT ADOPT BLANKET POLICIES CONCERNING STUDENTS WITH AIDS or AIDS RELATED CONDITIONS. Instead, it suggests that certain guidelines be followed and that the institution analyze and respond to each case as required by its own particular facts. Macomb will benefit from the maintenance of as much flexibility as possible in dealing with the issues AIDS raises; given the uncertain legal obligations and challenges involved, it is advisable not to devise and implement detailed policies at this time. However, it seems appropriate for Macomb officials to identify and designate a person, group, or department to assume a managerial role in providing consistent and reasonable analysis of each case.

GUIDELINES FOR INSTITUTIONS DERIVE FROM THE BEST CURRENTLY AVAILABLE MEDICAL FACTS ABOUT AIDS. Recommendations apply to all students or employees who are known to be infected with the virus thought to cause AIDS, Human T-Lymphotropic Virus, type III (HIV); this includes those who have a condition meeting the surveillance definition of AIDS itself, those who have one of the lesser manifestations of infection (AIDS-Related Complex, or ARC), and those who are currently healthy but have evidence by the presence of a serum antibody to HIV of exposure to and infection by the virus.

CURRENT KNOWLEDGE INDICATES THAT STUDENTS OR EMPLOYEES WITH AIDS, ARC, OR A POSITIVE HIV ANTIBODY TEST DO NOT POSE A HEALTH RISK TO OTHER STUDENTS OR EMPLOYEES IN AN ACADEMIC SETTING. AIDS is thought to be transmitted by intimate sexual contact or by exposure to contaminated blood. Although HIV can be found in many body secretions of those who are infected, its presence there is not necessarily correlated with disease transmission by those fluids. There has been no confirmed case of transmission of AIDS by any household, school, or other casual contact. THE PUBLIC HEALTH SERVICE STATES THAT THERE IS NO RISK CREATED BY LIVING IN THE SAME HOUSE AS AN INFECTED PERSON; CARING FOR AN AIDS PATIENT; EATING FOOD HANDLED BY AN INFECTED PERSON; BEING COUGHED OR SNEEZED UPON BY AN INFECTED PERSON; CASUAL KISSING; OR SWIMMING IN A POOL WITH AN INFECTED PERSON.

II. Recommendations for an Institutional Response to AIDS

The above facts, derived from the best epidemiologic data currently available, are the basis for the following guidelines recommended by the American College Health Association.

1. Most Macomb students who have AIDS, ARC, or a positive HIV antibody test, whether they are symptomatic or not, should be allowed regular classroom attendance in an unrestricted manner as long as they are physically able to attend classes. (See also Recommendation Number 9.) There is no known medical justification for restricting the access of students with AIDS, ARC, or a positive HIV antibody test to the College's student unions, theaters, restaurants, cafeterias, snack bars, gymnasiums, swimming pools, recreational facilities, restrooms, or other common areas.

2. A determination of whether, or under what conditions, an HIV infected person should be restricted from activities shall be made on a case-by-case basis. In making this determination, the College shall seek the opinion of appropriate physicians and public health officers who will take into consideration: (1) the physical/mental condition of the student; (2) the expected type of interaction with others in the College setting; and (3) the impact on both the infected student and others in that setting. Their recommendations will be forwarded to the President of the College.

3. The program of education provided by Macomb should emphasize the following recommendations of the U.S. Public Health Service:
   1. Even though they may be asymptomatic, persons with confirmed positive HIV antibody tests may transmit infection to others through anal or vaginal sexual intercourse, the sharing of needles, and possibly through oral-genital contact or intimate kissing.

   2. The efficacy of condoms in preventing infection with HIV is unproven, but the consistent use of them may reduce transmission.

   3. Toothbrushes, razors, and other implements that may become contaminated with blood should not be shared.

   4. Persons with AIDS, ARC, or confirmed positive HIV antibody tests should not donate blood, plasma, other body organs, other body tissues, or sperm. The American College Health Association also endorses the request of the American Red Cross that persons who fall into defined risk categories for AIDS not donate blood or plasma.

   5. If persons with confirmed reactive (positive) antibody tests have accidents involving bleeding, contaminated surfaces should be cleaned with household bleach freshly diluted 1:10 in water.

   6. When seeking medical, dental, or eye care, those persons should advise the practitioner of their positive antibody status so that appropriate evaluation can be undertaken and precautions can be taken to prevent transmission to others.

4. Consideration of the existence of AIDS, ARC, or a positive HIV antibody test should not be part of the initial admission decision for those applying to attend Macomb.

5. The American College Health Association does not advocate the routine requirement that students be asked to respond to questions about the existence of AIDS, ARC, or a positive HIV antibody test. It is, however, appropriate to encourage students to inform campus health authorities if they have AIDS, ARC, or a positive HIV antibody test in order that Macomb can provide them proper medical care and health education. This, like all other medical information, must be handled in a strictly confidential manner in accordance with the procedures and requirements in effect in the College.

6. Macomb officials should not undertake programs of screening newly admitted or current students for antibody to HIV; neither should mandatory screening of employees be implemented. Especially, the College should not attempt to identify those in high risk groups and require screening only of them.

7. Macomb Health Services should be familiar with sources of testing for antibody to HIV, and should be able to refer students or employees requesting such testing. Health care providers should understand the capabilities and limitations of the test, and should be able to counsel those desiring to be tested or to refer them to counseling sources elsewhere. Testing should only be done where it is confidential or anonymous, where positive results can be confirmed by specific tests, and where both pre- and post-test counseling are available.

8. Guidelines concerning the handling of confidential medical information about students with AIDS, ARC, or a positive HIV antibody test follow the general standards included in the American College Health Association's Recommended Standards and Practices for a College Health Program, Fourth Edition, 1984:

   In general, it is recommended that no specific or detailed information concerning complaints or diagnosis be provided to faculty, staff, administrators, or even parents [family members], without the expressed written permission of the patient in each case. This position with respect to health records is supported by amendment to the Family Education Rights and Privacy Act of 1974.

   Certainly no person, group, agency, insurer, employer, or institution should be provided any medical information without the prior specific written consent of the patient. Given the possibility of unintended or accidental compromise of the confidentiality of information, health officers should carefully weigh the importance of including any specific information regarding the existence of AIDS, ARC, or a positive HIV antibody test in the medical record except in circumstances of medical necessity created by the evaluation of an illness. At minimum, the inclusion of any such information in the medical record should be discussed with the patient prior to its entry.

   Macomb employees must remember that all confidential medical information is protected by statutes and that any unauthorized disclosure of it may create legal liability. The duty of physicians and other health care providers to protect the confidentiality of information is superseded by the necessity to protect others only in very specific, threatening circumstances. The number of people in the College who are aware of the existence and/or identity of students or employees who have AIDS, ARC, or a positive HIV antibody test should be kept to an absolute minimum, both to protect the confidentiality and privacy of the infected persons and to avoid the generation of unnecessary fear and anxiety among other students and employees.

9. Macomb health policy should encourage regular medical follow-up for those who have AIDS, ARC, or a positive HIV antibody test. Special precautions to protect the health of immunologically compromised individuals should be considered during periods of prevalence of such contagious diseases as chicken pox and measles.

10. Those who are known to be immunologically compromised should be excused from Michigan Department of Public Health requirements for certain vaccinations, notably measles and rubella vaccines, as those vaccinations may lead to serious consequences in those with poorly functioning immune systems.

11. Macomb should adopt safety guidelines as proposed by the U.S. Public Health Service for the handling of blood and body fluids of persons with AIDS, ARC, or a positive HIV antibody test. The following articles in Morbidity and Mortality Weekly Reports provide detailed guidelines that should be generally followed:
    1. Centers for Disease Control: Acquired Immuno-deficiency Syndrome (AIDS): Precautions for Clinical and Laboratory Staffs. MMWR 1982; 31:577-580.

    2. Centers for Disease Control: Acquired Immuno-deficiency Syndrome (AIDS): Precautions for Health Care Workers and Allied Professionals. MMWR 1983; 32:450-452.

    3. Centers for Disease Control: Acquired Immuno-deficiency Syndrome (AIDS): MMWR 1985; 34:533-534.

12. Macomb Health Services should use disposable, one-user needles and other equipment whenever such equipment will puncture the skin or mucous membranes of patients. Health care officials should not rely on students or employees to identify themselves as having AIDS, ARC, or a positive HIV antibody test, since many infected persons are unaware of their status; safety precautions must be used in all cases. Extreme caution should be exercised particularly in disposing of needles.

13. Macomb should adopt safety guidelines for the handling of blood and body fluids of all students in other settings as well. Laboratories used in a teaching context, such as those required in biology courses, should be safe experiences. Given the fact that the existence and identity of those with AIDS, ARC, or a positive HIV antibody test may not be known, procedures for the decontamination of environmental surfaces and objects soiled by blood or body fluids should be adopted and implemented. Laboratory courses requiring exposure to blood, such as finger pricks for blood typing or examination, should use disposable equipment and no lancets or other bloodletting devices should be re-used or shared. No students should be required to obtain or process the blood of others. The U.S. Public Health Service guidelines noted above include information about disinfection of environmental surfaces; a simple method they recommend is the cleaning of contaminated surfaces with a household bleach freshly diluted 1:10 in water.

14. Macomb Health Services must strictly observe public health reporting requirements for AIDS. Patients who meet criteria for the revised surveillance definition of AIDS must be reported to the local public health authorities. The detailed surveillance definition is included in:

    Centers for Disease Control: Revision of Case Definition of AIDS for National Reporting -- United States: Morbidity and Mortality Weekly Reports 1985; 34:373-375.

III. Recommendations for Preventing TRansmission of HIV Infection in the College as a Work Place

The following recommendations are based upon those from the Centers for Disease Control entitled: "Recommendations for Preventing Transmission of Infection with Human T-Lymphotropic Virus Type III/Lymphadenopathy-Associated Virus in the Work Place." MMWR, 1985; 34:681-695, most notably that general employees, including personal service and food service staff need not be restricted from work if HIV infected unless they have evidence of other infection or illness for which any such worker should also be restricted. More detailed recommendations are made with regard to health care workers whose work involves contact with patient's blood or other bodily fluids, the consideration of which is incorporated in the guidelines below:

1. Mandatory screening as a condition for employment or continued employment is not warranted based upon available data.

2. A determination of whether, or under what conditions, an HIV infected Macomb employee should be permitted to remain employed in a capacity that involves contact with students or other College employees shall be made on a case-by-case basis. In making this determination the College shall seek the opinion of appropriate physicians and public health officers who will take into consideration: (1) the physical/mental condition of the College employee; (2) the expected type of interaction with others in the College setting; and (3) the impact on both the infected College employee and others in that setting. Their recommendations will be forwarded to the President. Macomb should attempt to assure that HIV infected College employees, whether able to continue their employment or not, are eligible to receive medical disability, retirement, other disability benefits, health insurance coverage and other benefits which such employees would be eligible for had they contracted any other contagious or infectious disease. Applicable rights to union representation shall not be impaired.

3. An Macomb employee shall be required to teach and provide other normal personal contact services in school to an HIV infected student and work with an HIV infected College employee unless a determination to the contrary has been made.

Approved by the Board of Trustees
Macomb Community College
November 17, 1987