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Registration Number: {{org_field_registration_no}}

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HIV Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} provides safe, person-centred, compassionate and non-discriminatory care and support to people who are living with HIV or who are affected by HIV. The policy supports staff to understand HIV, reduce stigma, protect confidentiality, apply Standard Infection Control Precautions correctly and meet their legal, regulatory and professional responsibilities within Care at Home services in Scotland.

This policy is aligned with the Health and Social Care Standards, the Care Inspectorate Quality Framework for Support Services, the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, the SSSC Codes of Practice 2024, the Equality Act 2010, data protection legislation and current Scottish infection prevention and control guidance.

This policy ensures that:

• People living with HIV receive equitable and compassionate care, free from stigma or discrimination.
• Staff understand the facts about HIV transmission, prevention, and treatment.
• Strict infection control and confidentiality protocols are in place.
• Staff receive appropriate induction, training, supervision and competency checks in HIV awareness, equality and non-discrimination, confidentiality, Standard Infection Control Precautions, sharps safety, COSHH, incident reporting and post-exposure action.
• Legal and ethical responsibilities regarding HIV care are upheld.

• People’s HIV status is never used as a reason to refuse, delay, reduce or alter care and support.
• Information about a person’s HIV status is only recorded or shared where it is lawful, necessary, proportionate and either consented to by the person or otherwise justified under safeguarding, public health or legal requirements.
• Any HIV-related need is included in the person’s personal plan only where it is relevant to their care and support, and the person has been involved in deciding what is recorded.

2. Scope

This policy applies to:

• All employees, including care workers, supervisors, and management, ensuring they follow correct procedures in supporting individuals with HIV.
• Agency and temporary staff, ensuring they adhere to the same professional and infection control standards.
• People receiving care, their families, and advocates, ensuring they are aware of their rights and confidentiality protections.
• External healthcare professionals and service providers working in partnership with {{org_field_name}}.

• Staff who provide personal care, medication support, meal support, domestic support, social support, community support or end-of-life support.
• Office-based staff who may handle confidential information, including care coordinators, administrators, quality assurance staff and managers.
• Volunteers, students and any other person acting on behalf of {{org_field_name}}.

This policy applies regardless of whether a person’s HIV status is known, suspected, disclosed or not disclosed. Staff must apply Standard Infection Control Precautions consistently with everyone receiving care and must not make assumptions about a person’s health, lifestyle, relationships, sexuality, gender identity, drug use, culture or personal circumstances.

3. Legal and Regulatory Framework

This policy is underpinned by the following legal, regulatory and professional requirements:

• Public Services Reform (Scotland) Act 2010 – establishes the Care Inspectorate’s role in registering, regulating, inspecting and supporting improvement in care services.
• Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 2011/210 – including requirements about welfare, fitness of providers, staffing, complaints, personal plans and records.
• Regulation 5: Personal Plans, SSI 2011/210 – requires a written personal plan to be prepared within 28 days of the person first receiving the service and reviewed at least once every six months. The Care Inspectorate’s adult personal planning guidance confirms that people and families cannot opt out of having a personal plan.
• Health and Social Care Standards: My support, my life – including dignity and respect, compassion, inclusion, responsive care and support, and wellbeing. These standards apply across health and social care services in Scotland.
• Care Inspectorate Quality Framework for Support Services (care at home, including supported living models of support) – used for self-evaluation, scrutiny and improvement support. The Care Inspectorate states that the framework supports services to evaluate their performance and is used by inspectors to provide independent assurance.
• SSSC Codes of Practice for Social Service Workers and Employers 2024 – sets the standards of practice and behaviour expected of social service workers and employers in Scotland.
• Equality Act 2010 – protects people from discrimination, harassment and victimisation. HIV is treated as a disability from the point of diagnosis, so discrimination because of HIV status is unlawful.
• Human Rights Act 1998 – including respect for private and family life, dignity, autonomy and non-discrimination.
• Data Protection Act 2018 and UK GDPR – HIV status is special category health information and must be processed lawfully, fairly, securely and only where necessary.
• Public Health etc. (Scotland) Act 2008 – provides the public health framework for communicable disease protection in Scotland.
• Health and Safety at Work etc. Act 1974 – requires safe systems of work for staff and others affected by work activities.
• Management of Health and Safety at Work Regulations 1999 – requires suitable and sufficient risk assessments.
• Control of Substances Hazardous to Health Regulations 2002 (COSHH) – applies to exposure to biological agents including blood and body fluids.
• Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) – applies where a work-related exposure, injury or dangerous occurrence meets reporting criteria.
• NHSScotland National Infection Prevention and Control Manual – current Scottish best-practice guidance for infection prevention and control across health and care settings.

4. Understanding HIV and Dispelling Myths

HIV, or Human Immunodeficiency Virus, is a long-term health condition that can be managed effectively with treatment. People living with HIV who are diagnosed and treated can live well and receive ordinary care and support without being treated differently. Undetectable = Untransmittable (U=U) means that a person living with HIV who is taking effective treatment and has an undetectable viral load cannot pass HIV on through sex. NHS Scotland information also confirms that someone with an undetectable HIV viral load cannot pass HIV on through sex.

HIV is not transmitted through:

• Casual contact (hugging, touching, sharing utensils).
• Air, water, or insect bites.
• Toilets, showers, or common household items.
• Providing personal care, washing, dressing, continence care, medication support, meal support, domestic support or social support, provided Standard Infection Control Precautions are followed.

HIV can only be transmitted through:

• Sexual contact where effective prevention is not in place. Effective HIV treatment resulting in an undetectable viral load prevents sexual transmission.
• Sharing needles or injecting equipment.
• During pregnancy, birth or breastfeeding/chestfeeding where effective treatment and specialist healthcare are not in place. With appropriate medical care, the risk can be greatly reduced.
• Blood-to-blood contact through open wounds.

Staff must not give clinical advice beyond their role. Where a person requests advice about HIV treatment, PrEP, PEP, pregnancy, breastfeeding/chestfeeding, sexual health or medication side effects, staff must support the person to contact their GP, HIV specialist clinic, sexual health service, pharmacist, community nurse or NHS 111, depending on urgency.

4.1 Stigma, Language and Respectful Practice

Staff must use respectful, factual and non-stigmatising language when discussing HIV. Staff must not use terms such as “clean”, “infected person”, “AIDS sufferer” or “risk lifestyle”. Staff should use person-first language, such as “person living with HIV” or “person affected by HIV”.

Staff must not ask intrusive questions about a person’s sexual history, relationships, drug use, diagnosis or treatment unless the information is directly relevant to the care and support being provided and the person has agreed to discuss it.

Any discriminatory, judgemental, mocking, avoidant or fear-based behaviour towards a person living with HIV will be addressed through supervision, training and, where appropriate, disciplinary procedures.

5. Confidentiality and Non-Discrimination

5.1 Protecting Personal Information

• HIV status is confidential special category health information. It must only be recorded, accessed or shared where this is lawful, necessary and proportionate for the delivery of safe care and support, and normally only with the person’s explicit consent.
• Staff must comply with GDPR and Data Protection Act 2018 to protect sensitive information.
• Staff must not disclose a person’s HIV status to family members, friends, advocates, other people receiving care, visitors, other staff or external professionals unless the person has consented or there is a clear legal, safeguarding or public health justification.
• HIV status must not be written in daily notes, handover records, rotas, staff messages or communication books unless there is a clear care-related reason. Where it is recorded, the wording must be factual, respectful and limited to what staff need to know to provide safe care and support.
• Where a person chooses not to disclose their HIV status, staff must continue to provide safe care using Standard Infection Control Precautions. Staff must not pressure any person to disclose their HIV status.
• Any breach of confidentiality relating to HIV status will be treated seriously and may be managed as misconduct, a data protection incident, a safeguarding concern or a reportable incident, depending on the circumstances.

5.2 Ensuring Equality and Non-Discrimination

• People living with HIV have the same rights as all other people receiving care.
• HIV status must not affect whether a person is accepted for a service, the level of care offered, the timing of visits, staff allocation, staff willingness to provide personal care, medication support, continence care, meal support, domestic support or community support.
• Refusing, delaying, restricting or providing a poorer standard of care because a person is living with HIV is unlawful, discriminatory and contrary to the SSSC Codes of Practice and the Health and Social Care Standards.
• Staff must challenge and report discriminatory behaviour in accordance with our Whistleblowing Policy.
• Care should be person-centred, promoting dignity and respect.

Where a person living with HIV also experiences discrimination linked to disability, race, sex, sexual orientation, gender reassignment, religion or belief, age, pregnancy or maternity, marriage or civil partnership, mental health, substance use, homelessness or poverty, staff must recognise the person’s individual circumstances and provide respectful, inclusive and trauma-informed support.

6. Infection Prevention and Control Measures

HIV transmission in Care at Home settings is extremely unlikely when Standard Infection Control Precautions are followed. Infection prevention and control must never be based on assumptions about who may or may not have HIV. Staff must apply Standard Infection Control Precautions consistently with every person, every time, whether infection is known or not known.

6.1 Standard Infection Control Precautions

Staff must follow the NHSScotland National Infection Prevention and Control Manual and the organisation’s Infection Prevention and Control Policy. This includes:

• carrying out a risk assessment before each care task;
• hand hygiene before and after care, after removing PPE, after contact with blood or body fluids, and after contact with the person’s environment;
• using appropriate PPE where there is a risk of contact with blood, body fluids, non-intact skin, mucous membranes, contaminated items or cleaning chemicals;
• using gloves only when indicated and changing gloves between tasks;
• using disposable aprons where clothing may become contaminated;
• using eye or face protection where splashing or spraying of blood or body fluids is anticipated;
• covering any cuts, abrasions or broken skin with a waterproof dressing before providing care;
• safely managing laundry, equipment, cleaning and waste in line with local procedures;
• disposing of sharps immediately at the point of use in an approved sharps container;
• never re-sheathing, bending or manually removing needles;
• reporting any unsafe practice, PPE shortage, sharps risk, spill or exposure incident immediately.

6.2 Blood and Body Fluid Spillages

Blood or body fluid spillages must be managed promptly, safely and discreetly in line with the organisation’s Infection Prevention and Control Policy, COSHH assessments and current NHSScotland infection prevention guidance.

Staff must:

• prevent access to the affected area until it is safe;
• wear appropriate PPE;
• use the correct cleaning and disinfectant product in line with the product instructions and COSHH assessment;
• dispose of contaminated waste safely;
• perform hand hygiene after removing PPE;
• record and report the incident where required;
• seek advice from a manager if the spillage cannot be managed safely.

6.3 Managing Occupational Exposure to Blood or Body Fluids

If a staff member has a needlestick injury, sharps injury, bite that breaks the skin, blood splash to the eyes, mouth or broken skin, or any other significant exposure to blood or body fluids, they must:

• encourage the wound to bleed gently, where appropriate;
• wash the affected skin with soap and running water;
• flush eyes or mouth with plenty of water if splashed;
• not suck the wound;
• cover the area with a waterproof dressing;
• stop the task safely and ensure the person receiving care remains safe;
• report the incident immediately to the Registered Manager or on-call manager;
• seek urgent medical advice from Occupational Health, Emergency Department, NHS 111 or the local agreed pathway, as post-exposure prophylaxis may be time-critical;
• complete an accident/incident report before the end of the shift, or as soon as practicable;
• follow RIDDOR, Care Inspectorate notification and organisational reporting procedures where the incident meets the relevant reporting threshold.

The manager must ensure the incident is reviewed, any immediate risks are addressed, relevant records are completed, confidentiality is maintained and learning is shared without identifying the person living with HIV unless disclosure is lawful and necessary.

6.4 Care Inspectorate Notifications

A person’s HIV status, diagnosis or disclosure is not in itself a Care Inspectorate notification. Confidentiality must be maintained.

The Registered Manager must consider whether a Care Inspectorate notification is required where there has been:

• an accident, incident or injury;
• an outbreak of infectious disease;
• a death of a person using the service;
• an allegation of abuse or protection concern;
• an allegation of misconduct by a provider or employee;
• any other event that meets the Care Inspectorate’s current notification guidance.

Notifications must be made in line with the organisation’s Statutory Notifications Policy and current Care Inspectorate guidance. The notification must include necessary factual information but must not disclose a person’s HIV status unless this is directly relevant, lawful and proportionate.

7. Supporting People Living with HIV

7.1 Providing Holistic Care

• Care and support must be based on the person’s assessed needs, wishes, choices, strengths, outcomes and what matters to them.
• Staff must support the person to maintain independence, dignity, relationships, routines, privacy, community involvement and ordinary daily life.
• Staff must encourage and support access to healthcare, including GP, HIV specialist services, sexual health services, community nursing, pharmacy, mental health support, counselling and peer support, where this is part of the person’s wishes or assessed needs.
• Staff must support medication routines only where this is included in the person’s personal plan and the organisation’s Medication Policy.
• Staff must be alert to changes in health, wellbeing, mood, nutrition, cognition, mobility, skin condition or medication tolerance and report these in line with the person’s personal plan and organisational procedure.
• Staff must recognise that people living with HIV may have experienced stigma, trauma, bereavement, isolation or discrimination and must provide sensitive, trauma-informed support.

7.2 Coordinating with Healthcare Providers

• The person’s personal plan must include HIV-related care and support needs only where these are relevant to the support being provided, the person has been involved in deciding what is recorded, and recording the information is lawful, necessary and proportionate.
• With the person’s consent, staff should work in partnership with relevant professionals, which may include the person’s GP, HIV specialist team, sexual health service, community nurse, pharmacist, mental health practitioner, social worker, advocacy service or other agreed professional.
• Communication with healthcare providers should be timely and coordinated, ensuring necessary adjustments to care, such as changes in medication, infection control measures, or nutritional support.
• Where necessary, referrals should be made to social workers, benefits advisors, or housing support teams to address wider social determinants affecting the individual’s well-being.
• Staff should be aware of emergency care protocols for individuals living with HIV, including understanding potential medication side effects and the importance of prompt medical attention when required.
• Staff must not contact HIV specialists, sexual health services, family members or other professionals about a person’s HIV status without the person’s consent unless there is a lawful safeguarding, public health or emergency reason to do so.

7.3 Encouraging Independence and Empowerment

• People living with HIV should be supported to maintain their independence and dignity, making their own choices about daily activities and lifestyle.
• Staff should provide education on HIV management, including information on treatment effectiveness, transmission prevention, and self-care strategies.
• Advocacy and empowerment programmes should be encouraged, helping individuals challenge stigma and discrimination through self-advocacy, peer networks, and community initiatives.
• Individuals should be encouraged to take an active role in their care planning, ensuring their needs, preferences, and goals are respected.
• Where appropriate, staff should help individuals access employment, education, or volunteering opportunities to support personal growth and social inclusion.

7.4 Personal Plans and Reviews

Where HIV-related support is relevant to the service being provided, the person’s personal plan must set out:

• what support the person wants and needs;
• what information the person agrees can be recorded;
• who may be involved in discussions about HIV-related care;
• how medication support will be provided, if applicable;
• any signs, symptoms or changes that staff should report;
• any agreed healthcare contacts;
• any confidentiality preferences;
• any equality, cultural, communication, trauma-informed or advocacy needs;
• what outcomes the person wants to achieve.

A personal plan must be prepared within 28 days of the person starting to receive the service and reviewed at least every six months, or sooner if the person’s needs, wishes, risks, outcomes or circumstances change. The person and, where appropriate, their representative or advocate must be fully involved in developing and reviewing the plan.

7.5 Medication Support

Some people living with HIV take antiretroviral therapy or other prescribed medicines. Staff must support medication only where this is part of the agreed service and recorded in the person’s personal plan and medication records.

Staff must:

• follow the organisation’s Medication Policy;
• support the person’s independence with medication wherever possible;
• maintain confidentiality when handling, prompting, assisting or recording medication;
• report missed doses, refusal, vomiting after medication, side effects or concerns in line with the Medication Policy and the person’s plan;
• seek advice from the appropriate healthcare professional if there are concerns about medication, interactions, side effects or adherence;
• never give advice to stop, start or change HIV medication.

8. Staff Training and Awareness

All staff must receive induction and refresher training appropriate to their role. This must include:

• HIV awareness, including current facts about transmission, treatment and U=U;
• equality, diversity, inclusion and anti-discriminatory practice;
• confidentiality, data protection and lawful information sharing;
• Health and Social Care Standards;
• SSSC Codes of Practice 2024;
• Standard Infection Control Precautions;
• hand hygiene and PPE;
• sharps safety and blood/body fluid exposure action;
• COSHH and safe handling of cleaning products and contaminated waste;
• accident, incident, RIDDOR and Care Inspectorate notification procedures;
• medication support, where this forms part of the worker’s role;
• person-centred and trauma-informed care;
• adult support and protection and whistleblowing.

Managers must ensure that staff understand this policy and can apply it in practice. Competency must be checked through supervision, spot checks, observations, audits, team meetings, reflective discussion and review of incidents or near misses.

8.1 Staff Concerns, Refusal or Stigma

Staff must not refuse to support a person because the person is living with HIV or because the staff member believes the person may be living with HIV.

Where a staff member feels anxious or unsure, they must speak to their line manager immediately. The manager must provide factual guidance, supervision and training. Anxiety or lack of knowledge must not result in delayed, reduced or discriminatory care.

Any refusal to provide care, breach of confidentiality, discriminatory comment, avoidant practice or stigmatising behaviour may be managed under the organisation’s disciplinary procedure and may be considered in relation to the worker’s fitness to practise.

9. Monitoring, Evaluation, and Continuous Improvement

To ensure ongoing compliance and improvement, {{org_field_name}} will:

• audit confidentiality and information-sharing practice;
• audit infection prevention and control practice, including hand hygiene, PPE use, sharps safety, waste management and incident response;
• review accident, incident, exposure and near-miss records for patterns and learning;
• review whether Care Inspectorate notifications have been made where required;
• check that personal plans are person-centred, current, reviewed at least six-monthly and contain only necessary HIV-related information;
• review staff training, supervision and competency records;
• seek feedback from people receiving care, where appropriate, about whether they feel respected, included, safe and free from stigma;
• use complaints, concerns, compliments, audits, supervision and inspection findings to improve practice;
• update this policy when legislation, Care Inspectorate guidance, SSSC guidance, NHSScotland infection prevention guidance or recognised HIV guidance changes.

10. Related Policies

This policy should be read alongside:

• Infection Prevention and Control Policy
• Confidentiality and Data Protection Policy
• Equality, Diversity and Inclusion Policy
• Adult Support and Protection Policy
• Medication Policy
• Accident and Incident Reporting Policy
• Statutory Notifications Policy
• COSHH Policy
• Health and Safety Policy
• Waste Management Policy
• Staff Training and Supervision Policy
• Whistleblowing Policy
• Complaints Policy
• Personal Planning / Care Planning Policy
• Records Management Policy
• PPE Policy, where separate

11. Practice Checklist for Staff

Staff must:

• treat every person with dignity, compassion and respect;
• apply Standard Infection Control Precautions with every person, every time;
• protect confidentiality and never disclose HIV status without lawful reason;
• avoid assumptions about HIV, sexuality, relationships, gender identity, drug use or lifestyle;
• support the person’s choices, independence and personal outcomes;
• follow the personal plan and report any changes in need, risk or wellbeing;
• follow medication procedures where medication support is provided;
• report blood or body fluid exposure immediately;
• complete required records accurately, respectfully and promptly;
• challenge and report discrimination, unsafe practice or confidentiality breaches.

12. Policy Review

This policy will be reviewed at least annually, or sooner where there are changes to legislation, Care Inspectorate guidance, SSSC guidance, NHSScotland infection prevention and control guidance, recognised HIV guidance, organisational procedures, inspection findings, incidents, complaints or learning from practice. Any changes will be communicated to staff and, where relevant, to people receiving care and their representatives.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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