As of December 2003 the CDC was aware of only fifty-seven documented cases of health-care workers other than surgeons in the United States who had become infected with HIV as a result of occupational exposures. The breakdown of those who were infected was as follows: nurses (twenty-four), clinical laboratory workers (sixteen), nonsurgical physicians (six), nonclinical laboratory technicians (three), housekeeper/maintenance workers (two), surgical technicians (two), embalmer/morgue technician (one), health aide/attendant (one), respiratory therapist (one), and dialysis technician (one).

The CDC was also aware of 139 cases of HIV infection or AIDS possibly linked to occupational exposure among health-care workers as of December 2003. These workers have not reported other risk factors for HIV infection. They had reported a history of occupational exposure to blood, body fluids, or HIV-infected laboratory material but had not documented infection after a specific exposure.

The known and possible cases of occupational acquisition of HIV undoubtedly represent an underestimate. There are likely unknown numbers of people who acquired their infection through occupational exposures, although, even in 2007, this is purely conjecture.

According to the National Institute for Occupational Safety and Health (2007), since June 2002 twenty-one states have enacted needle-safety legislation to safeguard health-care workers from bloodborne pathogen (agents that cause disease) exposures. State laws aim to strengthen and supplement the federal standards mandated by the Occupational Safety and Health Administration. Many of the state laws require the creation of a written exposure plan that is periodically reviewed and updated; protocols for safety device identification and selection; logs to document and report injuries with sharp instruments; and strict requirements and training for workers on how to use safety devices.

In ''Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis'' (Mortality and Morbidity Weekly Report, vol. 50, RR11, June 29, 2001), the U.S. Public Health Service updated the guidelines for treatment to prevent health-care workers with occupational exposure to HIV from becoming infected with the virus. Known as postexposure prophylaxis (PEP), the recommendation was that affected workers be given a four-week regimen of two antiretroviral drugs such as ZDV and lamivudine, with the addition of a third drug for HIV exposures that pose an increased risk of transmission. Another update was issued by Panlilio et al. in September 2005 because since publication of the 2001 update, the U.S. Food and Drug Administration (FDA) had approved new antiretroviral agents, and additional information had become available about the use and safety of PEP. Even though the best strategy to protect health-care workers is to avoid exposure to HIV and other bloodborne pathogens, PEP has, as of 2007, proven generally effective in preventing HIV infection in workers who have been exposed.

Health-care officials are not the only ones worried about HIV transmission in the health-care setting. Patients also fear that infected health-care workers could transmit the virus to them. In ''HIV Transmission from Health Care Worker to Patient: What Is the Risk?'' (Annals of Internal Medicine, vol. 116, 1992), Mary E. Chamberland and David M. Bell develop a model of the risk of HIV transmission to patients and estimate that the risk of a patient becoming infected by an HIV-positive surgeon during a single operation is anywhere from 1 out of 42,000 to 1 out of 420,000. This risk is considerably less than the risks associated with many other medical procedures.

In ''HIV and Its Transmission'' (July 1999), the CDC notes that of more than 22,000 patients of 63 HIV-infected health-care workers, no documented evidence has been found that links HIV infection to medical or dental care, except for the five patients of a Florida dentist in 1990. Medical researchers have tried without success to determine how the dentist infected his patients and whether the exposure was accidental or deliberate. One theory is that he did not properly sterilize his dental tools; another is that he accidentally cut his finger or jabbed himself with a hypodermic needle, did not notice it, and bled into the patients' mouths. Before his death in 1990, the dentist denied intentionally exposing his patients.

In 1990 Rudolph Almarez, a Baltimore breast surgeon who performed operations on as many as two thousand patients, died from AIDS. The nature of his death stirred up such concern that shortly after he died a Baltimore law firm solicited clients to seek legal advice, whether they were infected or not. The law firm told clients that they might be reimbursed for the emotional distress they now suffered if they sued the hospital where Almarez had practiced. Two separate legal complaints--Rossi v. Almarez (Baltimore City Cir. Ct. No. 90344028 CL1-23396, May 23, 1991) and Faya v. Almarez, Baltimore City Cir. Ct. No. 90345011 CL12345g, May 23, 1991)--based on the fear of HIV exposure were dismissed by a Baltimore judge. The judge further stated that there were no allegations that Almarez had not followed recommended safety procedures or that any accident had taken place during surgery. None of the patients alleged infection from Almarez. A later study failed to find any HIV-positive patients among those Almarez had treated.

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