Managing occupational exposures to human immunodeficiency virus type 1 (HIV-1) in the healthcare workplace remains both controversial and complex. Healthcare workers' perceptions of risk for occupational transmission of HIV-1, their knowledge of risk-reduction strategies, and their perceptions about appropriate postexposure management are all derived from an intricate interplay of scientific, political, social, and emotional sources. Following an occupational exposure to blood or blood-containing body fluids, a healthcare worker's immediate emotional response may be extreme gut-wrenching anxiety, with perceptions often biased by ignorance, uncertainty, and fear. The healthcare worker's postinjury emotional and psychological stress can be extraordinary; postinjury therapy, of necessity, must integrate medical, physical, psychological, and psychosocial aspects of care. Clinical decisions regarding HIV-1 injury management, therefore, are based not only on available scientific and medical information but also on measured actions designed to manage and presumably to diminish the profound anxiety almost invariably associated with an occupational exposure to HIV-1. In stark contrast to this common and extreme emotional reaction, the likelihood of disease transmission from such occupational exposures is relatively small.
In this article, we will discuss a series of questions and issues typically encountered when a healthcare worker sustains an occupational exposure to HIV-1.