By the end of May 2002, the Supreme Court of the United States will probably decide whether it wants to hear the case of dental hygienist Spencer Waddell, fired from his job when his employer learned he was HIV-positive.

The Court should do so because of the case's broad implications for medical practice and because Mr. Waddell's firing pits uneducated fear against solid scientific evidence collected over nearly two decades. That evidence? That there is no real risk of a healthcare worker transmitting HIV to a patient.

The facts of the Waddell case are simple. Mr. Waddell worked as a skilled dental hygienist at the Valley Forge Dental Clinic in Atlanta from about January 1996 until September 1997, when the clinic learned that he is HIV-positive. The clinic's initial response was to offer him a receptionist job at roughly half his original pay, which Mr. Waddell refused to accept. The clinic thereupon fired him.

Notwithstanding the unanimous conclusion of nationally renowned medical experts that Mr. Waddell's patients were completely safe--and the similar opinions voiced by the American Dental Association and nine other public health organizations in this case--the district court applied its own subjective views and decided against Mr. Waddell.

Had the court given due weight to results of objective medical studies, it could have appreciated that emotional reactions to perceived risks are harmful, not helpful, to public health. Removing any skilled healthcare professional with unquestioned qualifications on the basis of imaginary risks reduces both levels of care and overall levels of safety. This becomes clear when one considers the broad detrimental consequences of allowing the exclusion from employment of HIV-positive people, notwithstanding the fact that they pose no risk.

First of all, the district court's decision signals contempt for many years of arduous studies that have provided a solid rationale for the effective infection-control policies now in place. At the same time, the decision condones reliance on lingering public fears that thrive on ignorance of the evidence. The result is a tragically misguided victimization of HIV-positive professionals, and a false sense of security among everyone else in the workplace.

Moreover, if the discovery of an employee's HIV-positive status can result in the loss of a professional livelihood, the result is a strong incentive to avoid knowing, or disclosing, that one is HIV-positive. This poses an additional danger to society, because ignorance or secrecy continues into social and personal lives that include sexual relations, through which HIV is indeed transmissible.

Careful assessment of the risk of HIV transmission is nearly as old as the epidemic itself. The emergence of AIDS, and the 1984 recognition of HIV as its causative agent, almost immediately raised concerns about the possibility that transmission may occur not only from HIV-infected patients to healthcare personnel but also from HIV-infected healthcare workers to patients.

Public health agencies and academic authorities have thoroughly examined the risk of HIV transmission in the healthcare setting through painstaking studiesÑstudies that have resulted, over time, in a great deal of information on varying degrees of risk of transmission under various circumstances. Federal health officials issued recommendations built on the cornerstone of the strict application in all healthcare settings of "universal infection control" measures. These involve the use of protective gloves and clothing as well as specific procedures that virtually eliminate risk, regardless of either the doctor's or the patient's HIV status. These procedures are highly effective in preventing the transmission of not only HIV but also other blood-borne infectious agents.

For example, to determine convincingly whether HIV-infected healthcare workers pose a risk to their patients, the Centers for Disease Control and Prevention evaluated more than 22,000 HIV negative patients who received medical care from more than 50 HIV-infected healthcare providers. Not a single case of HIV transmission was detected. In fact, 20 years after the start of the HIV epidemic, and after some 1.5 million HIV infections in this country alone, only two healthcare workersÑone in the United States and one in FranceÑcould be linked to patient infection. Given this evidence and the noninvasive nature of dental hygiene work, the risk posed to patients by dental hygienists is infinitesimally small, for practical purposes actually zero. There is, therefore, simply no medical, scientific, or ethical justification to exclude a skilled HIV-positive dental hygienist from patient care.

If the high court listens to the scientists and public health experts, Spencer Waddell may finally get back the career options he lost overnight when fear prevailed over fact. And healthcare workers will be encouraged to be honest regarding their HIV status. And everyone will use appropriate precautionary measures because of the recognition that some healthcare workers, although not dangerous to their patients, may indeed be HIV-positive.

After this article was written, on May 28, 2002, the U.S. Supreme Court issued an order denying our petition for certiorari, meaning that they will not review the case.

Dr. Mathilde Krim is Founding Chairman and Chairman of the Board amfAR (the American Foundation for AIDS Research).