Submission Into Draft 1 Of Certificate III In Individual Support, Certificate IV In Ageing Support, And Certificate IV In Disability Support.pdf

Positive Life NSW notes that there are no core or elective units that relate to HIV, blood
borne viruses (BBVs), or sexually transmissible infections (STIs), nor are there any units
relating to universal infection control. “HLTINF001: Comply with infection prevention and
control policies and procedures” is a unit of competency in the Individual Support Certificate,
but not the Ageing Support Certificate. This seems like an oversight. Certificate IV in Ageing
Support needs to address HIV, BBVs, and STIs in both a clinical and person-centred
capacity, whether by including the content in “CHCCCS001 Address the needs of people
with chronic disease” unit (not ideal) or creating a discrete elective unit for this purpose to be
included in the Ageing Support Certificate. Namely, the unit should include knowledge on the
clinical management and treatment of HIV, BBVs, and associated chronic health conditions;
the transmission risk of HIV and other BBVs in care settings, including an understanding of
Treatment as Prevention (TasP) and Undetectable Viral Loads (UVLs); and universal
infection control, prevention procedures, and management.

Regarding the unit entitled “CHCINM001: Meet statutory and organisation information
requirements”, which does not have a draft for consultation published online thus far, we
recommend that HIV privacy and confidentiality legislative and clinical policy requirements
are included in the unit.

Regarding the unit entitled “HLTHPS007: Administer and monitor medications”, which does
not have a draft for consultation published online thus far, we recommend that the dangers of
polypharmacy, non-adherence to HIV and other medications, electronic prescribing, misuse
of prescribed and non-prescribed medications (including illicit drugs) and their relationship to
hospital admissions, disability, and premature death be addressed within the competencies
of the unit.

CHCAGE009: Provide services for older people:
The “Knowledge evidence” portion of the draft unit covers: “Legal and ethical considerations
and organisational policies and procedures for working with older people, including: duty of
care; dignity of risk; human rights; privacy, confidentiality and disclosure; work health and
safety.” We suggest that a specific addition of privacy and confidentiality around a person’s
HIV or BBV status must be covered in this unit. This is particularly the case considering the
section addressing families and carers, where a person living with HIV’s family and/or carer
may not know about their HIV status, thus confidentiality must be maintained at all times,
even when a personal care worker may otherwise assume that there is no risk of breach of
confidentiality.

A further area of knowledge evidence should involve the transition of people in residential
aged care facilities to and from acute care facilities and/or palliative care, ensuring continuity
of care, privacy and confidentiality, and appropriate shared care arrangements are
maintained.

CHCAGE010: Implement interventions with older people to reduce risk:
The “Knowledge evidence” portion of the draft unit states that: “Workers must be able to
consider all older people, inclusive of all backgrounds and life experience, while
acknowledging and working towards equitable outcomes for those older people more
disadvantaged by intersecting and oppressive circumstances.” The list of major risk areas for
older people notably excludes stigma and discrimination experienced by people who are
ageing, of which these experiences compound depending on intersecting disadvantages held
by ageing people. For instance, the provision of non-discriminatory aged care to people living
with HIV (PLHIV) will challenge aged care services who employ staff who may have deeply
held fears and prejudices about homosexuality, illicit drug use, sex work, gender dysphoria,
and HIV. Despite the efficacy of modern HIV treatment to control HIV infection and prevent
transmission, HIV remains a highly stigmatised disease requiring lifetime specialist treatment
and monitoring. When addressing stigma and discrimination, it is also imperative that its
impacts on physical and emotional health are considered, particularly for those most
vulnerable such as PLHIV, people who identify as LGBTQIA+, people who inject drugs, etc.

CHCDIV003: Manage and promote diversity:
Through a community consultation conducted in 2019 by Positive Life NSW about
experiences of aged care services, which was undertaken by over 400 people living with HIV
(PLHIV) survey respondents, we received a significant number of complaints from ageing
PLHIV about personal care workers (PCWs) being poorly trained, rude, unhelpful, having
poor communication skills, and in some cases, patronising and disrespectful. We have
received reports of discriminatory behaviour by PCWs who have no or limited knowledge of
HIV. Some feared they would contract this blood-borne virus (BBV). There were also
examples reported of discrimination by PCWs who were homophobic. Acts of discrimination
ranged from being ignored, shamed, and silenced, to outright refusals to provide service and
receiving payment for services not rendered. Abuse and neglect primarily resulted from
ignorance and fear on the part of PCWs about HIV, HIV treatment, and the negligible risk of
transmission to staff.