Confidentiality & HIV/AIDS

1. Confidentiality& HIV/AIDS Allyson Schumacher

2. What is Patient-provider confidentiality? • All information discussed between patient and provider must remain confidential, or private • Confidentiality is an ethical practice that provides the patient a safe place to talk • This includes personal stories shared, and all health data collected (Hodgson, Mendenhall, & Lamson, 2013) • Principalism: The provider follows many ethical principles when keeping patient information confidential, such as respect for persons, fidelity, and justice

3. Why is confidentiality important? • Confidentiality is vital in order to maintain trust • Confidentiality is critical for therapeutic care • The provider must respect confidentiality in order to maintain a perception of alliance with the patient (Duncan, Hall, & Knowles, 2015)

4. When can patient-provider confidentiality be breached? • When the patient gives permission to share his/her information • When consulting with colleagues in a professional manner • When there is legal obligation to do so • When there is immediate risk of harm to an identifiable person (Duncan et al., 2015)

5. Where’s the Dilemma? • Sounds straight forward right? • There are some situations that bring forward gray areas which have been heavily discussed • Most of the confusion lies in the “risk of harm” area • It is at the providers discretion to decide what degree of “at risk” needs to be reported (Burke, 2014)

6. the gray area • For example: Adolescent patient drinking and driving • Another example: Patient cutting her wrists (Duncan et al., 2015) • The main topic: Patients with HIV/AIDS • Partner notification- partner is “at risk” for infection and further spread of the virus • Parental notification for minors- minor is “at risk” to deviate from follow up care and the emotional responsibilities that come with the diagnosis

7. Patients with HIV/Aids • Do patients have the right to decide not to disclose their diagnosis of HIV with sexual partners and others of potential exposure? • What about parents of minors? Do they have the right to know of their child's HIV status? • Is it unethical for the provider to share a patients HIV status with someone else, despite the patients wishes?

8. An example • A female patient who is HIV positive gets pregnant. After birth the infant is given IV AZT to prevent infection due to exposure. The father of the child is present, but is unaware that the mother is HIV positive. He questions the medications being given to his child (Burke, 2014). • Does he have a right to know due to his likely exposure? • What about a right to know about his child's exposure? • What about the mothers right to confidentiality?

9. On one hand: fidelity and justice for the patient with HIV • The patient should be able to have confidentiality from their health care provider (Hodgsonet al., 2013) • The HIV infected patient has the right to privacy and to decide whether or not to disclose this information (Burke, 2014) • Patients may want to withhold information to avoid stigmatism and false beliefs about the condition (Nie, Walker, Qiao, Li, & Tucker, 2015) • Minors may not want to inform unsupportive parents (Duncan et al., 2015) • From a provider standpoint, confidentiality will promote more people to get tested without the fear of release of information by the provider, and therefore be educated and able to prevent spread of disease (Burke, 2014)

10. On the other hand: communitarian ethics • HIV is an infection that can cause serious health issues and therefore transmission needs to be monitored (Burke, 2014) • It is a public health concerns for a HIV infected patient to be transmitting the virus to others, especially without partners knowledge of the risks (Njozing, Edin, San Sebastian, & Hurtig, 2011) • Early treatment for HIV infection with antiretroviral medication can greatly improve complications of the infection, but without knowledge of exposure, treatment cannot be given (Njozing et al., 2011) • A sexual partner has the right to know if he/she is going to be exposed to a potentially life changing infection (Burke, 2014) • A parent has the right to know if their child is HIV infected in order to make sure good treatment is being maintained

11. Partner/parental notification • There are no federal laws regarding the process of HIV testing, or the balance of confidentiality and notification. • There are laws in place in each individual state that either mandates a provider to disclose this information to those at risk of exposure, or does not mandate notification • There are also state laws regarding if a minor can consent for HIV testing and treatment, and if parental notification is required for minors (State HIV Laws HIV-Specific Criminal Laws, State Guidelines for Health Care Workers with HIV, Youth Access to STI and HIV Testing and Treatment, HIV Testing, n.d.)

12. Laws In Georgia • Care providers are required to ensure notification of spouse, sexual partner, and child of the patient of possible exposure to HIV • Georgia law does not allow minors to consent for HIV testing and/or treatment • Provider may inform the parent of a minor about their HIV status without consent of that minor (State HIV Laws HIV-Specific Criminal Laws, State Guidelines for Health Care Workers with HIV, Youth Access to STI and HIV Testing and Treatment, HIV Testing, n.d.)

13. surrounding states • Is partner notification required in other states? • Florida: No • Alabama: Yes • Tennessee: No • South Carolina: Yes • Is parental notification required for minors? • Florida: No • Alabama: Yes • Tennessee: No • South Carolina: No • Currently, 31 states allow minors to consent for HIV testing and treatment without parental notification (State HIV Laws HIV-Specific Criminal Laws, State Guidelines for Health Care Workers with HIV, Youth Access to STI and HIV Testing and Treatment, HIV Testing, n.d.)

14. My Conclusion: Education is key • There is a fine balance between patient confidentiality and a responsibility to warn of spread of disease • In all cases, education is the most important factor. • Educate the patient regarding the spread of the virus, and protection to be used • Also inform the patient on the importance of early treatment, and how this can change the overall effects of the infection. And how this may correlate to others the patient may have exposed to the infection • Education about the infection may lead individuals to disclosing their HIV status to any sexual partners, and therefore take the responsibility of the provider out of the situation all together

15. resources Burke, J. (2014). Discretion to Warn: Balancing Privacy Rights with the Need to Warn Unaware Partners of Likely HIV/AIDS Exposure. Boston College Journal Of Law & Social Justice, 34(3), 89-116. Duncan, R. E., Hall, A. C., & Knowles, A. (2015). Ethical Dilemmas of Confidentiality With Adolescent Clients: Case Studies From Psychologists. Ethics & Behavior, 25(3), 197-221. Hodgson, J., Mendenhall, T., & Lamson, A. (2013). Patient and Provider Relationships: Consent, Confidentiality, and Managing Mistakes in Integrated Primary Care Settings. Families, Systems & Health: The Journal Of Collaborative Family Healthcare, 31(1), 28-40. Nie, J., Walker, S. T., Qiao, S., Li, X., & Tucker, J. D. (2015). Truth-telling to the patient, family, and the sexual partner: a rights approach to the role of healthcare providers in adult HIV disclosure in China. AIDS Care, 2783-89. doi:10.1080/09540121.2015.1071772 Njozing, B. N., Edin, K. E., San Sebastián, M., & Hurtig, A. (2011). "If the patients decide not to tell what can we do?"- TB/HIV counsellors' dilemma on partner notification for HIV. BMC International Health & Human Rights, 11(1), 6-16. doi:10.1186/1472-698X-11-6 State HIV Laws HIV-Specific Criminal Laws, State Guidelines for Health Care Workers with HIV, Youth Access to STI and HIV Testing and Treatment, HIV Testing. (n.d.). Retrieved from https://www.hivlawandpolicy.org/ state-hiv-laws