ethical dilemna

I'd be interested to see what the responses to this one are...legally speaking, I'd assume you'd be bound by HIPPA, but it is against the law to not report HIV status to sexual partners. On the other hand, it could be considered a kind of abuse to be not disclosing, which we're obligated to report. It's a conundrum.

I know that at an area high school out here they are offering testing to all students, but won't say what prompted it. It made national headlines. The assumption is that someone who is HIV positive has been sleeping around and not disclosing, but we have no way to know what the actual story is. I do know that all cases of HIV are reported to the health dept when the patient tests positive.

You'd probably have to call the BON of your state for information regarding the legal issues.

This one's a toughy. The manner in the school nurse learning of this risky behavior would play a large role. And medical confidentiality cartainly comes into play. But there is a caveat there in that if the person is a danger to self or others, it must be reported -this is clearly a case where he is a danger to others. Another aspect though, is that there have been successful prosecutions of people that had unprotected sex knowing that they were HIV+ that did not inform their partners. Assuming that the student came in to confide in me about this type of behavior, i would counsel him in the gravity of this behavior and inform him that his partners must be informed. I would also let him know that this is the type of behavior that i may not be able to keep confidential.

Don't know about other states, but legal issues always trump HIPAA. In this case, having unprotected sex is considered 'assault with a deadly weapon' - it is a felony. This has already been established by case law.

The school nurse has an obligation to report illegal/life-threatening activity. This is in the same category as turning in a drug pusher or a 'child' who confided in her that he is planning to shoot his teacher.

this relates to a physician who found himself in this kind of situation:

my hospital's legal counsel informed me that i wasn't under any legal obligation to inform someone at risk, though i was required to report hiv patients and known partners to the health department. on the other hand, according to the american medical assn.'s code of ethics, "if a physician knows that a seropositive individual is endangering a third party, the physician should, within the constraints of the law (1) attempt to persuade the infected patient to cease endangering the third party; (2) if persuasion fails, notify authorities; and (3) if the authorities take no action, notify the endangered third party."

http://www.aegis.com/news/lt/2008/lt080502.html

obviously, this is from the ama, not anything legally binding.

i still say that the final opinion on disclosure or not should rest on information from bon and possibly health dept, but thought that this might help.