Protocol for HIV partner notification

[NurseLoveJoy88]

At work a very interesting discussion came up. There are two patients at our facility who are homosexuals and have become partners. One of the patients is HIV +. They do engage in sexual activity. My question is : What role do health care providers play in this ? My original thought was there will be NO notification to the unaffected partner due to HIPAA. At the same time if the partner do infect someone, that person should be made aware but the identity of the partner that passes it remains unknown. The only thing we can do I suppose if encourage safe sex to both partners, and anyone else gay or straight.

Thoughts ??

[Jolie, BSN]

Regarding testing - you might check the fine print of your hospital's admission papers - where I was doing clinicals patients give consent to testing whether or not they know it. It's in the "fine print."

The OP doesn't state whether this is a hospital or office setting.

You are correct that patients sign a general consent on hospital admission, but in practice, they are able to refuse specific tests/treatments that they don't want.

I googled "HIV testing without consent" and found this very interesting article. It is specific to IL. I don't know if other states have similar laws, but I find this disconcerting, and a reason to choose one's physician very wisely. Most would not abuse this law, but I think we all have worked with physicians who might test a patient against his/her wishes just because s/he can.

http://biotech.law.lsu.edu/cases/privacy/sierakowski_v_ryan_brief.htm

HIV Testing without the Patient's Consent - Sierakowski v. Ryan, 223 F.3d 440 (7th Cir. 2000)

This is an interesting HIV testing case. Plaintiff suffers from a seizure disorder and must take a medication that can damage the liver. His physician tests him for liver function abnormalities every 3 months as part of this care. At one point plaintiff required hospitalization and as part of this workup he was asked to give permission for HIV testing. He refused, but was tested anyway pursuant to the Illinois AIDS Confidentiality Act. This act provides that: "[n]o person may order an HIV test without first receiving the written informed consent of the subject of the test or the subject's legally authorized representative." However, the act contains exceptions, including section 8, which providers:

"Notwithstanding the provisions of Sections 4 and 5 of this Act, written informed consent, information and counseling are not required for the performance of an HIV test . . . (b) when in the judgment of the physician, such testing is medically indicated to provide appropriate diagnosis and treatment to the subject of the test, provided that the subject of the test has otherwise provided his or her consent to such physician for medical treatment. 410 ILCS 305/8."

What a can of worms!

[GreyGull]

The hospital protocols will be based on the State regulations.

examples

California

http://www.cdph.ca.gov/programs/aids/Documents/RPT2010_01HIVAIDSLaws2009.pdf

NY

http://www.health.state.ny.us/diseases/aids/regulations/

Washington

http://www.kingcounty.gov/healthservices/health/communicable/hiv/epi/legal.aspx

Interesting discussion

http://depts.washington.edu/hivaids/prevent/case5/discussion.html

Florida

http://www.doh.state.fl.us/disease_ctrl/aids/legal/Partnot.html

Federal facilities such as VA medical centers and clinics may have a different protocol than the state.

[SweettartRN]

I think you can actually be in trouble with the law if you have sex with someone and not tell them you are HIV positive. I don't think it would be out of the question to mention that to your HIV + patient, it might encourage them to be upfront about the whole thing.

You are absolutely right.

We had a man here in Michigan charged with murder for sleeping with 8 women and not disclosing his HIV positive status when he was released from prison.

Needless to say, he's back where he started from.

[SeeTheMoon]

Not sure if this is just a GA thing, but I think we have laws where if an HIV pos individual (who is aware that they have the disease) exposes someone (through intercourse, needles, etc) w/ out disclosing their condition, it can be a felony.

[Jenni811, RN]

It would be a HIPAA violation. It's so hard to sit back and see things like this knowing you should say something. All you can do is encourage safe sex practices. Encourage the risks of not practicing safe sex. If the unaffected HIV person agrees or chooses not to use safe sex, then that is his own choice. By you telling him, he was well informed of the risk.

Are you sure he doesn't already know?? Maybe his partner told him and they are practicing safe sex. I hope so anyway!!

but i agree, it's so hard to sit back and watch it happen knowing fully what the dangers are. My rule of thumb with HIPAA: If you question it, just don't do it.