Question about HIV patient

[SNLou84]

Hi everyone. So I am a nursing student taking patient education and we were given the following scenario - Basically there is an 18 year old male who has HIV, he admits to the nurse that he is intimate with his girlfriend but that she does not know he has HIV. He states that she would leave him if he told her. I have heard many news stories about people being arrested for not disclosing their HIV status. I put this as my response - that I would educate him about the risks and the risk he is putting his partner in. I would also talk to someone who is above me who also knows the patients situation and find out if the police should be involved. Before I put my response, I even looked online and found many different cases in which this occurred in the newspaper. The only thing I am unsure about is if this would be violating HIPPA to involve the police. Yet, if the police weren't involved, and he continued to have sex with more and more people, wouldn't he be spreading HIV and putting more and more people at risk? That to me seems completely immoral. But my instructor said going to the police would make for an awkward situation, so then I started feeling like my response was not correct. Any insight would be greatly appreciated! Thanks!

[heron, ASN, RN]

so, if we know that someone is HIV positive, we can not be charged with aiding and abetting murder if we dont tell their unsuspecting partner?

No ... but you will, as Mexarican pointed out, both lose your license and get sued if you disclose. I don't know if there are criminal penalties attached as well, if so there could be fines, jail time or both.

OP, please, please, please don't take it upon yourself to disclose this. I understand your concern for the gf, but she's not your patient and you can no more rescue her from hiv than you can from hep B, syphilis or gonorrhea when she has made a choice to have unprotected sex.

I share your dismay at the thought of the pt keeping his status secret from her. Having cared for a beautiful lady who died of AIDS after her husband and his family hid his disease from her (and he knew when they got married, and he had 2 children with her anyhow! The lady received antiretroviral therapy during her pregnancies and both children are hiv negative), I know exactly how you feel and have the same contempt for his behavior.

The only thing I can suggest might be a psych or social work consult to help him work through his fears. You might ask him why he doesn't think she'll find out anyhow when she sero-converts ... and she probably already has if they are sexually active together with no protection.

I heartily disagree with "HIPPA be damned" ... medical confidentiality has got to be like the seal of the confessional. It's hard enough to get the truth out of our patients as it is, sometimes ... if they think we're going to put their business in the street, they'll never tell us anything! Not to mention the damage that can be done to the patient.

If your state is one that has criminal penalties for intentionally exposing a sex partner, you might want to mention that to him as well ... and let him know that being sick in prison is no day at the beach!

Over time, there may be a need for legislation that mandates this kind of disclosure the way psychiatrists are required to notify a patient's family/aquaintances of the possibility of violence or threats against them. Until then, refer it to medical ethics, risk management and your manager ... and don't talk out of school!

[elkpark]

As Mexarican points out, it is NOT the place of any individual healthcare provider to divulge protected information about anyone to members of the public, even if they are at risk of something awful. You report "reportable diseases" to your public health department, and it is the responsibility of the public health department personnel to take any further action, in accordance with state and Federal law.

In regard to the original question, about client education, if it's a new diagnosis, I would also educate the client about the whole "reportable disease" issue and that his test results will be reported to the health department and he may be hearing from them.

[dudette10, MSN, RN]

If your state is one that has criminal penalties for intentionally exposing a sex partner, you might want to mention that to him as well ... and let him know that being sick in prison is no day at the beach!

I like this part, and it seems to fall into the "teaching" portion of our duties. If the person who knows about their own positive HIV status is not divulging to potential partners for his/her own benefit, this might bring the pt pause to reconsider continued silence.

[Mexarican]

so, if we know that someone is HIV positive, we can not be charged with aiding and abetting murder if we dont tell their unsuspecting partner?

Yes, that's correct...as healthcare workers we are often put in difficult situations where decisions are not black n white but rather a sea of gray...such is the profession. If you wanted black n white choices then you definately shouldn't have chosen nursing...

Mex

[Batman25]

Nicely stated and very informative posts, Mexarican. Thank you,