A 36 year old man comes to his physician for a complaint of swellings in his neck. You find out that he has lymphadenopathy. In a screening test panel, you find out that he has HIV infection. You discuss with him the implications and treatment options. He says that he is willing to undergo treatment but he does not want you to tell his wife. Your next step should be to:
Answer is 4.
HIV patient does not want to tell wife - Can you?
Yes. There is a risk to somebody,s life in this case. The human benefit of breaching confidentiality in this case is much more than not breaching it. Even if the patient says that he will tell his wife, you must confirm that this is done. If he does not do it, you must ensure that she is informed (even if this involves the health department/police contacting her if you cannot manage so yourself).
This comes from the fact that confidentiality need not be maintained if there is danger to somebody's life.
The following information is posted from the NY state regulations of reporting to partners:
"Notifying Partners:
If you test HIV positive, your provider will talk with you about the importance and benefits of notifying your partners of their possible exposure to HIV. It is important that your partners know they may have been exposed to HIV so they can find out whether they are infected and benefit from early diagnosis and treatment. Your provider may ask you to provide the names of your partners, and whether it is safe for you if they are notified. If you have been in an abusive relationship with one of these partners, it is important to share information with your provider.
For information regarding services related to domestic violence, call 1-800-942-6906.
o Under state law, your provider is required to report to the health department the names of any of your partners (present and past sexual partners, including spouses, and needle sharing partners) whom they know.
o If you have additional partners whom your provider does not know, you may give their names to your provider so they can be notified.
o Several options are available to assist you and your provider in notifying partners. If you or your provider do not have a plan to notify your partners, the health department may notify them without revealing your identity. If this notification presents a risk of harm to you, the Health Department may defer the notification for a period of time sufficient to allow you to access domestic violence prevention services.
o If you do not name any partners to your provider or if a need exists to confirm information about your partners, the health department may contact you to request your cooperation in this process. Revised: March 2000"