Ethical Issues in HIV Patient Care

Human immunodeficiency virus -- HIV -- is a precursor to acquired immune deficiency syndrome -- AIDS -- which is a fatal illness. HIV carries a stigma in many societies because it is often transmitted through drug use or sexual behaviors. It can also be transmitted through blood transfusions or blood to blood or other bodily fluid contact with an infected person. There are several ethical issues surrounding the care of patients with HIV.

Testing

• Patient consent is required for HIV testing. Some health care providers like surgeons are routinely exposed to patient's blood. For this reason, patients might be asked to give permission for HIV testing prior to treatment. Ethically, all patients should be treated the same, using universal precautions, whether they are HIV positive or not. However, doctors sometimes take extra steps to protect themselves -- using more personal protective equipment -- when working with patients with HIV. Doctors who order HIV testing must be prepared to discuss a positive diagnosis with their patients and recommend proper follow-up care and counseling.

Confidentiality

• Health information is subject to privacy laws to protect patients from discrimination. The Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 to address issues faced by people with HIV/AIDS and other at risk populations. HIPAA prevents insurance companies from denying coverage to people or companies based on HIV status. In addition, The HIPAA Privacy Rule provides standards for the protection of personal health information, including information that is stored electronically.

Discrimination

• Patients with HIV can be subject to discrimination, whether or not it is intentional. Health care workers need to ask themselves if they would be providing the same level of care to the patient if he was not HIV positive. Patients might question whether they are receiving the same level of care as those without HIV. Doctors might assume that patients with HIV are irresponsible and won't follow through with treatment recommendations.

Transmission

• Doctors who treat patients with HIV might feel an ethical obligation to encourage patients to discuss their diagnosis with other family members present. Because HIV also affects the health of the patient's sexual partner, doctors may feel that the partner has a right to know about this risk of exposure. HIV can also be transmitted from a mother to an unborn child, raising the issue of HIV testing and counseling during pregnancy. Anti-HIV medications are available and can reduce the chance of disease transmission to the baby.