Running head: CONFIDENTIALITY OF PATIENTS HIV POSITIVE STATUS

Confidentiality of Patients HIV Positive Status

Kaytlyn Stephens
Dixie State University

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Confidentiality of Patients HIV Positive Status
In nursing school we learned about the importance of keeping information about patients
confidential. But, at what point is it alright to breach confidentiality? When another person may
be at risk of getting harmed? Is it ethical to breach confidentiality to save another person from
getting harmed? The ethical issue that will be discussed is patient confidentiality related to HIV
positive status. This is both a healthcare related issue and a nursing related issue. According to
the CDC, About 1.2 million people in the United States were living with HIV at the end of
2012,Of those people, about 12.8% do not know they are infected. About 50,000 people get
infected with HIV each year (CDC 2015). Because HIV is a terminal illness and can be spread
easily through different bodily fluids; should a patients HIV positive status be confidential?
Many health care professionals believe that a HIV positive individual should have the same
confidentiality rights as anyone else, but, is it alright for patients with HIV to keep confidential if
it risks infection other people?
Confidentiality of HIV Status
The Health Insurance Portability and Accountability Act (HIPPA) of 1996 set regulations
about patient privacy and safeguarding of patient information. HIPPA regulations required that
patients health information be kept safe and confidential. HIPPA applies to all health
information of a patient: so why should HIPPA laws be disregarded when it comes to HIV status?
People diagnosed with HIV should have the same privacy rights as people who have not been
diagnosed. There are federal and state laws that give HIV positive individuals the confidentiality
needed in respects with their HIV status. We have to respect our patients wishes about their
information. In the end the patient has the final say on what information can be given out and

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what information needs to be kept confidential. As healthcare professionals we have an
obligation to report any people diagnosed with HIV to the health department. When reporting to
the health department, in some cases, they do not need to know names. Now when healthcare
professionals are reporting HIV, it can be confidential. There is also something new, the health
department can contact past sexual partners or people that may have been in contact with the
patient, without revealing the infected persons name (Klitzman, Kirshenbaumm, Kittel, Morin,
Daya, Mastrogiacomo & Rotheram-Borus, 2014). This is a great way to keep patients
confidentiality but also let people know they will need to get tested, it protects both the patient
and other people. As a nurse, not knowing the HIV status of patients does not mean I do not
already take precautions when it comes with blood, needles and other bodily fluid.
Confidentiality with Exceptions
As a healthcare team, we pass on information relevant to our patients so everyone is on
the same page regarding patient care. This has been going on for many years and collaborating
with the healthcare team has shown to have improved outcomes for patients. Passing on a
patients HIV status will help with treatment and testing. If a normal health adult comes into a
clinic with the flu, there is standard treatment; usually the flu will go away on its own in a few
days. When an HIV positive patient comes in with the flu, it can be much worse. HIV positive
individuals have a weakened immune system that can cause a simple disease to become a deadly
disease. The treatment for the two patients will be different as well; hence the importance of
breaking confidentiality in a certain circumstance. In an article titled AIDS and medical
confidentiality the author made a good point on why in some situations it is in the best interest of
the patient to have their HIV status revealed. He said if the general practitioner does not know

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of the patients HIV positivity he may make wrong diagnoses, not treat the patient properly or
order potentiality risky diagnostic tests (Gillon, 1987 p. 1675). People who are infected with
HIV many not want to tell anyone because they are embarrassed or think that people will judge
them. What these patients do not know is how important it is to their health and wellness to let
doctors and other medical professionals know. Another reason confidentiality should be broke in
a certain circumstance is if someone working with a patient gets a needle stick. There are
protocols that health care workers have to go through if they get a needle stick, but knowing that
your patient is positive for HIV will let treatment get done quicker and they known over the next
few months to watch for HIV. Healthcare workers want patients to get better and want to know
everything about a patient so they can best assess the situation and get the best treatment plan for
each particular patient.
No Confidentiality with HIV Status
HIV is spread though vaginal fluids, rectal fluids, blood, semen, breast milk and
preseminal fluid. When someone is diagnosed it can be overwhelming. First you probably think
about your own health and life, but after you think of the lives of the many people you have had
sexual relations with or shared a needle with. This is a very hard concept of grasp but it is very
important. As healthcare workers in the United States, we have a duty to report any STDs to the
CDC; this helps the CDC tract how these diseases are being spread. When a patient gets
diagnosed with HIV, we legally have to report it to the CDC, even if the patient does not want us
to. In this situation we need to break patient confidentiality because the benefits outweigh the
patients risks (Wolf & Lo 2001). The effects of HIV are devastating. Letting people you have
come in contact with know about your HIV status is very important, but what if the person does

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not want anyone to know? Does HIPPA apply to this situation? If we do not tell people, they will
never know to get tested. There is also the fact they could be spreading it themselves without
even knowing. In an article about misleading sexual partners about HIV status, the authors
researched people living with HIV who are not telling their sexual partner about their HIV status
(Benotsch, Rodrguez,Hood, Lance,Green, Martin, & Thrun, 2012). Even though the person
who has been diagnosed with HIV is taking measures to prevent the spread of HIV they are still
misleading their sexual partners about their HIV status. In conclusion of this research article, the
authors concluded that one out of five people admitted to misleading there sexual partner about
their HIV status (Benotsch, Rodrguez,Hood, Lance,Green, Martin, & Thrun, 2012). I believe it
is important to let sexual partners and people who may have shared needles know about a
persons HIV status. At this point, not telling anyone about the HIV status does not just affect the
person that has been diagnosed with HIV, but everyone who has had a change to have been
exposed to it as well, and the people who may be at risk from getting exposed.
Conclusion
My stance on this ethical dilemma is that people with positive HIV status should have
confidentiality but with exceptions. I think that information of this importance should be made
known to healthcare workers even if the patient does not want it to be. An ethical framework I
believe goes with my stances on the ethical dilemma is the utilitarian approach. The utilitarian
approach is the action that will provide the least amount of harm and provide the most good. In
our text book talks about utilitarianism, people who believe in utilitarianism say, It is useful to
society to achieve the greatest good for the greatest number of people who may be affected by an
action (Butts & Rich, 2016). This ethical framework is set up to get the best outcome for as

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many people as possible. Based on this approach, having a patient come out as HIV positive will
do the greatest good and have a lasting effect on many people. Also by having a patient reveal
they are HIV positive will allow for all people working with the patient to provide the best care
possible. When going to a doctors appointment, you give the doctor your medical history and
physical information. This should not be any different than if you have been diagnosed with HIV.
The doctors and health care workers are there to help the patients. By not disclosing this
information you may be doing more harm than good. In conclusion, having the healthcare team
that knows about a patients HIV status will ultimately help them, and positive lasting effects of
not just the healthcare providers but most importantly the patient.

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References
Benotsch, E. G., Rodrguez, V.,M., Hood, K., Lance, S. P., Green, M., Martin, A. M., & Thrun,
M. (2012). Misleading sexual partners about HIV status among persons living with
HIV/AIDS. Journal of Community Health, 37(5), 1049-57.
doi:http://dx.doi.org/10.1007/s10900-011-9529-5
Butts, J.B. & Rich K.L. (2016). Nursing Ethics: Across the Curriculum and Intro Practice.
Burlington, MA. Jones & Barelett Learning.
Centers of Disease Control and Prevention. (2015). HIV/AIDS Basic Statistics. Retrieved from
http://www.cdc.gov/hiv/basics/statistics.html
Gillon, R. (1987). AIDS and medical confidentiality. British Medical Journal (Clinical Research
Ed.), 294(6588), 16751677.
Harding, A. K., Gray, L. A. and Neal, M. (1993), Confidentiality Limits With Clients Who Have
HIV: A Review of Ethical and Legal Guidelines and Professional Policies. Journal of
Counseling & Development, 71: 297305. doi: 10.1002/j.1556-6676.1993.tb02216.x
Klitzman, R., Kirshenbaumm S., Kittel, L., Morin, S., Daya, S., Mastrogiacomo, M., RotheramBorus, MJ. (2014). Naming names: Perceptions of name-based HIV reporting, partner
notification, and criminalization of non-disclosure among persons living with HIV.
Sexuality Research & Social Policy. (vol. 1, Issue 3, pp 38-57)
Wolf, L.E. & Lo, B.(2001). Ethical Dimensions of HIV/AIDS. HIV inSite Knowledge Base
Chapter. Retrieved from hivinsite.ucfs.edu/InSite?page=kb-08-01-05