Question

When Ethics and Law collide. Please describe how you would handled the situation below considering that you were the physician or nurse in the scenario.

An HIV positive patient informed you that they have not discussed their condition with their partner, nor do they plan to. This patient also informed you that they plan to continue to have unprotected sex with their partner.

Outside of counseling the patient to take other action, what do you do?

Answer 1

Given Situation :

An HIV positive patient informed you that they have not discussed their condition with their partner, nor do they plan to. This patient also informed you that they plan to continue to have unprotected sex with their partner.

Response of Clinical practitioner to above stated situation :

Counselling in HIV and AIDS has become a core element in a holistic model of health care, in which psychological issues are recognised as integral to patient management. HIV and AIDS counselling has two general aims: (1) the prevention of HIV transmission and (2) the support of those affected directly and indirectly by HIV. It is vital that HIV counselling should have these dual aims because the spread of HIV can be prevented by changes in behaviour. One to one prevention counselling has a particular contribution in that it enables frank discussion of sensitive aspects of a patient's life—such discussion may be hampered in other settings by the patient's concern for confidentiality or anxiety about a judgmental response. Also, when patients know that they have HIV infection or disease, they may suffer great psychosocial and psychological stress including fear of rejection by their family & partner, social stigma, disease progression, and the uncertainties associated with future management of HIV. Good clinical management requires that such issues be managed with consistency and professionalism, and counselling can both minimise morbidity and reduce its occurrence.

Aims of counselling in HIV infection

• Prevention : Prevention of spread of disease in pregnancy or in partner of a positive tested person is core of management plan .

• Determining whether the lifestyle of an individual places him or her at risk.

• Working with an individual so that he or she understands the risks

• Helping to identify the meanings of high risk behaviour

• Helping to define the true potential for behaviour change.

• Working with the individual to achieve and sustain behaviour change

• Support : It includes efforts to increase mental strength of the patient.

• Individual, relationship, and family counselling to prevent and reduce psychological morbidity associated with HIV infection and disease.

Promotion of safer sexual behavior by persons who are HIV-positive has the potential to decrease the incidence of HIV and sexually transmitted infections (STIs), and is the basis of efforts targeting “prevention with positives” However it the patient states the he/ she has not made their partner aware of being HIV positive , a RN or clinician should recommend the patient to make him/ her aware to prevent future morbidity & mortality as well as to prevent severity of disease in their partner.

Although many factors may contribute to the risk of HIV transmission, some evidence suggests that counseling can play a role in decreasing high-risk behavior by HIV-infected patients.Although patients reporting unsafe sex are a priority to receive counseling, patients reporting safe behavior may benefit from healthcare providers' reinforcement.