Ethical Principles In Counselling A Patient With A Positive HIV Screening Result.

A 35 year old male, businessman by profession presents to your clinic with history of fatigue and weight loss for last 3-4 months. He has come to you to discuss his HIV screening report which shows positive result. He does not want this to be discussed to anyone, not even his wife.
Answer the following questions:
1. How would you counsel the patient keeping in mind the ethical principles?
2. Enlist 4 tests you would like to do in this patient?
3. Give your opinion regarding breach of confidentiality in this case. Justify your answer?

( Question from MCPS Family Medicine October 19th 2016 paper)

Solution:


 1. How would you counsel the patient keeping in mind the ethical principles?

Answer: Keeping in mind the ethical principles the patient should be counselled in following manner:

• Appreciate the patient for getting screened for HIV and coming in to discuss the positive test result. ( Develops Trust With The Patient) 
• Provide a confidential environment and face to face contact while discussing the result.( Confidentiality) 
• Give appropriate time to discuss the information in a clear and direct manner.
• Inform that he may need further testing to confirm the screening results. ( Beneficence) 
• Inform that he will be referred to a specialist for management of his disease. ( Beneficence) 
• Counsel him to let himself tell his wife about his test results. (justice) 
• Counsel him about safe sex practice and avoid multiple sex partners or prostitutes.

2. Enlist 4 tests you would like to do in this patient?

Answer: 

1. Western blot or indirect immunoflourecence assay or PCR for confirmation of screening results
2. CBC ( Look for WBC count)
3. CD4 count ( which helps determines the disease stage)
4. Chest X ray ( to look for associated complications like TB )

3. Give your opinion regarding breach of confidentiality in this case. Justify your answer?

Answer: Since the patient is unwilling to let his wife know about his positive HIV result first we would try our best to counsel him and explain him that it is important to let his wife know about his result. He should indeed himself inform his wife about it in a private confident environment. 

If the patient still refuses, inform him in a polite manner that it is your responsibility to let his wife know his positive HIV status in order to prevent transmission of disease to her or even she might already have contracted he disease so she needs to be tested and treated .

Also if she is not tested and treated, he himself can again get the disease from her even after treatment. 

Justification to the answer is its the wife's right to know the HIV status of her husband and it is one of the principles in ethical counselling to let the spouse know the HIV results and get themselves tested as well.