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HIV complicates question of who to tell what

Ethics Forum. Oct. 6, 2003.

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Scenario: Should you avoid telling a patient you have to report HIV status?

A general internist strongly suspects from his patient's history and the findings on a physical exam that his patient is HIV-positive. In the state where he practices, people who test seropositive for HIV must be reported by name to the county health department. The physician knows if he tells the patient of his duty to report, the patient will not consent to the test. If he withholds the fact in order to get consent, and the seropositive patient is later contacted by the health department, the physician may lose the opportunity to treat him.

Reply:

With the advent of named reporting for HIV in the United States, some physicians are having to weigh the risk of clients' refusal of needed HIV testing with the benefits of maintaining an honest relationship with them.

Yet, the concern that named reporting will deter patients from being tested has not been substantiated.

In surveying people at risk, colleagues and I found that, theoretically, named reporting does constitute a barrier to testing.

At least two other reported studies, however, concluded that named reporting had little or no effect on actual testing uptake.

Despite the paucity of data linking named reporting to HIV testing acceptance, the physician in this case believes a discussion of named reporting would deter the patient from being tested.

The question of whether to be honest with this patient is not difficult to answer -- "informed" consent requires that patients be given information about named reporting so that they can make a truly informed decision about whether to test.