To Tell, or Not to Tell; Confidentiality in an Iranian HIV Positive Patient: A Viewpoint
AbstractConfidentiality is a basic concept in medical ethics and protecting confidentiality is considered as physicians’ duty. In some occasions, this protection is in conflict with the right of the patient’s sexual partner, who should be informed about the possibility of being infected. The sexual partner being pregnant, the situation is going to be more complicated. In this paper, we present a case discussion with special ethical, legal, social, cultural, and religious aspects. According to this informing sexual partner with the patient’s assent, opt-out Human immunodeficiency virus (HIV) screening in pregnant women and enhancing psychosocial and family support are highly recommended. Strategic changes in health system policies and regulations seem to be necessary as well.
Parsa, M. Medicine and patients' privacy. Iran J Med Ethics Hist Med 2009; 2: 1-14.
Donovan M, Palumbo P. Diagnosis of HIV: challenges and strategies for HIV prevention and detection among pregnant women and their infants. Clinics in Perinatology 2010; 37: 751-63.
Slowther A, Kleinman I. Confidentiality. In: Singer PA, Veins AM, eds. The Cambridge textbook of bioethics. UK: Cambridge University Press, 2008: 43-8.
Abraham S, Prasad J, Joseph A, Jacob KS. Confidentiality, partner notification and HIV infection. Indian Journal of Medical Ethics 2016; 10:157-60.
Center for HIV and Policy. State HIV laws.http://www.hivlawandpolicy.org/state-hiv-laws (accessed on 2015).
Johnson R, Persad G, Sisti D. The Tarasoff rule: the implications of interstate variation and gaps in professional training. J Am Acad Psychiatry Law 2014; 42:469-77.
American Medical Association. AMA’s Code of Medical Ethics. https://www.ama-assn.org/about-us/code-medical-ethics (accessed on 2016).
Veatch RM, Haddad AM, English DC. Case studies in biomedical ethics.1st rev. UK: Oxford University Press, 2010.
British Medical Association. Medical ethics today: The BMA’s handbook of ethics and Law, 3rd rev. UK: Wiley, 2012.
Office of National AIDS Policy. National HIV/AIDS strategy for the United States. https://obamawhitehouse.archives.gov/administration/eop/onap/nhas
Scambler G. Health-related stigma. Sociol Health Illn 2009; 31:441-5.
Olivier C. Telling the truth about HIV? Testing and disclosure in a culture of stigma. Bioéthique Online 2013. http://bioethiqueonline.ca/archives/4440
Haghdoost AA, Mostafavi E, Mirzazadeh A, Navadeh S, Feizzadeh A, Fahimfar N, et al. Modeling of HIV/AIDS in Iran up to 2014. J AIDS HIV Res 2011; 3:231-9.
Fowler MG, Gable AR, Lampe MA, Etima M, Owor M. Perinatal HIV and its prevention: progress toward an HIV-free generation. Clin Perinatol 2010; 37: 699-719.
World Health Organization. Antiretroviral drugs for treating pregnant women and preventing HIV infections in infants: towards universal access. http://www.who.int/hiv/pub/mtct/arv_guidelines_mtct.pdf?ua=1 (accessed on 2016).
World Health Organization (WHO).HIV programme: achieving our goals.
http://apps.who.int/iris/bitstream/10665/112666/1/9789241507110_eng.pdf?ua=1 (accessed on 2016).
United Nations AIDS. Children and pregnant women living with HIV.
http://www.unaids.org/sites/default/files/media_asset/09_ChildrenandpregnantwomenlivingwithHIV.pdf (accessed on 2016).
Centers for Disease Control and Prevention. Reducing HIV transmission from mother-to-child: an Opt-out approach to HIV screening. https://npin.cdc.gov/publication/reducing-hiv-transmission-mother-child-opt-out-approach-hiv-screening
Salari P, Azizi M. The necessity of HIV testing in Iranian pregnant women and its ethical considerations. J Med Ethics Hist Med2009; 2: 1.
Branson BM, Handsfield HH, Lampe MA, Janssen RS,
Taylor AW, Lyss SB, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 2006;55:1-17.
Schuklenk U, Kleinsmidt A. Rethinking mandatory HIV testing during pregnancy in areas with high HIV prevalence rates: ethical and policy issues. Am J Public Health 2007; 97:1179-83.
Iranian Ministry of Health and Medical Education. Guidelines for the prevention of HIV transmission from mother to child.
http://www.mums.ac.ir/shares/aids/bahrainis4/PDF/pmtcversion_1390.pdf [in Persian] (accessed on 2015).