At my infectious-diseases clinic in Southeast Washington, I work with some of the city’s most indigent patients. Some don’t have jobs, a home, a car or enough to eat. But recently, I saw a patient whose problem made these issues seem trivial.
Dealing with fatigue, a cough and a fever for several months, this woman in her 40s had been evaluated by four internists. They had tested her for a variety of conditions but not HIV. Each had recommended rest, two prescribed antibiotics, and one suggested an over-the-counter cough medicine. Experiencing no physical relief from these suggestions, the woman had decided to “lay down and die.”
However, after her longtime partner insisted she get medical help, she agreed to go to a hospital emergency room. After a rapid test, which she initially refused because she said she was not at risk for HIV, she learned that she was HIV-positive.
After that ER visit, she brought her partner, whom she credits with saving her life, to my clinic to be tested; she was concerned that she had transmitted the virus to him. He tested positive. About a week later, when he accompanied her to an appointment with me, I asked if he had been seen by a doctor to discuss treatment. He said no and indicated that he wanted to establish care in the clinic.
When I asked if he had ever been on HIV drugs, he gazed at the medication chart and pointed out his previous regimen, a cocktail that contained indinavir. Because I and many other doctors stopped prescribing this medication a decade ago, I knew he had been keeping his condition from her for years. He stopped talking and avoided my gaze. It was clear he knew that I had learned his secret. I had many questions for him; but this visit was for her.
It was not the right moment to dredge up this history and ask how he could keep his diagnosis hidden while watching his partner struggle with her health. I chose not to ask about his dishonesty, their relationship and whether they had used condoms to protect her from getting HIV. At this point, I needed to help her understand that, even though she felt weak and sick, the medications would soon make her feel better. And that, with the right treatment, she could still live a long life.
While talking with my patient about her treatment, my mind kept wandering back to her partner’s secret. Was it my role to admonish him in front of her, or would that make things worse? What would they say to each other when they got home? I wanted to discuss these questions, but did I have a right to insert my judgment into this situation? At a private visit with me two weeks later, she let me know that this was the moment she realized he’d been keeping his diagnosis from her for years.
As a physician, I am not allowed to reveal any medical information about my patients or their circumstances without their written permission. This confidentiality is sacred. But in this case, that constraint felt inappropriate and irresponsible.
Unfortunately, this was not the first time I had seen an HIV diagnosis being kept secret in a serious monogamous relationship. Over the past four years, I have encountered dozens of HIV-positive patients, men and women, who have not told their sexual partners about their diagnosis. This is extremely troubling, especially considering that, in the United States, about 20 percent of people with HIV are unaware they are infected.
A few months ago, a patient of mine urgently wanted to know her viral load — which would tell her the amount of HIV in her bloodstream. She had a new boyfriend and had decided that if the amount of virus in her blood was low and was controlled by her medication, she would not disclose her status until they were married. For the first time, I realized that our incredible achievements in reducing HIV infections could be undermined by the fact that good treatment may make people feel less responsible for disclosing their status.
Am I somehow complicit in perpetuating the dishonesty if I say nothing?
I encouraged this patient to think about how she would feel if she were in her partner’s position. She did not feel strong enough to divulge her secret on her own and asked if she could bring him for a visit, so they could get tested together. That way, she reasoned, she could feign shock and distress when I revealed her diagnosis.
We played out the scenarios. What would happen if he learned that we both were being dishonest? Would physical harm come to her? Would I jeopardize my credibility and integrity as a physician? I certainly believe so.
This ethical dilemma looms large in medical practices across the country. Since we can’t destroy the sacred patient-provider confidentiality, we encourage patients to tell their partners about their HIV status and to use condoms, and we link them to support groups if we can. The next patient comes in, and the cycle repeats.
These issues give me heartburn. Most of my patients are very comfortable with me; they know they can tell me anything without being judged. But am I being a responsible medical professional by keeping someone’s health history confidential when I know that my patient might be putting someone else at risk? Should there be consequences for people who don’t tell their partners they have HIV? How do we balance personal responsibility while minimizing stigma and shame?
We cannot ignore these questions. We have conferences, research meetings and working-group discussions about prevention strategies, research agendas, and how to improve care and treatment. But in my experience, we don’t discuss, devise or implement ways to help patients be honest with their partners.
Above all, we need to remove the stigma associated with HIV testing and being HIV-positive. If health-care providers and patients viewed and handled the disease like the manageable and treatable condition it is, we could chip away at the negative perceptions associated with the virus, like we have done with cancer, tuberculosis and syphilis.
Changing perceptions of HIV, despite how it is transmitted, will eventually facilitate disclosure. Six years ago, the Centers for Disease Control and Prevention recommended routine HIV screening in all medical settings. But in Washington, a city with one of the highest HIV/AIDS prevalence rates in the country, many health-care providers still think that they can discern which patients are at risk for HIV. If providers thought of the disease as a chronic condition similar to diabetes or high cholesterol, and tested for it regularly, HIV’s stigma would recede.
This seems simplistic because it is. Change would start with testing everyone at a certain age and continuing to do so routinely, whether or not they are “at risk” of infection.
A credible body such as the Institute of Medicine or a similar scientific group should convene a civil discussion about how and where to implement routine HIV screening in the primary-care setting. Officials should also reconsider HIPAA and other patient confidentiality regulations to determine when and if exceptions can be made.
If we want to eliminate the disease, we have to address the most difficult and unspoken parts of it. If we don’t, the achievements we’ve made in fighting HIV will plateau, and the epidemic will continue to grow.
Lisa Fitzpatrick, MD is a CDC-trained medical epidemiologist and infectious-diseases physician in Washington. From 2005 to 2007, she directed the CDC’s Global AIDS Program in the Caribbean and implemented the President’s Emergency Plan for AIDS Relief (PEPFAR) for that region. This piece originally appeared in The Washington Post on July 20, 2012.
I have just pulled my records from a certain hospital and found out prior to an operation that because I was taking certain pills at the time and I thought I was addicted they put me down as HIV positive when I told them I have had a recent test and I was negative I’ve just found this on my results are doctors allowed to do that he hasn’t put a? Against it he is saying HIV positive I can prove this now to this day that I am not I have regular blood test I do not use needles what are my Options at this point as this has led to me being treated very badly by the staff and I have had a nose operation that they have just have to I’ve been treated like crap throughout the system and now I read this record it makes sense, I just can’t believe it that they can make a call like that without a confirmation of a blood test when I told them when I had my blood test and where so they could look and it was recent they didn’t even bother they just put me down as HIV positive how dare they
AMYOTROPHIC LATERAL SCLEROSIS (ALS)
I was diagnosed of ALS (amyotrophic lateral sclerosis) in summer of 2012, my symptoms started out with a “foot drop” on my left foot, from there my left leg lost all muscle tone followed by slurred speech and inability to eat without getting choked, strangled, and coughing. My neurologist prescribed me some medications to help my symptoms but the medications did no good and their side effects were too severe. In 2015 i started on NewLife Herbal Clinic ALS Herbal formula treatment, i read alot of positive reviews on their success rate with the ALS Herbal treatment and i immediately started on the treatment. Just 11 weeks into the ALS Herbal formula treatment I had great improvements with my coordination, speech, breathing and muscle movements. I have basically gone stronger than i’d thought i could ever be again, visit NewLife Herbal Clinic official website www. newlifeherbalclinic. com or email info@ newlifeherbalclinic. com. The fatigue and general muscle weakness had also declined, this treatment is nothing less of a miracle!
I am indeed very happy for my life; My name is Maquilla Gemma Protacio, I never thought that I will live on earth before the year runs out. I have been suffering from a deadly
disease (HIV) for the past 5 years now; I had spent a lot of money going from one places to another, from one church to another, hospitals have been my every day residence. Constant
checks up have been my hobby not until last Month, I was searching through the internet, I saw a testimony on how DR. ALI EKER helped someone in curing her HIV disease, quickly I
copied his email which is (firstname.lastname@example.org). I spoke to him, he asked me to do some certain things which I did, he told me that he is going to provide the herbal to me, which he
did, then he asked me to go for medical checkup after some days after using the herbal cure, I was free from the deadly disease, he only asked me to post the testimony through the
whole world, faithfully am doing it now, please brothers and sisters, he is great, I owe him in my life. if you are having a similar problems just email him on (email@example.com) .
He can also cure disease like Cancer, Diabeties, Herpes, Hepatitis B, Etc. You can reach me on email: firstname.lastname@example.org
This is my life Story
My name is Grace Morgan, who will believe that a herb can cure six years HIV in my body, i never believe that this will work i have spend a lot when getting drugs from the hospital to keep me healthy, what i was waited for is death because i was broke, 2-02-2017. One day i hard about this great man who is well know of HIV and cancer cure, i decided to email him email@example.com ,unknowingly to me that this will be the end of the HIV aids in my body, he prepare the herb for me, and give me instruction on how to take it, at the end of the two week, he told me to go to the hospital for a check up, and i went, surprisingly after the test the doctor confirm me negative, i thought it was a joke, i went to other hospital was also negative, then i took my friend who was also HIV positive to the Prophet, after the treatment she was also confirm negative.He also told me that cure any kind of sickness please i want every one with any of this virus to be free, that is why am dropping his email address, firstname.lastname@example.org email him he can cure any kind of diseases like Helps,Gonorrhea,Cardiac problem,Cancer,Watering sperm,Womb fertilization,Penis erection,Witchcraft Attack,S T D diseases,Low sperm count,Internal heat. he is a great man Prophet Ogunu thank you for saving my life, and Dairy long time sickness I promise I will always testify for your good work.
My Husband was DX with ALS for years and i went everywhere to get useful information that will help cure or suppress the disease. then i came across testimonies of those that took my hard earn money without any useful information or cure but they keep telling stories. about two months ago, a new staff was applied in my place of work and when He heard about my Husband Disease He was so remorseful and told me about DR AZIEGBE but i felt it was still one of those internet guys so i didn’t call or text DR AZIEGBE later that week, He asked me if i have heard from DR AZIEGBE and he gave me proof and reasons to try. well, lots of thanks to DR AZIEGBE because as i am writing this message, my Husband is CURED through the herbs that DR AZIEGBE sent to us. so after my experience, i decided to save some people from falling to the hands of SCAMS. thanks for your time and if you require the service of DR AZIEGBE you have to reach him via email: DRAZIEGBE1SPELLHOME@GMAIL.COM OR you can whatsApp him +2348106618681 or if you need my assistant text me +14848668184 my Email: email@example.com…..
Dont waist your time contacting fake doctors the only herbal doctor that have this hiv cure is Dr Osita (Drositamiraclespell@gmail.com) whatapp
(+2348110670600) he charge for the herb and DHl fee depends on
your distance from him , try him and be happy just like me and my
husband , Grace Smith , contact me via whatapp on (+14242768402)
Dont waist your time contacting fake doctors the only herbal doctor that have this hiv cure is Dr Osita (Drositamiraclespell@gmail.com) whatapp
(+2348110670600) he charge you $450 for the herb and DHl fee depends on
your distance from him , try him and be happy just like me and my
husband , Grace Smith , contact me via whatapp on (+14242768402)
Hello, My name is Sarah. I’m here to let you know if your having issues with your health, The solution is out there now. I dont actually know your health condition but am fully convinced your health can be restored back to normal with the use of herbs. I was cured of HIV with the use of a herbal medicine from Dr Baba Ogu. I was diagnosed with this virus for almost 12yrs but i was cured within few weeks after drinking the herbs which Dr Baba Ogu sent to me. Dr Ogu is a herbalist doctor. I know of this doctor through others people testimonies, they were all thanking him and praying for him. He has herbs for the following illness, Asthma, Cancer, Diabetic 1&2, Impotence, HBP,Herpes 1&2, Hiv, Chronic, Arthritis, Depression, etc. He is also a spell caster, he can cast spell to bring back Ex lovers, a spell to make more profit in business, good luck spell, etc. Email him now via: (firstname.lastname@example.org) You can also call or Whatsap him on +2348137291215. Please once you are cured, let people know about it. Together, we must fight to remain healthy. God bless you.
I am JAMES from SOUTH AFRICA, I Never
believed i was ever going to be HIV
Negative again,Dr takuta has given me reasons to
be happy, i was HIV positive for 2years and all the
means i tried for treatment was not helpful to me,
but when i came on the Internet i saw great
testimony about Dr takuta on how he was able to
cure someone from HIV, this person said great
things about this man, and advice we contact him
for any Disease problem that Dr takuta can be of
help, well i decided to give him a try, he requested
for my information which i sent to him, and he tod
me he was going to prepare for me a healing
portion, which he wanted me to take for days,and
after which i should go back to the hospital for
check up, well after taking all the treatment sent to
me by Dr takuta i went back to the Hospital for
check up, and now i have been confirmed HIV
Negative, friends you can reach Dr takuta on any
treatment for any Disease he is the one only i can
show you all up to, reach him on dr takuta on his
call or whatsapp him
HE IS ALSO SPECIALISED ON
(4) URINARY TRACT INFECTION,
10) HE ALSO HAVE SPELL TO BRING BACK YOUR EX hiv/aids,perkinsons disease, ALS,CANCERS,HERPES. contact him with his email via email@example.com or whatsapp him through the following contact on +27788634102
I THOUGHT THE PHYSICIANS SAY NO CURE FOR HIV/AIDS?, I AM TELLING YOU TODAY THAT DR OZI CURE HIV/AIDS WITH HIS HERBAL MEDICINE AND ONCE YOU GET CURED YOU ARE FOREVER CURED IT IS NEVER REVERSABLE.
MY NAME IS WILSON KITA JOYCE FROM THE UNITED STATE OF AMERICA,I AM USING THIS GREAT OPPORTUNITY TO SAVE LIFE BY SHARING MY TESTIMONY THAT THERE IS A CURE FOR HIV/AIDS BECAUSE I AM A LIVING TESTIMONY,I SUFFERED FOR HIV/AIDS FOR GOOD ONE YEAR AND TWO MONTHS AFTER LOOSING HOPE THAT I CAN NEVER GET THE CURE BEACAUSE THE DOCTORS SAID THERE IS NO CURE FOR IT,BUT THANKS BEEN TO THIS GREAT MAN CALLED DR OZI WHOM I READ A TESTIMONY ABOUT ON HOW HE CURED HIV/AIDS WITH HIS HERBAL MEDICINE,I NEVER BELIEVE THIS BUT I DECIDED TO CONTACT HIM THROUGH THE STATED EMAIL,(firstname.lastname@example.org) and he send to me a herbal medicine and ask me to drink and bath with the herbal medicine for one 3 weeks but to my greatest surprises, i went for a medical test after two weeks and my status was negetive till today i cant keep sharing this testimony please brothers and sisters there is a cure to hiv/aids, contact this man for what ever you are going through, what ever sickness you are suffering from, like
(4) URINARY TRACT INFECTION,
(10)SIMPLEX HERPES AND GENITAL HERPES
11) HE ALSO HAVE SPELL TO BRING BACK YOUR EX
hiv/aids,perkinsons disease, ALS,CANCERS,HERPES. contact him with his email via email@example.com or whatsapp him through the following contact on +2348060858046
MUST READ: HOW I GOT CURED FROM MY HIV/AIDS VIRUS)
Hello, My name
is Clara,i will never forget what dis. I was diagnosed of HIV in 2012 and I have tried all
possible means to get cure but all to no avail, until i saw a post in a
health forum about a herbal doctor from West Africa ( Dr Oje ) who
prepare herbal medicine to cure all kind of diseases including Hiv
virus, at first i doubted if it was real but decided to give it a try,
when i contact this herbal doctor via his email, he prepared a herbal
medicine and sent it to me , when i received this herbal medicine, he
gave me step by instructions on how to apply it, when i applied it as
instructed, i was cured of this deadly virus HIV within two weeks of usage I
am now free from the virus, i was tasted negative. Contact this great
herbal doctor via his email:firstname.lastname@example.org or call him +2347035302579, he is able to cure any type of diseases
Greetings to my distinguish guest,i am very glad to share my experience to everyone for the wonderful work done by the great Dr Adura for curing my HIV/AIDS DISEASE. i have been diagnosed of HIV/AIDS for the past 4years and ever since my life has become a totally disaster i had done series of tests from several hospitals and many others but nothing did happened i wasn’t myself anymore until one fateful day when i came across so many testimonies about how doctor Adura has cure several people from HIV/AIDS so i had to contact his email address:email@example.com when i contacted Dr Adura he assured me he will prepare a powerful herbal medicine for me and within 2 weeks i will be totally cured,i believed in every of his instruction,and afterwards he prepared a herbal medicine for me and after i received it,i used it for two weeks just as he told me assured me after 2weeks of usage i was indeed cure of my HIV/AIDS disease,i was tested and was confirmed negative thanks to DR Adura for his help in my life, so you too can also receive this miraculous work by great Dr Adura just contact his Mobile:+2347089978383 or you can visit his email:firstname.lastname@example.org.
Greetings to my distinguish guest,i am very glad to share my experience to everyone for the wonderful work done by the great Dr Adura for curing my HIV/AIDS DISEASE. i have been diagnosed of HIV/AIDS for the past 4years and ever since my life has become a totally disaster i had done series of tests from several hospitals and many others but nothing did happened i wasn’t myself anymore until one fateful day when i came across so many testimonies about how doctor Adura has cure several people from HIV/AIDS so i had to contact his email address:email@example.com when i contacted Dr Adura he assured me he will prepare a powerful herbal medicine for me and within 2 weeks i will be totally cured,i believed in every of his instruction,and afterwards he prepared a herbal medicine for me and after i received it,i used it for two weeks just as he told me assured me after 2weeks of usage i was indeed cure of my HIV/AIDS disease,i was tested and was confirmed negative thanks to DR Adura for his help in my life, so you too can also receive this miraculous work by great Dr Adura just contact his Mobile:+2347089978383 or you can visit his email:firstname.lastname@example.org
I have been HIV positive for 3 years and long for the day to be free of this disease. I would love to be part of any trial that helped find the cure, i have an undetectable viral load and CD4 count of around 1100.
I have tried almost everything but I couldn’t find any solution on my disease, despite all these happening to me, i always spend a lot to buy a HIV drugs from hospital and taking some several medications but no relieve, until one day i was just browsing on the internet when i came across a great post of !Michelle! who truly said that she was been diagnose with HIV and was healed that very week through the help of this great powerful healing spell doctor ,I wonder why he is called the great Dr, Odia, i never knew it was all because of the great and perfect work that he has been doing that is causing all this. so I quickly contacted him, and he ask me some few questions and so i did all the things he asked me to do,He ask me to buy some herbs and which I did for my cure,only to see that at the very day which he said i will be healed, all the strength that has left me before rush back and i becomes very strong and healthy, this disease almost kills my life all because of me, so i went to hospital to give the final test to the disease and the doctor said i am HIV negative, i am very amazed and happy about the healing doctor Odia gave to me from the ancient part of Africa, you can email him now for your own healing too on his email: ( email@example.com ) or call him on +2347032130627. He is always able to help you get your heart desire granted…………….. I thank Dr, Odia
I would just like to thank Prophet suleman for all his help and care during the time he cast a spell for me as a HIV Patient he was able to heal me from this disease ,,I highly recommend anyone to try him and believe in him
it truly honestly works,,Thank u so much for helping me in my time of need.. i will be recommending you to my friends and anyone who needs help in their lives Contact him through his email if you need his help (Prophetsuleman@gmail.com)
thank dr.daniel for his good work, I really believe HIV have cure I was HIV positive over since 1year before I come across a comment dr.daniel that he have cure any disease and virus but when I saw it i have it in mind that he can’t cure HIV I just decided to give a try I contact him that lucky night to meet him,and he said yes but I don’t believe him I think it was a scam or some thing like that but I still hold on to see the work of dr.daniel if he is saying the true he ask for different thing and some question about me I give him all the detail he needed and I wait to see his reply to my problem after all the thing is done he ask me to go for check up I went for hiv test I cant believe I was negative thanks dr.daniel for helping me, for not dying at this young age if you need help contact him now with this EMAIL and tell him your problem firstname.lastname@example.org
Have you heard of Lord Kakabu miraculous work???. This man is full of wonders and miracles, his miracle is what have turn my life and that of my wife for better. I contacted him for help to win a lottery and also help cure my wife who have been suffering from kidney problem for 3 year. Lord Kakabu replied and told me that he will help me and i will win the lottery and my wife will be healed within 12 to 16 hours, i believed him and did all he told me and to my greatest surprise everything happened just as he said. My wife was healed 14 hours later and o also won the lottery, i bought a house and I am living happily with my wife and daughter now. I am excited and will continue to testify about Lord Kakabu till Christ comes, there is no miracle Lord Kakabu can not do that is why he is called Lord on Earth…Are you sick? do you want to win a lottery? do you need a child or need your ex back? then contact Lord Kakabu via email: email@example.com
Interesting article. When I first read the title of, “Should Doctors Keep Patients’ HIV Status a Secret?”, my first reaction was no. However, after reading this article, I understand the ethical dilemmas that doctors are faced with and I think this doctor handled the situation appropriately.
I USED TO HAVE HIV, AND I WORK WITH THE U.S ARMY… I LOOKED FOR CURE
ALMOST ROUND THE WORLD, NOT UNTIL I CONTACTED DR OGBODU, I
NARRATED MY PREDICAMENT TO HIM, I WAS SHOCKED HE SAID ”NO CAUSE FOR
ALARM”’ HE SAID HE WILL NEED TO PREPARE THE MEDICATION FOR TWO DAYS, AFTER PREPARING IT, HE WILL SEND IT TO ME THROUGH COURIER SERVICE [DHL]. I RECEIVED IT AND I TOOK THE MEDICATION FOR TWO WEEKS AND THEN I WENT BACK TO THE HOSPITAL FOR MEDICAL CHECK UP…..MY FRIENDS YOU WON’T BELIEVE IT WAS NEGATIVE…. NOW I’M SOUND AND HEALTHY
STILL WORKING WITH THE U.S ARMY .
I BELIEVE HE CAN CURE ANY TYPE OF SICKNESS.
HIS EMAIL ADDRESS IS: [firstname.lastname@example.org] .
I am out here to testify about the good work Dr Ogbodu has done in my life with his HIV herbal medication. I have been suffering from HIV disease for the past 3 years now before I came across Dr Ogbodu who healed me with his powerful HIV herbal medication. I never believe that Dr Ogbodu could ever get my HIV-AIDS cured with his herbal medication, i have tried almost everything but i could not find any solution to my disease, despite all these happening to me, i always spend alot to buy a HIV drugs from hospital and taking some several medications but no relief, until one day i was just browsing on the internet when i came across a great post of a lady who was testifying about how she get cured of her HIV disease with the help of Dr Ogbodu. So i have to contact him, and he ask me some few questions and he said a thing i will never forget that anyone who contact him is always getting his or her healing in just 2 weeks after taking his medication, so i did all the things only to see that at the very day which he said i will be healed, I regain all the strength that has left me before back and i became very strong and healthy, this disease almost end my life, so i went to the hospital to give the final test to the disease and the doctor said i am HIV negative, i am very happy and grateful to Dr Ogbodu about the healing he has given to me with his herbal medication. You can also email him for any kind of help via email email@example.com. Thank you once again Dr Ogbodu.
“Ghulam Ahmed Bilour has taken a principled stand,” agrees Ayesha Bibi, a housewife in the Pakistani capital. “The problem is that countries like the United States allow people like those who made the controversial film to hurt the feelings of Muslims. Why has the U.S. not prosecuted those who made the film?”
MY NAME IS STACY WILLIAMS FROM SOUTH USA.I SAW A COMMENT ON POSITIVE BLOGS AND I WILL LOVE TO TELL EVERY BODY HOW MY STATUS CHANGES TO NEGATIVE, AND AM NOW A LIVING WITNESS OF IT AND I THINK ITS A SHAME ON ME IF I DON’T SHARE THIS LOVELY STORY WITH OTHER PEOPLE INFECTED WITH THIS DEADLY VIRUS. HIV HAS BEEN ONGOING IN MY FAMILY, I LOST BOTH PARENTS TO HIV. AND IT IS SO MUCH PAIN I’VE NOT BEEN ABLE TO GET OVER.. AS WE ALL KNOW MEDICALLY THERE IS NO SOLUTION TO IT..AND MEDICATION IS VERY EXPENSIVE..SO SOMEONE INTRODUCED ME TO A HERBAL PRACTITIONER . I HAD A JOB THERE TO EXECUTE SO I TOOK TIME TO CHECK OUT ON HIM.I SHOWED HIM ALL MY TESTS AND RESULTS.. I WAS ALREADY DISORGANIZED WITH HIV AND IT WAS ALREADY TAKING ITS TOWL ON ME.. I HAD SPENT THOUSANDS OF DOLLARS SO I DECIDED TO TRY HIM OUT ALTHOUGH I DID’NT BELIEVE IN IT, I WAS JUST TRYING IT OUT OF FRUSTRATION? AND AFTER 2 DAYS, HE TOLD ME TO GO FOR A NEW TEST. AND YOU WON’T BELIEVE THAT 5 DIFFERENT DOCTORS CONFIRMED IT THAT AM NEGATIVE..IT WAS LIKE A DREAM,,I NEVER BELIEVE AIDS HAS CURE..AM NOW NEGATIVE,, AM A LIVING WITNESS..I DON’T KNOW HOW TO THANK THIS MAN? I JUST WANT TO HELP OTHERS IN ANY WAY I CAN.. I HAVE JOINED MANY FORUMS AND HAVE POSTED THIS TESTIMONIES AND ALOT OF PEOPLE HAS MAIL AND CALLED THIS MAN ON PHONE AND AFTER 2 DAYS THEY ALL CONFIRMED NEGATIVE.. BBC NEWS TOOK IT LIVE AND EVERY EVERYBODY SAW IT AND ITS NOW OUT IN PAPERS AND MAGAZINES THAT THERE IS A HERBAL CURE FOR HIV AND ALL WITH THE HELP OF THIS MAN,, IF YOU WISH TAKE IT OR NOT..GOD KNOWS HAVE TRIED MY BEST. ABOUT 28 PEOPLE HAVE BEEN CONFIRMED NEGATIVE THROUGH THE HERBAL CURE OF DR.SAKURA.. AND THEY SEND MAILS TO THANKS ME AFTER THEY HAVE BEEN CONFIRMED NEGATIVE,,THIS MAN IS REAL..DON’T MISS THIS CHANCE,,HIV IS A DEADLY VIRUS,,GET RID OF IT NOW.. If there is anyone who has similar problem and still looking for a way out, his email ıs dr.gabalaspelltemle@gmaıl.com
Thank you for any other useful website. The spot otherwise might just I get that type of real information designed in a very excellent usually means? I own a venture that i’m at the moment working in, and I have been on the look out and about pertaining to similarly info.
He that work and never ask for anything thanks drosas for good work
for healing my brother for HIV sickness he was very sick for a year +
and my daddy have spend so much money on medical care and drug he have
being taking to some many place for healing… even different pastor
have pray for him it get worse every 6hous the man that heal with
45mins is here the man that the lord god have giving the power to put
every thing in place the man that give a word and never fail my kid
brother was just chatting one day when he see this post of jack about
the curing of HIV virus by drosas he run to my daddy and tell him
about the man my daddy decided to call him and confirm it if it is
true about the cure the man just assure him about his work that the
great power of is for father and his gods cure any disease include
HIV/AID, Ebola, Rota virus, Smallpox ,Hepatitis well we have hope on
him which we give a try to after five days my kind brother started
getting better as am write this comment his is at work now what a
miracle….. if you need help from drosas contact him now my friend
through his email or phone number drosassolutioncenter@gmail.Com call
please i wish to know the implications of not reviling hiv test result to my a partner,husband or wife … what effect will these have in a family
if you are free tomorrow at 1pm EST, join the conversation about this topic!
Thanks to “condom size chart” above I am now seeing your comment. :). I believe a critical mass of providers should petition CDC and HRSA to consider these issues and provide national guidance. What do you think?
Hello my loved one! I want to say that this post is amazing, great written and include approximately all significant infos. I’d like to see more posts like this .
Great post, thank you Dr. Fitzpatrick for your thoughtfulness on this topic. I am a social worker in a busy public HIV clinic, and I find myself being extra cautious (in terms of privacy) in ways that I don’t think would apply if I worked, say, in a dialysis clinic. Clearly HIV is still highly stigmatized, but I wonder if health care professionals aren’t adding to the stigma by always “tiptoeing” around the issue? I mean, when a doctor feels the need to call me in to deliver positive test results because they’re THAT uncomfortable, I think there’s a problem.
This is a little tangential, but still relevant to the privacy vs. public health issues you’ve raised – considering the emphasis on retention in care and “treatment as prevention” in HIV positive patients, how far should we (social workers, doctors, etc) go in trying get bodies in the clinic? If you have a patient who is difficult to reach (phone being cut off, moving constantly, etc), how much can you reveal to a family member or partner in attempting to communicate that the patient NEEDS to be seen? Because HIV is an infectious disease, we can’t just give up and say “oh well” if a patient falls out of care (without viral suppression, they’re putting others at higher risk of infection), but I also think that people do have a right to some choice in the matter of receiving medical treatment…
Not easy questions!
Good post. Very controversial topic that needs more public awerness.
Thanks for the post. This is definitely a difficult area of ethical grayness. However, I agree with your decision to uphold the law and maintain your patient’s privacy. Guaranteed secure trust between patient and doctor encourages individuals to seek medical assistance in the first place. But just because you should maintain patient privacy doesn’t mean you are forbidden from counseling the patient towards revealing their condition to their partner.
Counseling patients to disclose is a given and standard of care in our practice. We also routinely offer to help them disclose by having them bring their partners in….but few take us up on this offer. The solution requires something much broader beyond the walls of our clinic and the support we offer. They are not disclosing because of HIV stigma. The question is how to meaningfully and impact fully address this on a societal level.
There is a critical element left out of the discussion so far. An HIV diagnosis is reportable in all jurisdictions in Western industrialized countries. Public health personnel have the authority, responsibility and training to carry out partner notification. This is done routinely in most jurisdictions and is carried out with respect and tact. The public health department will help you resolve your dilemma.
I disagree that health departments are equipped to address this problem and able to help solve the dilemma. Despite decades of STI contact tracing experience, many have not implemented partner notification for HIV. We have a program here but it does not effectively address the issue related to disclosure.
According to the New York City Department of Health & Mental Hygiene “If your doctor already knows the name of your partner, he/she is required to report that name to the State Health Department”. Lisa can you notify the health department in your state if you feel the HIV positive patient is putting their partner at risk? Then the health department is required to notify their partner(s). Or is this not the law in the state that you practice in?
Hi Lisa –
I’m an HIV doc and clinical ethicist and I feel your pain! This is a tough one. I’m glad you’ve worked to open the conversation like this.
The problem is that there are competing priorities here. We want to earn our patients’ trust (and thus be most effective in the promotion of their health) in part by respecting their privacy, but we want to protect their partners from harm. Our first obligation is to the patient in front of us, but we do have some measure of responsibility for that unseen other.
As you have said, there is no easy solution on a case-by-case basis, and it would be nice for national guidance on this to be clearer. It’d be a nice outcome of your thoughtful article to see more conversation about this.
For what it’s worth, I’ll tell you how I handle it: I err on the side of respecting privacy unless I think there is a clear danger to somebody else. By this I mean that I do the same kind of extensive counseling you do with the patient, which includes encouraging them not only to disclose but to use safer sex practices. In those rare situations in which there is a partner who does not know about HIV, and whom the patient is not protecting via disclosure or reasonably effective preventive measures, then I tell my patient that I feel worried that danger is nigh and that I’d like to help them make things better. Would they be willing to disclose or have my help with disclosure? If this doesn’t work and still the patient admits to real HIV risk to their partner, I let them know I feel duty bound to disclose anonymously for the safety of that other patient.
This is analogous in my mind to a psychiatrist who learns of murderous intent or a family practice doc who learns that patient is abusing a child – some priorities trump even privacy.
Hope it’s helpful to have that perspective, and thanks again for keeping the conversation alive.
Interesting discussion. Here’s a random question.
Should a doctor who is HIV positive be required to tell their patients?
Not sure I have a position on this – and certainly not arguing for any kind of 80s style policies. Come to think of it, might argue no. But wondering what policies people have seen?
Should everyone who is HIV-positive be required to wear a Star of….well, HIV on their shirts, blouses, or coats? If a doc’s medical condition is of no material risk to a patient, then the answer is ‘No’.
Whoa. Treat the question in the manner it was asked. That battle is over. Done. We need to get over it.
You’re perhaps forgetting how intensely physical the practice of medicine can be. And perhaps not thinking about the things that happen in emergency rooms. Sharp objects go flying. Instruments get dropped. Accidents happen. Hospitals are dangerous places.
I am arguing no. But I want to understand what is happening.
Yeah, it was inflammatory and tangential. And you’re right about the dangers in hospitals. But the “risk” — is any — should by now be an empirical matter, than than just a conjured spectral “threat.”
I was just thinking more of outpatient setting.
I still argue “no” on balance.
Here’s another thought for us to all chew on.
Much of our current thinking about what privacy is and how it should be handled dates back to this moment in history.
As a result – to some significant degree – hospital privacy policies are insane.
Many of our applicable laws are insane.
For these and other reasons – communication and basic information sharing is limited and often virtually impossible.
I think we should stop and think about that. In a scientific, thoughtful way. And then I think we should do something about it.
“Six years ago, the Centers for Disease Control and Prevention recommended routine HIV screening in all medical settings. ”
Exempting themselves, of course (the CDC staffers who wrote and published this recommendation).
Are there any solid data on the sensitivity vs specificity and Bayesian misclassification rates of HIV screens? Would these misclassification rates escalate proportionally to a ramp-up to mass screenings? (Asked and Answered)
I’m a 67 year old non-drug using healthy white male, faithfully married for a 3rd of a century to a professional woman who routinely donates blood.
The probability of my being HIV positive is — effectively — exactly zero. The probability of an error during a “routine HIV screen” of my blood, however small in nominal terms, is consequently infinite in comparison. The upshot of such an error could wreak havoc on me.
Also, at a cost of ~$50 each per rapid-HIV assay, well, do the mass screen math. There are roughly 238 million adults in the U.S.
It is true widening the screening net will yield some false positives but we continue to miss many people by not routinely screening. The cost of an HIV test is no longer $50 but more along the lines of $15-20.
I will continue to test people who have never had an HIV test because I believe any sexually active person should be tested at least once. For every story I hear about a 67 year old with zero chance of being positive, I could match it with stories of 60 and 70 year old celibate people who were never tested but diagnosed with AIDS because a provider thought they had zero risk and zero chance of being infected.
The cost-effectiveness of this strategy has been demonstrated.
“For every story I hear about a 67 year old with zero chance of being positive”
It’s not a “story,” it’s a fact. For me, it would have ZERO “cost-effectiveness.” It would be all cost, unknowable (but >0) risk, and no benefit.
Basically, what Bobby is saying is “forget reducing the incidence of HIV and potentially saving lives by having regular testing, what about the fact that I have to pay $15 a year for a test I don’t need?”
What is a small fee a year compared to someone’s life?
Naive. Ignorant of assay reality.
Dear Sue and Bobby,
To bring the conversation back to concepts and away from the tempting polarization of online commentary, I thought some background might help.
Since all HIV testing assays are imperfect, there are trade offs to consider: how many false positives are an acceptable cost of finding the approximately 20% of people who are infected but don’t know it, and also are the costs justified?
Modern HIV assays are awesomely accurate and nearly all algorithms require confirmatory testing of some sort, so the false positive risk is minimized, but not zero. The cost is also quite low given the magnitude of clinical benefit that can result.
As you can imagine, these and other factors were considered in detail in formulation of the 2006 CDC guidelines which suggest all US adults be offered testing at least once regardless of their or the clinician’s estimate of risk. That last clause is because seroprevalence studies have repeatedly shown that many people erroneously believe they are not at risk when they are. That’s a major reason why 20% of those infected have not been tested: they think they are not at risk when in fact they have low or average risk and of course HIV is happy to get lucky when we do.
Given that decades of life saved result from most HIV diagnoses for those with access to care, and that the cost of those lives saved is quite reasonable according to cost effectiveness studies, this policy seems reasonable.
That said, despite the huge public health benefit of finding and treating those 20%, testing is of course entirely voluntary and so patients who truly believe infection is too unlikely to consider testing after education are welcome to decline the offer.
For those wanting more details, Wikipedia has a nice brief summary of likelihood of false positives etc (link below) and the actual CDC recommendations are online plus PubMed has a gozillion related epidemiological studies.
Hope that helps –
Thanks Tim. The only other point I’d add is that the cost of HIV testing should now be covered by insurance companies thereby alleviating concern of cost to the patient.
You can offer counsel without violating privacy.
Yes and that is exactly what we do. My staff and I spend an extraordinary amount of time with patients like these trying to get them to a place of comfort and support to feel strong enough to disclose their status. These efforts are largely unsuccessful because we can not go home with them.
Good post. However, I waited for your own personal pronouncement as the piece concluded.
Where do you stand, if you will express your personal feelings? Ethics may be muddled in cases such as these, but we have our own morals. How do you handle above situations?
For me, I might feel one way in theory (engage but remain at arms length), but in the moment, outrage might overrule my good reason.
Brad F thanks for asking. I have not and will not divulge a patient’s status to an unsuspecting partner because right now for this infection it is against the law. Hence, my uneasiness. If a patient came into my office with active TB, I would be required to report this and his family members would be notiified. The way we have stigmatized and exceptionalized HIV requires me to behave differently so I would not.
I understand why it is difficult for patients to tell their partners or anyone about their status. Having HIV remains taboo. But I hope raising these issues will force a conversation about why in 2013 HIV remains so stigmatized and how healthcare providers are part of the problem. Many of us feel uncomfortable talking about sex and HIV despite it now being a completely treatable sexually transmitted disease.
Until we can figure out how to talk as openly about it being a treatable condition as we do about other infections and diseases I will continue to protect my patient’s information despite my discomfort knowing about the potential risk to others. It’s the law. I dont like it and that is why I am speaking out about this.
Lisa, great article and discussion! You make a very interesting point about notifying the patients family if a patient tests positive for TB but if a HIV positive patient is putting their partner at risk for contracting HIV it is a HIPAA violation. This seems contradicting! I agree with keeping their HIV confident unless they are jeopardizing others health by engaging in risky behaviors and not disclosing their HIV with their partner(s).