This week’s discussion is an extension of last week’s discussion, in that it utilizes the same client, only 4 years has passed. Last week, we learned that a mother was keeping her daughter’s HIV diagnosis from her under the premise that she did not believe her daughter was old enough to emotionally handle knowing of her diagnosis. The staff respected the mother’s wishes. Fast-forward 4 years, the client, Victoria, is 16 and has become sexually active with her boyfriend and has confessed to the clinic staff that they sometimes do not utilize proper protection. The mother is not aware that her daughter is sexually active, but still insists that clinic staff not reveal Victoria’s diagnosis. The mother still insists that her daughter will abstain from sex due to personal and religious beliefs.
Due to the severity of the situation and the great potential that Victoria could transmit her HIV to her boyfriend, the staff should encourage her to speak with her mother and inform her of her sexually active status. While a large majority of youth with positive HIV statuses have acquired the virus perinatally, HIV is also highly transmitted and acquired through risky behaviors such as unprotected sex and injection-drug use (Leonard, Markham, Bui, Shegog, & Paul, 2010). Victoria is at a huge disadvantage with not knowing her diagnosis. This puts others at risk, especially with the knowledge that Victoria is engaging in sexual activity unprotected. Perhaps if her mother knew of her activity, her mother would feel more inclined to revealing her daughter’s diagnosis and this could lead to Victoria taking preventive measures to avoid exposing others any further than what she already unknowingly has.
The fact that Victoria is having unprotected sex should be reason enough to break confidentiality and inform the mother of Victoria’s activities. Victoria is unknowingly putting other people’s lives in danger, individuals who have the right to their own health and well-being. Thus, yes, the boyfriend absolutely has the right to know of his sexual partner’s HIV status. Not knowing takes away his basic rights to free will and the ability to make informed decisions about who he sleeps with, as well as informed decisions about using protection during sexual encounters.
Being that the daughter is 16 years old and is sexually active, it can be assumed that she is mature enough, and I use that word loosely, to understand her diagnosis and then to make better choices regarding her care and intimate relationships. Additionally, because the risk of transmitting the virus to sexual partners, along with the daughter’s potential to get pregnant, is now extremely probable, I believe the rights of the mother to not disclose her daughter’s diagnosis is void. Heeren (2011) pointed out that disclosing a minor’s diagnosis sooner rather than later is more conducive to the minor’s overall development, survival rate, and cooperation with medical interventions. At this point, we know that the daughter is not fully complying with consistently taking her medications and she is also having unprotected sex. This is primarily because she has no indication that she has HIV. Perhaps the knowledge of her diagnosis will enable her to adhere to necessary medical interventions, as well as discourage her from engaging in any more risky behaviors that could lead to her exposing others to the virus.
Studies have illustrated that disclosure is largely decided on individuals weighing the risks (fear of abandonment and discrimination) and benefits (need for support) of the disclosure (Obermeyer, Baijal, & Pegurri, 2011). Victoria’s mother has refused to disclose her daughter’s diagnosis, as well as her own, largely out of her personal feelings of guilt for transmitting the virus to her daughter. While this is a natural emotion to feel, the mother is ultimately causing more damage than good by keeping both of their diagnoses secret. The mother does have the right to keep her own diagnosis private; however, once the daughter learns of her own diagnosis, she will also need to be informed of how she contracted the virus. This puts the mother’s privacy at risk. I believe the best way to resolve this is for the mother to just be honest with her daughter about her own status, including revealing how the she herself became infected.
The American Psychological Association’s code of conduct states that a treatment provider may disclose information without consent when mandated by law or when valid purposes, such as to “(1) provide needed professional services; (2) obtain appropriate professional consultations; (3) protect the client/patient, psychologist, or others from harm; or (4) obtain payment for services from a client/patient, in which instance disclosure is limited to the minimum that is necessary to achieve the purpose” (APA, 2010, Standard 4.05). This standard is highly applicable in this case. While staff can encourage both mother and daughter to inform each other of their respective issues (the mother informing the daughter of being HIV positive and the daughter informing the mother of being sexually active), neither one may choose to comply. In such an event, staff can go to the courts and have disclosure mandated due to the fact that Victoria could potentially have exposed her boyfriend to the virus and the possibility of her becoming pregnant from unprotected sex. Thus, it is important that the daughter know of her diagnosis so that she may inform the boyfriend and he can be tested. At this point, a failure to disclose Victoria’s HIV status is highly negligent.
References:
American Psychological Association. (2010). Ethical principles of psychologists and code of conduct: Including 2010 amendments (Links to an external site.)Links to an external site.. Retrieved from http://www.apa.org/ethics/code/index.aspx
Heeren, G. A. (2011). Changing methods of disclosure: Literature review of disclosure to children with terminal illnesses, including HIV. Innovation – The European Journal of Social Science Research, 24(1-2), 199-208. doi: 10.1080/13511610.2011.553506
Leonard, A. D., Markham, C. M., Bui, T., Shegog, R., & Paul, M. E. (2010). Lowering the risk of secondary HIV transmission: Insights from HIV-positive youth and health care providers. Perspectives on Sexual and Reproductive Health, 42(2),110-116. doi: 10.1363/4211010
Obermeyer, C. M., Baijal, P., & Pegurri, E. (2011). Facilitating HIV disclosure across diverse settings: A review. American Journal of Public Health, 101(6), 1011–1023. doi: 10.2105/ajph.2010.300102
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