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Should doctors disclose HIV status of patients to partners?

BY NADINE WILSON Observer reporter wilsonn@jamaicaobserver.com

Wednesday, February 16, 2011    

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"I believe that she has a right to know, because it is her life that is at stake," says one practiotioner

MEDICAL doctors were Sunday divided when asked if they should be allowed to disclose the HIV/AIDS status of patients to partners who they were knowingly putting at risk.

The issue was raised by senior consultant in anesthesia at the University Hospital of the West Indies, Mona, and chairman of the Medical Association of Jamaica Ethics Committee Dr Allan Barnett at an Ethics Conference put on by the Jamaica Medical Doctors Association (JMDA) at the Mona Visitor's Lodge. The doctor presented a hypothetical situation involving a patient by the name of John who was HIV positive. Although John was found to be HIV positive, he refused to tell his pregnant partner Sue of his status and asked the doctor not to do so.

When asked what should be done in this situation, some amongst the large gathering of medical practitioners felt that the doctor in this situation should be allowed to inform the pregnant woman and John's general practitioner about his status, while others disagreed.

Doctors are at present bound by law to keep their patient's information confidential but are expected to report new cases of HIV to the Ministry of Health, which is then expected to activate John's tracing pattern and at some point inform Sue.

But Dr Barnett took issue with this. "The way things work in Jamaica, that is not likely to happen before she gets her baby delivered," he said.

Under the Medical Act of Jamaica, a registered medical practitioner would be deemed guilty of conduct that is disgraceful in a professional respect if he breaches a patient's confidence, but Dr Barnett believes that the disclosure of a patient's HIV/AIDS status to their partner should be an exception to this rule.

"In other jurisdictions such as the UK, there is legislation which permits disclosure in the public interest and ethically and legally Sue must be informed," he said. "What we are supposed to do under those jurisdictions is explain to the patient that 'look I am sorry, I understand your concern, but your partner is at risk and the baby is at risk and you need to tell them and if you are not going to tell them I will tell them, so you have three days in which to do that, after which I am going to come and speak to her and let her know'," he said.

Dr Barnett's call for a change in the law comes amidst concerns raised by the health ministry last week that HIV/AIDS cases in Jamaica were increasing despite various efforts in the past few years to address the issue. In 1999, the number of reported cases stood at 1,436 in comparison to 1,738 in 2009.

"This situation is exacerbated by [a] high incidence of multiple partnerships and low condom usage. Persons continue to engage in risky behaviour and thereby risk their lives and those of their loved ones," Health Minister Rudyard Spencer said in a recent statement.

Despite increased access to anti-retroviral drugs, AIDS claimed the lives of 378 people in Jamaica in 2009. In an effort to increase awareness of the disease, the ministry launched Safer Sex Week last week under the theme "Protect your love, use a glove", which was expected to serve as an urgent reminder for persons to stick to one partner and use a condom whenever they are having sex.

"Men have an average of six sex partners, while women have an average of three...," the minister said in his statement, in reference to data presented in the 2008 Knowledge, Attitude, Behaviour, and Practice Survey.

Given the increase in HIV cases and the high levels of promiscuity, vice-president of the JMDA, Dr Kenneth Appiah also believes that the doctor in John's case should be allowed to inform Sue that he is positive and that her baby is at risk.

"I believe that she has a right to know, because it is her life that is at stake and also the life of her child and we should try as much as possible to find ways and means in being able to not break the confidentiality issue but at the same time be able to ensure that she is not at a disadvantage because of legal ramifications," he said. He added that it was a matter which his group would discuss further.

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