Sunday Age article regarding unauthorised disclosure of HIV status

October 28, 2012 |

Today’s Sunday Age reports, in Half have HIV status disclosed without giving OK, over half of people with HIV had their status declared without their permission.  The report provides:

JUST over half of people with HIV have had their health status disclosed without their permission, and most have felt stigmatised, two new reports will reveal.

A preliminary analysis of La Trobe University’s HIV Futures Seven report, to be released later this year, shows friends and colleagues are the worst offenders in revealing HIV status. Doctors and healthcare workers are also responsible for more than 7 per cent of unauthorised disclosures.

This is what happened to Max Niggl. Lying in a busy emergency ward, he was stunned to hear one doctor loudly tell another that he was HIV positive. ”She had no right to do that,” said Mr Niggl, who was being treated for kidney stones at the time. ”I said to her, ‘You realise that everyone in here heard you. You’ve breached my confidentiality.’ She was quite shocked and embarrassed.”

Living Positive Victoria executive officer Brent Allan described unauthorised disclosure as adding ”another brick to your backpack”.

”You can imagine what this does to a person’s self-esteem and sense of control,” he said. ”People end up going into the closet with their HIV status, which is bad for public health.”

Unauthorised disclosures are a key focus of the HIV Stigma Audit, which will be released this week. The report – a survey of almost 700 Australians, jointly commissioned by the National Association of People Living with HIV/AIDS and the National Centre in HIV Social Research – calls for measures to ”build resilience among people with HIV”. It also calls for the abolishment of controversial New South Wales laws requiring HIV-positive people to tell sexual partners of their status.

In Victoria and other states, people with HIV are not compelled to inform partners but must try to prevent transmission. All states impose heavy penalties on individuals who knowingly or recklessly spread the virus.

”A disclosure in sexual settings is highly fraught,” the report says. ”A requirement for a person with HIV to take reasonable measures to avoid infecting another person should be sufficient.”

Mr Allan said there was anecdotal evidence to suggest that mandatory disclosure laws were counterproductive. ”It leads to people saying, ‘What’s the point in me knowing that I’m HIV positive if I’m forced to disclose it?’ Then they don’t get tested. This punitive law actually discourages testing and disclosure.”

While sexually transmissible infections laws in NSW have recently been amended to allow ”reasonable precautions” to be used as a defence, people with HIV are still compelled to disclose their status to sexual partners. NSW Health Minister Jillian Skinner said: ”I am comfortable that this allows for the protection of public health and the balance between rights and responsibilities of individuals.”

About half the respondents to the HIV Stigma Audit said they always or occasionally felt ”ashamed” or ”blamed” with sexual partners who knew their status, while a third felt this way with family and friends. Most occasionally felt ”avoided, rejected or excluded” or ”had awkward interactions” with sexual partners.

The report argues that while physical health must remain a priority, more should be done to fight stigma and build resilience in people with HIV.

”I’m open about my status, but nobody has the right to disclose it unless I give my express permission,” said Mr Niggl, who co-ordinates the HIV Positive Speakers Bureau.

”Imagine if I’d had a person next to me in hospital who was not well- informed about HIV and they had panicked. There would have been a bushfire to put out in that case.”

The article takes a range of instances where a person’s privacy is compromised in a general discussion about disclosure without permission.  The legal or ethical ill of one doctor telling another about the patient’s HIV status is a matter of why and how the information is imparted. If it is part of a consultation between practitioners, in an emergency ward, about a person’s condition it is difficult to see how there is a breach of doctor patient confidentiality or a privacy.  Like hepatitis or tuberculosis or any number of other chronic diseases knowledge of that condition is relevant in any analysis.  Disclosing that information in a room full of non interested parties is questionable both from an ethical prospective, definitely, and in breach of the Victorian Health Records Act and the Commonwealth Privacy Act. As the legislation stands the only viable means of taking action, and getting practical enforcement, is through the Health Records Act.

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