Discuss the benefits of universal, voluntary testing in light of V.T.’s case.
Individual vs. Public Health Protection
Situation
A nurse in a community clinic is having a follow-up visit with V.T., a
38-yr-old woman who was diagnosed with HIV infection during her
annual examination 2 weeks ago. During the visit, V.T. discloses that
her partner verbally and physically abuses her. V.T. says she had not
yet told her partner about the HIV diagnosis because she is afraid that
he will hurt her. She has not used any protection during sex with him
since she learned of her test results because she suspects he
infected her.
Ethical/Legal Points for Consideration
• You face a conflict between preventing further harm to V.T.
(possible increase in intimate partner violence), providing care to
her partner (his need for an HIV test, diagnosis, and treatment),
and protecting the public health (potential spread of HIV
infection to her partner or from her partner to others in the
community). Patient teaching and support are essential because
your primary obligation is to the patient.
• Because relevant law varies from state to state, your first step is to
be familiar with your state law concerning mandated reporting
for domestic partner abuse and infectious diseases.
• Federal laws about protection of privacy in HIV testing apply
everywhere.
• In many states, reporting domestic abuse is mandatory only
when the reporter actually witnesses the abuse or when the
immediate effects of the abuse (e.g., wounds, contusions, broken
bones) are witnessed.
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• You should be familiar with crisis counseling services for V.T.
and offer her the following advice: Collect and stash a set of car
keys or taxi money in a safe place, keep a bag packed and hidden
or even stored in a locker somewhere accessible, develop a code
phrase to use with a friend or family member to call for help,
keep a cell phone charged, and have money hidden in a safe
place.
Discussion Questions
1. Within the parameters of your state’s requirements for
reportable conditions, how can you protect the patient’s
confidentiality to prevent further intimate partner violence?
2. What services does your state offer to notify a partner without
disclosing the source patient’s name? How would V.T. access
those services in your state?
3. How can you protect the partner from possible infection while
also protecting V.T. from further violence?
4. How can you best address the issue of intimate partner
violence? What resources would V.T. have in your community?
5. Discuss the benefits of universal, voluntary testing in light of
V.T.’s case.
