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.