What should you do if your patient has a positive HIV test?

This case-study looks at whether you should inform a patient that their partner is HIV-positive.

The scenario can be viewed as an interactive story on the GMC website here - or you can read it in full below.

Introduction

Narrator: Adrian is 27. He is attending the sexual health clinic today to get the results of some tests. Adrian's partner, Maria, also attends the same clinic, although Adrian is unaware of this. Adrian has come to see Dr Peters to get some test results. Dr Peters also treats Adrian's partner, Maria, at the clinic. Maria attended the clinic last week when Dr Peters confirmed her suspicion that she is HIV positive.

Conversation between Dr Peters and Adrian

Dr Peters: Well, Adrian, the test results all came back negative, so everything's fine there, no concerns.

Adrian: Thank goodness for that! I never thought there would be a problem of course, but it's still a bit nerve-wracking getting test results. What a relief!

Dr Peters: But of course you should still continue to practise safe sex. You're using condoms at the moment aren't you?

Adrian: Yes that's right. But, actually doctor can I tell you something? I'm going to see if I can persuade my girlfriend to start trying for a baby! I'm one of five myself and really keen to start a family as soon as I can.

Dr Peters: I see…does your girlfriend mean to have these tests done as well? Many couples decide to have them done, just to make sure everything's okay, before trying for children.

Adrian: Yes, absolutely. In fact, Maria already had some tests done as she's been thinking of binning the condoms and going on the pill. Her results came back last week and everything's fine. So all I need to do now is convince her not to go on the pill but to try for a baby instead!

Should the doctor…

a. Tell Adrian that Maria is HIV positive because he has a right to know he is at risk of infection?

b. Call Maria and try to persuade her to tell Adrian the truth about her test results?

c. Do not tell Adrian because it is Maria's confidential medical information and he has no right to know?

You chose…

a. This would not be in line with GMC guidance without Maria's consent or knowledge at least. Dr Peters should tell Maria before he considers making a disclosure of this type to Adrian, and should first try to persuade Maria to tell Adrian herself.

b. This would be in line with GMC guidance. It appears that Maria has not told Adrian about her HIV diagnosis yet, in fact she might have dishonestly said that she has recently tested negative; if they have unprotected sex then Adrian will be at risk of infection.

c. This would not be in line with GMC guidance. Doctors may disclose information to a known sexual contact of a patient with HIV if that person is at risk of infection. However, Dr Peters should weigh the benefits and harms of disclosing confidential information without consent, and should first try to persuade Maria to tell Adrian herself.

What the doctor did

Narrator: Dr Peters did not disclose anything to Adrian immediately, but instead called Maria as soon as Adrian left the clinic, and tried to persuade her to tell him herself. He also said that he would consider telling Adrian directly if she chose not to and Adrian remained at risk of infection.

Maria was very angry that Dr Peters was considering breaching her confidentiality. Dr Peters explained that she had a responsibility to tell him she was HIV positive if they were going to have unprotected sex, though he did not disclose what Adrian had told him about wanting to try for a baby.

Although Maria was still reluctant to talk to Adrian, she agreed to come to the surgery the next day to speak to Dr Peters about it in more detail. Dr Peters resolved that, if he could not persuade Maria to tell Adrian – or if she failed to show for the appointment - he would disclose information to Adrian without Maria's consent.

References

Confidentiality: disclosing information about serious communicable diseases, Good Medical Practice, paragraph 10

10. You may disclose information to a known sexual contact of a patient with a sexually transmitted serious communicable disease if you have reason to think that they are at risk of infection and that the patient has not informed them and cannot be persuaded to do so.3 In such circumstances, you should tell the patient before you make the disclosure, if it is practicable and safe to do so. You must be prepared to justify a decision to disclose personal information without consent.

Good Medical Practice, paragraph 6

6. Confidentiality is central to trust between doctors and patients. Without assurances about confidentiality, patients may be reluctant to seek medical attention or to give doctors the information they need in order to provide good care. But appropriate information sharing is essential to the efficient provision of safe, effective care, both for the individual patient and for the wider community of patients.

Disclosures in the public interest, Good Medical Practice, Confidentiality, paragraphs 36-37

36. There is a clear public good in having a confidential medical service. The fact that people are encouraged to seek advice and treatment, including for communicable diseases, benefits society as a whole as well as the individual. Confidential medical care is recognised in law as being in the public interest. However, there can also be a public interest in disclosing information: to protect individuals or society from risks of serious harm, such as serious communicable diseases or serious crime; or to enable medical research, education or other secondary uses of information that will benefit society over time.

37. Personal information may, therefore, be disclosed in the public interest, without patients' consent, and in exceptional cases where patients have withheld consent, if the benefits to an individual or to society of the disclosure outweigh both the public and the patient's interest in keeping the information confidential. You must weigh the harms that are likely to arise from non-disclosure of information against the possible harm both to the patient, and to the overall trust between doctors and patients, arising from the release of that information.

Disclosures to protect others, Good Medical Pracitce, Confidentiality paragraph 53

53. Disclosure of personal information about a patient without consent may be justified in the public interest if failure to disclose may expose others to a risk of death or serious harm. You should still seek the patient's consent to disclosure if practicable and consider any reasons given for refusal.

This case-study is from the Good Medical Practice in Action section of the GMC website