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WHEN FIRST DIAGNOSED: UNDERSTANDING AND COMMUNICATING ABOUT
HIV-WHAT YOU NEED TO KNOW: WHO TO NOTIFY
People with HIV infection have an ethical and, in many places, a legal requirement to notify people they may have exposed to HIV. Those with HIV infection must also tell people with whom they are having the kind of contact that might transmit HIV. These are two of the hardest things someone with HIV infection has to do.
People with HIV infection are obliged to notify anyone they have exposed to the virus. This means anyone with whom they have had non-safe sex (that is, sex without a condom, or sex that involved exchange of body fluids) and with whom they have shared needles or works. This applies to past as well as present and future relationships.
For past relationships, the major problem is knowing how far back in time to go. Most people with HIV do not know when they acquired the infection. Since the infection may be silent for a long time, they may conceivably have been placing others at risk for several years. For practical purposes, most authorities recommend notifying all contacts for the past one or two years. This is the absolute minimum.
People who have been exposed should be notified and advised to take the test to find out if they are infected. They might also want to ask a physician about the probability of infection, the necessity for medical evaluation beyond simple testing for HIV, and the desirability of
subsequent testing. It may be at least somewhat reassuring to know that the virus is not easily transmitted. Studies of heterosexual couples show that the risk of infection is estimated to be less than 1 in 100 for a single sexual contact. The same studies show that, even for those who have had regular sexual contact over extended periods, the risk of infection is less than 50 percent. Similar studies have not yet been done for gay men; the risks are probably somewhat higher.
There are two reasons for notifying people you may have exposed to HIV. One is so they can obtain health care and counseling themselves; they will also need to take precautions not to spread the infection further. This is the only way, right now, that the epidemic can be controlled. The other reason for notification is that doing so is probably a legal requirement; depending on where you live, notification may be the law. Though legal requirements vary from state to state, most states now have laws that mandate notification.
Moreover, physicians may be obliged to notify anyone you do not notify. There is debate about this. On the one hand, the patient-physician relationship is privileged, or private. On the other, the physician has an obligation to society. A legal precedent was established with the case of Tarasoffv. Regents of the University of California, in which a psychologist who learned of a patient’s intent to murder a young woman was held liable for not taking appropriate steps to protect her. This decision established that the physician has what is called a “duty to warn” unsuspecting people who are engaged in behavior that puts them at risk. As a result, the physician will usually advise a patient to notify people who have been and continue to be placed at risk of infection. If the patient is unwilling to do this, the physician appears to have the authority and even the responsibility to do it, either directly or through public health authorities.
Notifying others of the possibility of HIV infection is extremely difficult. People who simply cannot do it are advised to discuss their concerns with their physicians. They might also benefit from consulting a psychiatrist or a psychologist, or by participating in support groups, or by talking to friends and relatives.
Those who remain unable to tell others directly might do it indirectly, through another individual such as a physician. An alternative is for the person or the physician to notify public health authorities, who will then make the necessary notification. Neither physicians nor public health authorities have to identify the source of their information. The person who may be exposed is simply told of the possibility of exposure without ever being told the specific source. Any of these alternatives is acceptable. The important thing is for the person exposed to be notified, tested, and counseled?and as soon as possible.
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