Am I My Patient’s Keeper?

I gave a presentation last night to a group of HIV/AIDS pharmacists who have been considering issues at the intersection of patient-pharmacist relationship and public health law.  Pharmacists involved in the care of persons who are HIV positive often are part of a health care team (doctor, nurse, social worker, case manager, pastoral care).  The work is highly specialized and often involves working exclusively with an HIV positive population.  These folks see a lot.

Most of their questions circled around the tension between their obligations to their group's patients and their larger ethical obligations to others (think sexual partners and needle sharers) who may be at undisclosed risk in these relationships.  Missouri law is convoluted, essentially permitting but not requiring non-consensual disclosure of HIV positive status and risk to a spouse or sexual partner. We compare this with New York's relatively new public law requiring such disclosure and the conversation took off from there.

They were a good group. They struggled with the need and desire to build an alliance with their group's patients and their sense that a single-minded focus on only the non-disclosing individual might leave others at risk.

Criminalization of non-disclosed status of HIV conduct was also discussed. Missouri goes one step further and crimnalizes the failure to disclose HIV positive status to a sexual partner. Some of the parmacists were easy with inviting the state in to police the sexual encounter. Others seemed to think that these statutory provisions would drive us further away from a culture of HIV testing, treatment, and even disclosure.

It has been said that we can either criminalize HIV positive status or lower its incidence, but not both.

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