I would also have to agree with Amanda on the subject of notifying police about your client’s HIV status and acts of unprotected sex with a friend. As you quoted from the Code of Federal Regulations, disclosure is necessary “to protect against an existing threat to life or of serious bodily injury, including circumstances which constitute suspected child abuse and neglect and verbal threats against third parties” (Code of Federal Regulations, 2020 current, 2.63(1)). That would also only apply if a court order were issued. And to my understanding of contracting HIV, it is not a “threat to life or of serious bodily injury”. With this knowledge I would not notify police and break the confidentiality laws.
I was also unclear at first as to what you would actually decide to do. In the first paragraph you mentioned that you would feel morally bound to reveal your client’s HIV status and warn their friend or tell the police, but I am glad that you cleared it up in your summary statement that although you would feel morally obligated to break confidentiality, that legally you think that you are not within your bounds to do so. As you also referenced from Miller (2020), only a court order would authorize you to disclose the activities of your client. I also did not find anything in the CFR code that would give you legal rights to disclose your client’s HIV status and sexual activities to warn the friend or the police.
Knopf, A. (2016). Ethics: New code from NAATP, ongoing from NAADAC. Alcoholism & Drug Abuse Weekly, 28(16), 4-6.
Miller, T. M., Lester, J., Kwan, L., Tandel, M. D., Karlan, B. Y., & Rimel, B. J. (2020). 21 Code of Federal Regulations Part 11–Compliant Digital Signature Solution for Cancer Clinical Trials: A Single-Institution Feasibility Study. JCO Clinical Cancer Informatics, 4, 854-864.
Sanders, C. (2014). Discussing the limits of confidentiality: The impact of criminalizing HIV nondisclosure on public health nurses’ counselling practices. Public Health Ethics, 7(3), 253-260.
42 C.F.R. § 2.63(1) (2020). https://www.ecfr.gov/cgi-bin/text-idx?SID=2af5605ec8425bc7d69e974c0087b473&mc=true&node=pt42.1.2&rgn=div5
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