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Friday, November 15 • 3:35pm - 5:34pm
S15: Collusions of Silence and Bioethical Dilemmas Unique to HIV Psychiatry - A Joint APM Bioethics and HIV/AIDS SIGs Invited Symposium

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While disclosure of any severe and complex illness can be complicated, the disclosure of HIV can be particularly challenging because of various personal, ethical, legal, and public health implications. Fear of being stigmatized or forced to disclose sexual activity or intravenous drug use can make people reluctant to acknowledge HIV infection. Disclosure can also lead to rejection by friends and partners, jeopardize housing, education, employment and relationships, and may increase the risk of intimate partner violence. Patients, families and health care providers sometimes engage, deliberately or unconsciously, in a conspiracy of silence around HIV status. Such collusion often serves a purpose, for instance, keeping a patient engaged in healthcare, or concealing a deceased mother's HIV status in order to hide her history of addiction and prostitution from her child, but secrecy can have significant consequences. Non-disclosure can lead to delay in diagnosis or treatment, non-treatment, increased risk of transmission to others and increased illness, disability and mortality. The outcomes can be frankly tragic. Psychiatrists are often asked to assist with difficult cases, but some issues defy easy resolution. In this symposium we will present three cases to illustrate some of the bioethical dilemmas unique to HIV psychiatry and provide participants with an opportunity to discuss similar bioethical binds, and posit a way forward.

When ethics, legal, obstetrics, psychiatry, and pediatrics (and the patient) can't agree: a pregnant woman who refuses to disclose to her husband that she is HIV positive- Catherine Harrison-Restelli, MD, University of Maryland School of Medicine, Baltimore, Maryland

Bioethical dilemmas raised in the cases of two adolescents with vertically transmitted HIV: challenges in evaluating capacity and planning for discharge and follow up care in minors with AIDS, cognitive impairment, noncompliance and multiple psychosocial stressors - Nicole Mavrides, MD, University of Miami Miller School of Medicine, Miami, Florida. Chair: Mary Ann Cohen, MD, FAPM, Mount Sinai School of Medicine, New York, New York. Discussants: Maryland Pao, MD, FAPM, NIMH/NIH, Bethesda, Maryland; Suad Kapetanovic, MD, NIMH/NIH, Bethesda, Maryland

Speakers
avatar for Mary Ann Cohen

Mary Ann Cohen

Clinical Professor of Psychiatrt, Mount Sinai School of Medicine
Dr. Mary Ann Cohen is Clinical Professor of Psychiatry at the Mount Sinai School of Medicine. Board certified in adult psychiatry, addiction psychiatry, geriatric psychiatry, and psychosomatic medicine, Dr. Cohen is a leader in the fields of psychosomatic medicine and HIV psychiatry... Read More →
avatar for Catherine Harrison-Restelli

Catherine Harrison-Restelli

Assistant Professor of Psychiatry, University of Maryland, Baltimore
Catherine Harrison-Restelli studied Economics at Penn, then spent 5 years in neuroscience research and earned her MD at Weill-Cornell. She completed her intern year in Gynecology-Obstetrics at Johns Hopkins, residency in Psychiatry at the University of Maryland-Sheppard Pratt and... Read More →
SK

Suad Kapetanovic

Assoc Deputy Clinical Director, NIH/NIMH
Psychiatric aspects of HIV/AIDS, full biopsychosocial spectrum.
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Nicole Mavirides

University of Miami MillerSchool of Medicine
MP

Maryland Pao

Clinical Director NIMH, National Institutes of Health
I am the Clinical Director of the National Institute of Mental Health Intramural Research Program at the National Institutes of Health, and Chief of the Psychiatry Consultation Liaison Service in the Mark O. Hatfield Clinical Research Center. I study distress at end-of life, anxiety... Read More →


Friday November 15, 2013 3:35pm - 5:34pm
Verbena Westin La Paloma Resort & Spa

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