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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
