Wednesday, May 15 th 1:00 p.m. – 1:30 p.m.

Dr. I. Jean Davis, PhD, DC, PA, AAHIVS

Dr. Berthie Labissiere, DPM

Maria, a 25-year-old Latina woman was diagnosed with HIV five years ago. She never sought treatment, but was eventually started on antiretrovirals when she developed a case of pneumonia. She was referred to the health department for case management services. During her application for these services, she brought in an application form for her health care professional to complete. This form requested detailed medical information about her health status. In keeping with the policy of the clinic, a signed informed consent was requested for the release of information. Several weeks later, Maria returned to the clinic, indignant, because her HIV status was disclosed in the form. After calming her down, it was discovered that she understood the informed consent to mean permission to say she had a medical condition, but not the details of her HIV status.

 What issues are related to the continued stigma surrounding HIV/AIDS?  How should the purpose of the informed consent be addressed?

Peter is a 31 year-old who began having sex with men when he was a teenager, but managed to hide this from his family. He felt having sex with men was natural for him, but worries his family would find out and make his life miserable. Other friends had been “discovered” by their parents and their lives had become hell and he wanted to avoid this. His family suspected he might be gay, but they didn’t bother him until he was 30, when they started to pressure him to get married. He agreed to the marriage to get them off his back. Soon after getting married, he found out that one of his previous male partners had tested HIV-positive, so he started to worry about his own status and questioned himself.

 What happened in the scenario?  Why is Peter behaving the way he is?  How does stigma affect disclosure to his partners and his use of health services?  Discuss the approach you would use to offer Peter the HIV test based on the information he has provided.  What key counseling strategy would you offer to him if Peter was found to be 1. HIV+ or, 2. HIV negative?

Kenny is a 28 year old African American man diagnosed with HIV three years ago. He was never prescribed ARVs. He has no history of opportunistic infections but is morbidly obese with co-morbidities of hypertension and hyperlipidemia. He presents with a 10 year history of crack cocaine addiction and alcohol abuse. Kenny states he has received treatment for his addictions but usually quits after a week because he forgets to attend. His last drug use was 1 year ago when he met Tasha. Tasha is his fiancée who had a positive home pregnancy test last week. Kenny has not disclosed his HIV status to Tasha because he does not believe ARVs are effective since HIV was caused by the drug company and taking drugs is one way to keep lining their pockets.

 How do you proceed?  Does the provider have an ethical responsibility to Kenny’s fiancé to reveal his diagnosis of HIV?  Could you identify any barriers to care in this encounter?  What could the provider do to build trust and establish a rapport with this patient?  Should the provider encourage Tasha to take an HIV test?  If Tasha is not infected, what precautions will be most important to be discussed?  Should he agree, describe the procedure you would implement to put Kenny on ART.  Should the provider address Kenny's co-morbidities?

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