Prevention with Positives HIV Clinician Training Legal concerns of providers integrating HIV prevention into clinical practice Carol Dawson Rose, PhD, RN

A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e 2 Objectives To explore the legal and ethical concerns of HIV providers who are integrating prevention into HIV clinical care To engage in a discussion of prevention framework Protecting selves Protecting others

A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e 3 What is happening?  Increased governmental policy focus on integrating HIV prevention into care  Government programs mandate inclusion of HIV prevention into HIV care  24 states have adopted statutes that criminalize intentional exposure or transmission of HIV  Variation in how criminal HIV laws are enforced

A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e 4 What are your concerns?  Ethical  Legal

A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e 5 What Exists Now? Confidentiality Policies State Funding Source HIPAA Regulations

A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e 6 What are provider concerns? What should I tell my patients? What can I document in the medical record? What are my ethical obligations when I know someone is at risk for becoming HIV infected by one of my patients? What am I liable for if someone I knew was at risk becomes infected?

A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e 7 Example: California Law Talking to your patient Reporting to the partner/PCRS Charting

A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e 8 Where do I find answers? Institutional Ethics Committee Community Advisory Committee HIPAA Regulations Institutional Legal Counsel HIV Criminal Law & Policy Project State Medical/ Professional Associations

A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e 9 Case Study Brian has been your patient for years Brian has not disclosed his HIV positive status to his wife of three years Brian has told you, that for over a year, he and his wife have been trying to have a child You have counseled Brian on the potential risk to his wife of HIV infection. You are concerned that Brian’s wife is pregnant and that Brian is still resistant to discussing his HIV status with his wife

A M e m b e r o f t h e U C S F A I D S R e s e a r c h I n s t i t u t e 10 Case Study What are your legal obligations? Specific to the state where you are practicing What are your ethical concerns? Brian’s wife and her HIV status Potential infection of the unborn child with HIV