Saturday, December 02, 2006


When I was doing my neonatology fellowship in the mid 1980's, we had a baby who was HIV positive, the virus having been transmitted from her mother during pregnancy. This was early in the AIDS epidemic, and people didn't really know or understand much about how contagious AIDS was. The baby was fine but had been removed from the mother's custody and thereafter spent months in our special care nursery, simply waiting for a family willing to take an HIV positive baby into their home. I don't remember how long the baby waited, but it was sad to see a baby languish in a hospital nursery when she really should be enjoying the stimulation of a home environment.

Yesterday was world AIDS day, which gives us a chance to see how far we've come in the fight against the disease and how far we still have to go. Today I don't think an HIV baby has nearly as much trouble finding a foster home, since we know people can live alongside HIV positive people without becoming infected. Also, anti-HIV meds have been somewhat surprisingly successful, at least for those who can afford them. Did anyone really think Magic Johnson would still be alive in 2006 when he first announced his HIV status?

But we still have a ways to go. Too many people continue to be infected, and too many people cannot afford anti-HIV drugs, especially in developing countries. It seems to me that one problem in the fight against AIDS is the conflict between the individual's right to privacy and the public's right to health. An HIV positive patient can go to a surgeon for a problem not related to his HIV, say for a hernia repair or appendectomy, and he has no obligation to tell the surgeon that he is HIV positive. Sure, the surgeon and all health care workers should practice standard precautions against catching HIV, but the fact of the matter is that we're a little more careful when we know that someone is HIV positive versus when we don't know their HIV status.

If I know a mother of my patient is HIV positive, information I need to know to properly treat the baby, but the mother has not told the father of the baby, her sexual partner, her HIV status, I have no right to tell the father of the baby that mother is HIV positive even though that information could be life saving for him. It seems like an unlikely scenario, but I'm certain it happens, and is that really right? If the mother refuses to tell her sexual partner that she is HIV positive, her right to privacy, which prevents us from notifying her partner, trumps the public's right to health by enabling the partner to contract HIV. Sure, the county public health agency is supposed to help with this, but it doesn't always work. I'm all in favor of privacy rights, but it seems that in this situation a little more emphasis on public health and less on individual rights might be appropriate.

P.S. Fat Doctor has a new Change of Shift up.


Blogger NeoNurseChic said...

We've had that situation happen! It tormented me. I really could not stand it!! What about the father's right to health and life? The way we handled it was that we were not going to come right out and tell the father that the baby was started on HIV prophylaxis, but if the father asked what the medication was that we were giving the baby, then I think first we were to say that it was an antibiotic or antiviral med (I think this was what we were supposed to do?) and if that didn't satisfy him, then we were to tell him the name of it. If he asked what it was for, then we were to tell him that. He is the baby's father, and while we do not have the right to tell him that his partner is HIV positive and concealing that from him, he does have the right to know about the medical treatment his child is receiving!

That's how we handled it - and I think it has come up in a few different ways. Not just HIV, but also in situations where mom was on certain drugs and the baby is being treated for NAS but dad didn't know mom was on the drugs/meds. I just do not like situations like that. I'm someone who values honesty so much that it pains me that two people have been so intimate, yet are not being honest with each other and they are keeping things from each other even with regards to their baby! It's just a very uncomfortable situation for me, and if given the choice, I'd frankly rather not take care of a baby in that sort of situation because it just feels like a moral conflict of interest...

I am glad we've come such a long way with respect to HIV and AIDS - and yes, still a long way to go! Another right is that when we get a needlestick, the person whose blood we got stuck with has a right to refuse to get tested for HIV. Learned that one the hard way!

Take care!
Carrie :)

10:56 PM  
Anonymous Anonymous said...

Yet if the mother had syphilis, you would be obligated to inform her partner(s). Bizarre.

10:40 AM  
Blogger SuperStenoGirl said...

It just doesn't seem right that her HIV status, which ultimately could effect his health/life cannot be shared or spoken of by the doctor. I wonder, in these situations, do doctors look at the partner (either man or woman doesn't matter) differently? I know I probably would. Does it make you think about the person in a different view, knowing that they won't inform their partner?

Like neonursechic said "it pains me that two people have been so intimate, yet are not being honest with each other.." you would think that if you care at all about your partner you would want to tell them, no matter the consequences (them being angry etcetera).

I just don't get it. Maybe I never will.

1:57 PM  
Blogger neonataldoc said...

I pretty much agree with Carrie and superstenogirl. I do look at the people a little differently if they do this; I have less respect for them.

Anonymous 10:40, are you sure? We need to report it to the public health department, but I thought we couldn't give out mother's information about syphilis or HIV without her permission.

8:58 PM  
Anonymous Anonymous said...

sometimes hippa is immoral and just plain wrong,but,the truth ultimately comes out(and sometimes the other poor person doesn't become infected,halleluyah)

10:05 PM  
Blogger purple_kangaroo said...

Very thoughtful post. These kinds of situations are so complicated.

12:34 AM  

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