The "Duty to warn" !!

We had a young female with HIV for 10 years,who came with an infected condyloma. She has had previous MAC, vulval cancer and cervical dysplasia  in the past. She has been with her partner for last 1 year, and they are sexually active,and use protection everytime. But when enquired, she said that the partner does not know about her HIV status , and she did not want to disclose this to him .Now.......do we have to honour her wish or...do we have to let the partner know?? Lets see what Connecticut law tells us.....(beware..this may not be true for other states!)

The term “duty to warn” refers to situations in which a  physician may learn that a patient is engaging in unsafe sex without having disclosed his or her HIV-positive status to the partner.
Connecticut law permits both public health officers and physicians, under certain circumstances, to inform or warn partners that they may have been exposed to HIV.The term “partner” means an “identified spouse or sex partner of the protected individual or a person identified as having shared hypodermic needles or syringes with the protected individual.” The requirements for such a disclosure by a public health officer are that:

1.There is a reasonable belief of a significant risk of transmission to the partner.

2.The public health officer has counseled the individual regarding the need to notify a partner and reasonably believes that the individual will not disclose to the partner; and

3.The public health officer has informed the protected individual of his or her intent to make the disclosure.

A physician may only warn or inform a known partner if both the partner and the individual with HIV are under the physician’s care. A physician may also disclose confidential HIV related information to a public health officer for the purpose of warning partners, if the physician takes the same steps with respect to his or her patient as public health officers must take above.

In making such a warning, the physician or public health official shall not disclose the identity of the HIV-infected individual and, where practicable, shall make such disclosure in person.

Well...this is still an evolving area of ethics, and might change in the future. Hope this helps.....and this is a sensitive issue to be dealt.