Sharing information about HIV status
The status of HIV positive patients should always be treated as highly confidential (see the HPCSA’s guidelines in Box 7). Your medical records system should, therefore, include a means of “sealing” highly sensitive information that can only be accessed by specified individuals.
Sharing information within the healthcare team about a patient’s HIV status is only permissible if the patient has given consent or if it is clinically indicated.
The HPCSA states: “In the management of an HIV positive patient it is important that the health care practitioner gives due consideration to other health care professionals who are also involved in the management of the same patient (eg where necessary, and with the patient’s consent, informing them of the HIV status of the patient).”5
Disclosure in the public interest
The National Health Act makes an exception to the rule of confidentiality if non-disclosure of a patient’s personal health information would pose a serious threat to public health.
HPCSA guidance states that, for disclosure to be justified, the risk of harm to others must be serious enough to outweigh the patient’s right to confidentiality. If you judge that this is the case, you should attempt (if it is safe and appropriate) to obtain the patient’s consent first, but should go ahead with disclosure to the appropriate authorities if this is not forthcoming.6
Carefully document the reasoning beside your decision to disclose, together with details about any discussions you may have had with colleagues in the course of your decision-making.
Box 7: HPCSA guidelines on patients’ HIV status
- Ethics, the South African Constitution (Act 108 of 1996) and the law recognise the importance of maintaining the confidentiality of the HIV status of a patient.
- The test results of HIV positive patients should be treated with the highest possible level of confidentiality.
- Confidentiality regarding a patient’s HIV status extends to other health care practitioners. Other health care professionals may not be informed of a patient’s HIV status without that patient’s consent unless the disclosure is clinically indicated. For treatment and care to be in the best interests of the patient, the need for disclosure of clinical data (including HIV and related test results), to health care practitioners directly involved in the care of the patient, should be discussed with the patient.
- The decision to divulge information relating to the HIV status of a patient must always be done in consultation with the patient.
- The report of HIV test results by a laboratory, as is the case with all laboratory test results, should be considered confidential information. A breach of confidentiality is more likely to occur in the ward, hospital or health care practitioner’s reception area than in the laboratory. It is, therefore, essential that health care institutions, pathologists and health care practitioners formulate a clear policy as to how such laboratory results will be communicated and how confidentiality of the results will be maintained.
HPCSA, Ethical Guidelines for Good Practice with Regard to HIV (2008), para 5.
Protection of vulnerable patients
If you have reason to suspect that a child or adult lacking capacity is being neglected or abused, you must act in the patient’s best interests by reporting your concerns to a responsible person or statutory agency.7 You should try to obtain the patient’s consent first, but if this is not forthcoming, the matter should still be reported (preferably with the patient’s knowledge).
Should you on reasonable grounds conclude that a child has been abused in a manner causing physical injury, or has been sexually abused or has been deliberately neglected, you must report that conclusion in the prescribed form to a designated child protection organisation, the provincial department of social development or a police official (see Section 110(1) of the Children's Act 38 of 2005).
The HPCSA recommends informing the child’s parents first, unless you judge that this would not be in the child’s interests.8
It is important that you carefully document your reasons for making a disclosure in these circumstances.