Counseling Sexually Active Clients with HIV
Lethal Sex:
Conditions of Disclosure in
Counseling Sexually Active Clients with HIV
Elliot D. Cohen, Ph.D. The present HIV pandemic presents challenges for mental health practitioners who, in the course of therapy, sometimes become privy to confidential information about potentially lethal sexual relationships ongoing between the client and one or more uninformed partner(s). In this lecture I will discuss the current professional/legal status of making disclosure in such cases, and my work as an applied professional ethicist in the development, drafting, and defense of a limited rule of disclosure. State statutes typically make it a crime for a person who knows that he or she is HIV positive to engage in unprotected sex with an uninformed sexual partner. The victim of such a crime need only suffer emotional distress upon learning about exposure to the deadly virus, and need not actually contract the virus from the offender. With some variation in state laws, there appears to be consensus that such acts of endangerment are beyond the tolerance of law and public decency. There is considerably less agreement about what is acceptable for mental health practitioners (such as psychologists, mental health counselors, and clinical social workers) who, in the provision of treatment, confidentially learn that their HIV positive clients are similarly endangering third party sexual partners. Do these professionals also have a duty to disclose such potentially life saving information to the third parties at risk? An affirmative answer to this question may seem compelling in the wake of the famous Tarasoff case in 1976, which, in recognizing a professional duty to warn unsuspecting third parties of immanent danger of bodily harm posed by a client, announced that “privacy ends where the public peril begins.” However, in 1999, the Texas Supreme Court denied that mental health practitioners in Texas owe a duty to warn third parties, “because the
Conditions of Disclosure in
Counseling Sexually Active Clients with HIV
Elliot D. Cohen, Ph.D. The present HIV pandemic presents challenges for mental health practitioners who, in the course of therapy, sometimes become privy to confidential information about potentially lethal sexual relationships ongoing between the client and one or more uninformed partner(s). In this lecture I will discuss the current professional/legal status of making disclosure in such cases, and my work as an applied professional ethicist in the development, drafting, and defense of a limited rule of disclosure. State statutes typically make it a crime for a person who knows that he or she is HIV positive to engage in unprotected sex with an uninformed sexual partner. The victim of such a crime need only suffer emotional distress upon learning about exposure to the deadly virus, and need not actually contract the virus from the offender. With some variation in state laws, there appears to be consensus that such acts of endangerment are beyond the tolerance of law and public decency. There is considerably less agreement about what is acceptable for mental health practitioners (such as psychologists, mental health counselors, and clinical social workers) who, in the provision of treatment, confidentially learn that their HIV positive clients are similarly endangering third party sexual partners. Do these professionals also have a duty to disclose such potentially life saving information to the third parties at risk? An affirmative answer to this question may seem compelling in the wake of the famous Tarasoff case in 1976, which, in recognizing a professional duty to warn unsuspecting third parties of immanent danger of bodily harm posed by a client, announced that “privacy ends where the public peril begins.” However, in 1999, the Texas Supreme Court denied that mental health practitioners in Texas owe a duty to warn third parties, “because the