Ethical Dilemma of Hiv Disclosure in Intimate Relationships

HIV Prevention with Positives in Thailand: Ethical Dilemma of HIV Status Disclosure in intimate relationship.

Abstract
Every year, there are about ten thousand new HIV infection cases in Thailand. The majority of new HIV transmissions in Thailand have changed from commercial sex to intimate relationships while HIV prevention generally focuses on self protection and universal precaution. In 2003, Center for Disease Control and Prevention recommend to integrate HIV preventive measure into routine HIV care. According to a survey of People Living with HIV and AIDS (PLWHA) in Thailand, 45% of HIV infections came from transmission between spouses and 10% believed that their partners knew their HIV status before having a relationship. Unprotected sex increased in those who did not disclose HIV status to partners. Health professionals reported the limitation of time for counseling and recognized the risk of HIV transmission between sexual partners. Health care providers face ethical dilemmas regarding disclosure of HIV status in intimate relationships. In this ethical dilemma, most exempt notifying patients’ sexual partner with the reason that it is the right and confidentiality of HIV patients. This paper argues that disclosure of HIV must be promoted in intimate relationships, because the right to healthy life of the sexual partner outweighs the right to privacy of the HIV positive individual and condom use is low and difficult to put in practice in intimate relationships. Given the largest proportion of spousal transmissions, the principle of responsibility should be complementary with the principles of self-protection and universal precaution. HIV prevention campaigns focusing on universal vulnerability are not effective in intimate partnerships where trust, fidelity and monogamy are mostly expected and are barriers of condom use. The legal requirements are unclear in Thailand and the policies are not explicitly determined. This paper proposes that PLWHA should

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