Following exposure to the human immunodeficiency virus (HIV) it is advisable for the healthcare worker (HCW) to take post-exposure prophylaxis. A prerequisite for this is the establishment of the HIV status of the HCW and the patient. Ordinarily, this would be preceded by the ascertainment of the HIV status of the HCW and the patient. This should be done as soon as possible after exposure, usually within 24 hours. If the exposure takes place when the patient is under anaesthetic, which is often the case, consent for HIV testing is not readily forthcoming and this poses an ethical dilemma. A similar dilemma is posed by a patient who, having awoken, is not in a position or is unwilling to give consent. This paper discusses the ethical and legal constraints on the HCW and the employer in circumstances where the patient is not in a position to give consent. The paper concludes by restating the need to respect confidentiality and the autonomy of the patient and that informed consent is paramount in testing for HIV status. The paper proffers the view that testing the patient will not substantially alter the course of action open to the HCW and, in any event, will do little to allay the fears of HCWs.
Social concerns relating to human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) can be understood in two ways. Firstly, social concerns can refer to the health determinants of the pandemic. The second disquiet relates to the way in which the HIV/AIDS pandemic has impacted upon society socially. One of the most vexing ethical dilemmas faced by doctors in this regard, concerns confidentiality. This pertains to whether or not their patient's HIV-positive status should be kept confidential, or disclosed it to a third party. In this article, we will examine the meaning of "confidentiality" as it relates to the doctor-patient relationship. We will then discuss the two oppositional positions: keeping a patient's confidentiality, or breaching it.