Confidentiality and Hippocratic Oath state that a doctor should do no harm and keep all patient information a secret. This oath has been followed since the dawn of medicine. However, working in the field of reproductive health and infectious diseases, I regularly question if this law holds true when your disclosure is in question.
Let’s presume a migrant worker from Mumbai enters into the clinic and complains of chronic cough, night fevers, significant weight loss and diarrhea. You take his sputum for a TB test and venous blood for a HIV test. Both results come back positive. You offer counseling and explain to him to bring his wife for further explanation. He refuses and says he doesn’t want to disclose. According to Hippocratic Oath, the results of the test will stay confidential between you and the patient. Although disclosure to partner is recommended, it is not a necessity.
Now, let’s try and picture this from a woman’s perspective in terms of gender roles and social support required. Working in Tanzania with HIV positive mothers and their infants, facilitated disclosure has been brought up multiple times to prevent mother to child transmission and ensure there is a social support in the community. Until now, facilitated disclosure has primarily been between a husband and wife. An article from Nepal outlines the gap in facilitated disclosure in Achham. This gap has led to an increase in infections amongst vulnerable populations, in this case migrant workers. Achham being one of the poorest regions, experiences a lot of migration to India particularly amongst men. These men work for years without seeing their families in an attempt to support their family.
Going back to our initial question, if it is the man’s responsibility to support the family, shouldn’t it be his responsibility to disclose his status if he knows he is infected? Many arguments can be made to and fro. Both in Tanzania and in Nepal, it is considered an honour to give birth to a son. This honour leads to a stereotype where all men should be respected. Women should not look up or speak against her husband or partner. If the husband doesn’t want to disclose his status it is okay, but his wife should keep him satisfied and happy. However, when the wife is illiterate and is dependent on her husband, does she have a right to know? What are her rights and how can she protect herself?
Currently, she has no way. In an era where billions have been invested into HIV/AIDS, we still ask the question, whose responsibility is it to inform the woman that her partner is infected? Is it her partner’s, her partner’s family or the doctors? How does she prevent herself and her child from being infected?
I answer the questions myself. Every individual has a right to keep information to themselves even if they are infected. However I also argue that to decrease the spread of communicable diseases and attain the WHO definition of health, there is a need to promote disclosure within partners and families to protect and decrease incidence, mortality and morbidity linked with a disease.
Astha Ramaiya is the Blog Manager for Nyaya Health and a student pursuing her MSc Public Health at the London School of Hygiene and Tropical Medicine