HIV and duty to protect: A survey of licensed professional counselors and physicians

This study was designed to investigate what course of action therapists and physicians report they would take in reconciling their conflicting duties to maintain confidentiality and protect third parties from harm in HIV-related situations. The physicians surveyed were licensed to practice medicine in Texas and board certified in Internal Medicine. The therapists surveyed were licensed professional counselors in Texas and members of one of three selected divisions within the Texas Counseling Association. A survey instrument developed by the researcher was mailed to 200 subjects randomly selected from each group.;The major findings of this study were as follows: (1) When an HIV positive client continues to engage in unprotected sex with an uninformed, identifiable third party, significantly more therapists and physicians reported they would inform the third party rather than maintain confidentiality or notify medical or law enforcement personnel. When the danger involved a needle-sharing partner, significantly more therapists would choose to inform the partner, while physicians would elect to notify authorities. However, when the client reports engaging in protected sex with a partner unaware of his HIV-status, significantly more therapists and physicians would choose to maintain confidentiality. (2) Respondents in both groups reported "degree of dangerousness" as the most important factor to consider before breaching confidentiality. Ethical guidelines and state statutes were identified as the two most important resources to utilize when making such a decision. (3) The results demonstrated therapists are not knowledgeable that Texas law limits breaching confidentiality to medical or law enforcement personnel when third parties are endangered. (4) Twenty-four percent of therapists indicated they would hesitate treating HIV positive individuals. The most frequently cited reason for hesitation involved the lack of clear ethical guidelines and state statutes relevant to this issue. (5) The majority of therapists recommended that ACA develop ethical guidelines which specifically address confidentiality and the duty to protect in HIV-related cases.