August 30, 2018
Introduction of highly active antiretroviral therapy (HAART) has significantly decreased deaths in HIV-positive children, most of whom were infected from pregnancy or breastfeeding. Before, HIV-positive children rarely lived past their fifth birthday; today, they are living into their teenage years. As a result, parents and health care providers struggle to decide how and when to tell an adolescent that he/she is HIV-positive.
Researchers from the Office of Public Health Studies at the University of Hawaiʻi at Mānoa explore this dilemma in a paper published in the American Medical Association Journal of Ethics this month, “Should There Be a Disclosure Mandate for Physicians Caring for Perinatally Infected Adolescents Who Don’t Know Their HIV Serostatus?” First author Sabhyta Sabharwal wrote the paper during a class when she was an MPH student at the University of Hawaiʻi at Mānoa with her instructor and assistant professor Victoria Y. Fan, ScD, SM. Jason W. Mitchell, PhD, MPH, assistant professor, is also a co-author on the paper. Sabharwal is currently a medical student at Tufts University School of Medicine in Boston, Massachusetts.
This paper highlights current gaps in HIV disclosure policies for adolescents in America. Currently, the law does not require providers or caregivers to tell minors that they are HIV-positive. In some states, the physician needs parental consent before they can tell a minor that he/she is HIV-positive.
On the one hand, disclosure may cause psychological distress, social stigma, or social isolation to the minor. On the other hand, adolescence is a time when children are more likely to engage in risky behaviors and if a minor does not know they are HIV-positive, they can have unprotected sex and infect unknowing partners. Furthermore, adolescents living with HIV could face criminal penalties if they fail to tell sex partners about their HIV-status once they turn 18.
For these reasons, physicians should be legally allowed to tell adolescents of their HIV serostatus, even if parental consent is not granted.
Additional details about this paper can be found here: https://journalofethics.ama-assn.org/article/should-there-be-disclosure-mandate-physicians-caring-perinatally-infected-adolescents-who