Chapter 3: Patient Care and Rights
In this chapter you will discover information and tips for helping out a HIV patient. You may never know if a client has HIV, but in the event that you learn you will be one step ahead. We will discuss particular laws that affect HIV patients, what the client may do or not do, and how you can ease the transition if HIV discovery is made.
– US Representative, Barbara Lee (D-CA)
HIV Patient Reactions Vary
HIV patients usually don't know they are infected until it is too late. The sudden surprise of this will be shocking. Patients will question what they did, who they trusted, if they will be ok and who will accept them. Anger and sadness can occur, but patients vary. As a health care worker you are not legally allowed to inform others about the patient's condition, unless they consent to it. So, until permission is given, your job is to educate and answer questions for your patient. Implied consent should be treated carefully.
How to Handle an HIV Patient
It is not good to say, "It will be okay." HIV is manageable, but it will take a lot for the patient to get used to, if they do at all. Your best approach is to offer information to help the patient cope, and to leave doors open for questions. It is possible that they have given or received the virus from someone. Loved ones may need to be tested. Time may also be needed to take this revelation in. Stay calm and ask the patient if they would like to know more. If they do not want information remind your patient that you are here to provide that to them. It keeps the door open for the patient, and helps avoid unnecessary conflict.
Questions and HIV Patient May Ask
HIV patients will want to know what resources are available to them when the time comes. Be ready to answer questions such as:
- Who is legally allowed to know about their condition?
- How will it affect my life?
- Will I be able to do normal things?
- Can I be intimate?
- Are there support groups?
- How did I get the virus?
- How should I tell my family?
- What are my top concerns?
- Is HIV covered as a disability for medication assistance?
With permission from the patient you may discuss your patient's HIV status with family members or friends. This can be done in order to help ease the transition. If you have not been permitted, you are liable for any unnecessary disclosures. It is important to teach HIV acceptance, that HIV is not easily spread and that the patient can still express love safely through hugs and kisses.
Patients have the same rights as any other person. They can make legal decisions for themselves, they can travel where they want to and they can be around whoever they want to. They may still have consensual sex (as long as the client acknowledges their status to avoid legal/criminal complications), and they may still have children. They can work anywhere, so long as there is not a heavy occupational risk of transferring HIV. This does not stop someone from making food or working in the medical industry for example. These jobs require gloves, which helps prevent HIV and hepatitis.
- Residents must be taught HIV prevention. If they persistently infect others with the virus it is legal for them to be held for 90 days. This period includes court and a counseling session.
- Pregnant women will be encouraged to take an HIV test prior to delivery. This is optional. Clients will sign a disinclination form.
- At the discretion of the person, HIV patients may inform their sexual partners through a professional health care worker. Professional care workers do not state the name of the infected.
- Victims of sexual assault are entitled to the HIV status of their convicted assailant.
Help can be found through local health departments. Case managers will provide this if requested.
National HIV/AIDS and STD Information (English & Spanish):
- 1-888-232-6348 (TTY)
HIV patients are protected by two primary laws:
- State Discrimination Laws: prevents discrimination based on HIV and hepatitis.
- Americans with Disabilities Act of 1990: requires reasonable accommodation in the workplace, and it prevents penalties in pay and unreasonable layoffs. This prevents employers, and people from discriminating against HIV individuals. HIV is a legal disability, so state services can help HIV patients afford medication. Damages can be sought in court. Note: This sets the framework for most state guidelines, as the ADA Act is a federal law.
- Note: Patients cannot be denied a promotion on the grounds of HIV and they cannot be denied legal services. Restaurant workers cannot refuse to serve a patient on the grounds of HIV; patients may not have an apartment application rejected and they cannot have their insurance coverage dropped solely because of HIV. Most importantly, they can never be denied health care.
In the Event of Discrimination
Employers are required by law to provide a discrimination-free workplace. If discrimination exists, you must inform your employer. If no action is taken, you may report your claim to the Office for Civil Rights or your state's Human Rights Commission within 180 days of your alleged encounter, regardless of a work setting.
HIV/AID patients may not apply for the Peace Corp, Job Corp, or the army. HIV information can be transmitted to insurance agencies (only when it is necessary), the local health department, in life or death emergencies, and between other healthcare workers. An intentional disclosure is a misdemeanor and carries fines up to $10,000. Medical workers must report HIV status to the local health department, like other STIs. This is for public health benefit purposes. Names are not publicly made available. Refer to your employer policy.
In 2010, the US redefined its view on national HIV policy. It no longer considered HIV a nationwide communicable threat. As a result, the travel ban was lifted for incoming and outgoing visitors with HIV. There are several key changes that occurred from this definition change:
- Visitors no longer had to take a test to declare their HIV status, however, they must still report it on applicable forms.
- HIV tests are no longer necessary for visa applications.
- Immigrants can no longer be denied citizenship for HIV.
Reasoning Behind Change
Worldwide there are unnecessary isolationist policies regarding HIV migrants, especially in places such as China. HIV as not as communicable as the flu and is relatively easy to treat and prevent. While this change in the US is a great step forward, many countries do not necessarily embrace this same policy. It is currently being pursued by the UN.