The HIV infected individual who puts others at unreasonable risk. The HIV Case Management Cttee.
Int Conf AIDS 1993 Jun 6-11; 9:124 (abstract no. WS-D21-3) Watson C, Philp A, Percy F, Hamilton M; Health Dept of Western Australia, Perth.
Faced with a strong allegation, self disclosure or other confirmatory evidence of an HIV infected individual putting others at unacceptable risk, a health department official (and indeed any doctor or health professional) has a serious responsibility to act appropriately to protect the public. These cases are rare, but if no action is taken, officials might well be held legally responsible at a later time for the infection of others. In Western Australia, this difficult issue has been successfully addressed over the past four years by a flexible system that has minimised the public risk while maintaining the trust and cooperation of individuals who admitted that they were putting others at risk. The main features of this system are: 1) comprehensive protocols developed in consultation with a range of stakeholders; 2) provision of adequate resources to investigate allegations and manage cases; 3) use of part time staff with extensive experience in management of individuals with serious behaviour problems; 4) availability of consultant assistance from a psychiatrist with a particular interest in these cases; 5) medical support from a unit experienced in HIV medicine; 6) availability of suitable housing for crisis accomodation; 7) supervision of all interventions by a small committee made up of public health officials, behavioural, management specialists, and a public interest representative. It has been our experience that public health laws are of little practical use in these cases except as a threat to encourage cooperation. We believe that it is vital to offer a service such as described above. Even if it cannot be adequately resourced, the service must have agreed protocols for case management and a supervisory committee which is accountable to the public. If this is not done, the results will be cases of HIV infection that could have been prevented, public outrage and authoritarian backlash. Finally, the individuals about whom allegations are made are often in need of counselling and other support on account of their general behavioural problems.
Keywords: AEGIS, HIV, Case Management, HIV Infections, Risk, Health Personnel, Risk-Taking, Psychiatry, Mental Disorders, Self Disclosure, Risk Factors, Referral and Consultation, Attitude of Health Personnel, Western Australia, ICA9 930606
WSD213
