Privacy, secrecy and confidentiality : changing paradigms in the face of the HIV pandemic

Master Thesis


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University of Cape Town

This paper stems from discussion of real life problems experienced at a local state hospital, and that have been presented to the University of Cape Town Bioethics Centre. These problems will be outlined from their social, medical and ethical perspectives. The dilemmas relating to confidentiality and disclosure of HIV status will be illustrated by empirical research data conducted in an HIV treatment unit, and with reference to the broad literature on this subject. It will be argued that confidentiality issues are poorly understood by healthcare professionals and their patients. In addition, and related to this lack of understanding, is a failure to construct and implement policies to protect specific confidentiality needs in the healthcare environment The practical problem of patient disclosure of HIV status will be explored using data generated from the author’s own practice. A review of the debate regarding confidentiality in the healthcare context will be provided, with reference to the literature on the subject. Guidelines for drafting a facility specific confidentiality policy will be provided, along with a draft policy for use as a template in this situation.

Includes bibliographical references (leaves 93-97).