A 25-year-old man presents to the sexual health clinic for HIV testing after a recent high-risk sexual exposure during a holiday. The test returns positive, and he is advised to start antiretroviral therapy as soon as possible to prevent the progression of the infection. He is also advised to inform his wife about his HIV status, however, he is reluctant to do so. He asks the doctor to keep it confidential. You re-visit this topic on multiple occasions but the patient still refuses to disclose this to his wife.

What is the single most appropriate action in this situation?

Options:
explanation: By simply leaving it up to the patient to decide may not be the right choice for the doctor, as the patient may be unwilling to inform his partner for various reasons, such as fear of rejection or violence. In such cases, it may be necessary to provide him with support and guidance to help disclose his HIV status.
name: Leave it for him to decide
label: e
answer: no
explanation: Informing the police would not address the public interest in this case, as it does not protect the patient's sexual partner from HIV transmission. Instead, it would potentially expose the patient to legal consequences and could harm the patient's reputation and relationships.
name: Inform the police
label: c
answer: no
explanation: While it is important to respect the patient's confidentiality, the doctor also has a duty to protect the public interest. In this case, the patient's sexual partner is at risk of contracting HIV if they are not informed about the patient's status. The doctor would be compromising the partner's health and well-being by not disclosing the partner. Therefore, this option is not appropriate.
name: Respect the patient's confidentiality and do not inform his sexual partner
label: b
answer: no
explanation: Informing the patient's GP would not protect the patient's sexual partner from HIV transmission, and it could potentially compromise the patient's confidentiality if the GP were to disclose the information to others. Instead, it would be more appropriate to work with the patient to find a way to inform the partner that respects the patient's autonomy and confidentiality.
name: Inform the patient's GP
label: d
answer: no
explanation: In the UK, there are services available to help individuals diagnosed with sexually transmitted infections (STIs) or HIV inform their sexual partners of their diagnosis. These services aim to protect the public by informing partners of the possibility of infection and encouraging them to seek medical care. In most cases, patients are given a choice to inform their partners themselves or to provide details to a healthcare worker to contact them anonymously. If the patient is unable to inform their partners within a specific time frame, the healthcare worker may step in to do so. In the case described, the man refuses to disclose to the wife of his HIV diagnosis, despite mulitple consultations. As HIV is a communicable disease, it is essential for the wife to be informed so that she can be tested and take steps to protect her health. Therefore, the healthcare provider would contact the wife through the partner notification program's protocols. The patient would be informed that this disclosure will occur, as long as it is safe to do so.
name: Notify wife via partner notification programme
label: a
answer: yes

Correct answer: a