History and Bioethics of HIV Counseling

This article discusses the history and bioethics of HIV counseling. It covers the ethical principles of confidentiality and informed consent, modifications in bioethics, and other ethical factors. The article also highlights the mandatory HIV counseling for pregnant women in developed countries.

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History of HIV Counseling
During the initial years, HIV counseling is done based on how the person got infected
with HIV, information about his or her partners or reference to multiple partners and
unprotected sex in conjugal life. Counseling used to take place once the people get affected
with HIV and questions were more gender specific. At present, the HIV counseling occurs
before marriage, at the time of the unplanned pregnancy or among the young live-in couple.
People are now more open-minded about their conjugal life and thus the pattern of questions
has been changed. Apart from the education about HIV, importance is also given to the
underlying psychological perspective behind sexual life and concept of the multiple partners
(Bor, Miller & Goldman, 2013).
General Bio-Ethics of HIV Counseling
There are three widely recognized principles under the American bioethics that apply
to research and the clinical ethics: respect for the service users and their family members,
justice for all and beneficence. Under the under the ethical issues related to HIV/AIDS
counseling, the main areas that are required to be taken under consideration include
confidentiality and informed consent. In United States, all medical information is considered
as confidential and protected under the law of the bio-ethics. Due to the sensitivity of the
HIV/AIDs related information, states in U.S have adopted additional laws that provide
stringent protection to the HIV-related medical health records. For example, states in the U.S,
the information related to HIV-check ups are not disclosed based on general release of the
medical information like the medical bulletin. The information related to HIV can only be
released upon specific authorization. However, breaching of confidentiality is permitted
under sudden circumstances (Tucker & Rennie, 2014). For example, the healthcare providers
working in the U.S are permitted to disclose a patient's HIV-related information to another

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person who is found to be vulnerable towards developing HIV. This breaching of ethical
principle of confidentiality does on impose legal penalty. However, in states like California, a
healthcare provider might not warn sexual partner or partner using drugs of an affected
individual without information first the patient of the intended disclosure. This kind of
exception of confidentiality is justified because breaching of the ethical issue of
confidentiality will ensure prevention of fatal harm to an identifiable person (Tucker &
Rennie, 2014).
The ethical issue of the informed consent under HIV counseling mainly encompasses
written consent before the initiation of counseling. The informed consent mainly highlights
detailed steps that will be performed in the counseling process, the questions that will be
asked, the intended outcomes, and the names of the additional members who might be
included in the counseling process for the improved outcomes (Tucker & Rennie, 2014).
Modification in the Bioethics
The current counseling process of the HIV/AIDs has invited in modifications in the
informed consent. Informed consent (IC) is not defined by CIOMS (Council for International
Organization of Medical Sciences) under the joint collaboration of World Health
Organization (WHO) as a decision of the service users to take part in the research. This
service user here is considered as competent individual who has received required
information and has adequately understood the information and then have arrived to decision
to take part in the availing the service. Informed consent is now based on the ethical principle
of autonomy that is freedom to choose. Moreover, under informed consent, adequate time
must be given to the participant attending the counseling in order to decide whether they are
willing to take part in the counseling process whole-heartedly by unknowing the intended
outcomes (Sugarman, 2013).

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Other ethical factors included in the ethical concerns for the HIV/AIDS counseling
include beneficence (responsibility to act in best interest for the individuals) and non-
malfeasance (not causing intentional harm) (Sugarman, 2013).
At present HIV counseling for the pregnant women in developed countries is
mandatory. It starts with pre-conception counseling. Under pre-conception counseling, the
informed consent is also mandatory. However, HIV-testing of the newborn (which is
mandatory) does not required consent of the parents and in such cases the HIV status of the
mother can be revealed, breaching the ethical obligation of informed consent (Hardy & Cu-
Uvin, 2015).

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References
Bor, R., Miller, R., & Goldman, E. (2013). Theory and practice of HIV counselling: a
systemic approach. Routledge.
Hardy, E., & Cu-Uvin, S. (2015). Care of the HIV-infected pregnant woman in the developed
world. Obstetric medicine, 8(1), 13-17.
Sugarman, J. (2013). HIV cure research: expanding the ethical considerations. Annals of
internal medicine, 159(7), 490-491.
Tucker, J. D., & Rennie, S. (2014). Social and ethical implications of HIV cure
research. AIDS (London, England), 28(9), 1247.