Discussing the Limits of Confidentiality: The Impact of Criminalizing HIV Nondisclosure on Public Health Nurses’ Counseling Practices, Public Health Ethics Volume 7, Number 3, Chris Sanders (2014)

This article explores whether and how public health nurses in Canada try to control information about the limits of confidentiality at the outset of HIV post-test counseling. The data, drawn from qualitative interviews with 30 nurses working at four public health units in Ontario, Canada, indicate variation in practices, as nurses pragmatically balance ethical and professional concerns. In Canada, public health records have been subpoenaed to aid in police investigations and/or to be presented in court as evidence against people living with HIV in criminal nondisclosure cases. This has led some to suggest that nurses should provide explicit warnings about the limits of confidentiality in relation to HIV nondisclosure crimes. Others maintain that a robust account of the limits of confidentiality will undermine the nurse–client relationship and the public health goals of reducing HIV/sexually transmitted infections. Although some nurses intentionally withhold information about the risk of subpoena, others report talking to clients about confidentiality in ways that focus on the risk of harm associated with criminalization. The variations in practice shed light on relations between health care and the criminal justice system.