A study of ethical decision-making in HIV-related psychotherapy.

Abstract

There are complex ethical and legal issues that arise when an HIV-positive client presents as a danger to others as a result of engaging in unprotected sex. The purpose of this study was to examine how and why psychologists deal with such a situation. The respondents were asked a combination of questions related to a case vignette in which a male client was diagnosed as HIV-positive after an extra-marital relationship with a work colleague. The client was not prepared to disclose his HIV-status to his wife. A total of 154 psychologists within South Africa responded to the study, which was a response rate of 25%. The results of this study indicated that an overwhelming pro­portion (96.7%) of the respondents assessed the client to be very dangerous in terms of the HIV/ AIDS risk to his wife. The majority of the respondents ( 65 .1 % ) indicated that the primary goal in psychotherapy would be to guide the client to disclose his HIV status to his wife. Almost 59% of the respondents indicated that they would not breach confidentiality by contacting the client's wife. Examination of the psychologists' ethical decision-making process took into account the respondents' knowledge of the HPSCA (2004) guidelines to guide the client to disclose his HIV status to his partner. The study also assessed the respondents' knowledge of the foundational ethical principles. The findings of this study have implications regarding how psychologists function in their professional domain. Of particular concern is that a significant proportion of psychologists may not have adequate knowledge of the ethical principles and HPCSA guidelines in this area. One of the limitations of this study was the low response rate (25%), which prevented the examination of a complete range of participant demographics. Given the low response rate, future research in this field is needed to better understand Psychologists' management of the duty to warn in HIV-related psychotherapy.