Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

19. HIV/AIDS and Substance Use Disorders 425undermine treatment. Therapists must confront their own feelings and attitudestoward drug addiction, homosexuality, and AIDS.Legal IssuesIssues of confidentiality arise when treating individuals with drug addiction andHIV infection. Federal law protects the confidentiality of patient records forthose persons under treatment for drug abuse. This includes drug-abusingpatients who have AIDS. (There is, however, no general federal confidentialityprotection for medical records of AIDS patients not being treated for drugabuse.) These federal regulations protect both oral and written communications(Pascal, 1987). The more recent Health Insurance Portability Assurance Act(2003) provides for the electronic transmission of health information and isconcerned with medical record privacy and the U.S. standards for the protectionand privacy of personal health information. In the acute delivery of healthcare, use of universal precautions obviates the need to identify specifically anyindividual as HIV positive. Disclosure to those outside the clinical setting ispermitted only with the patient’s written consent. Reporting of HIV status topublic health authorities may be required in some states and may be disclosedwithout patient consent to the extent required by law. In all other situations,disclosure without the patient’s consent must be obtained through a courtorder, based on a finding of good cause (Pascal, 1987). All employers should beaware of the provisions of the Americans with Disabilities Act.Once a health care provider has knowledge of a positive HIV test, he orshe is obligated to inform the individual. Failure to do so may make the providerliable for any harm that results to the individual or to his or her sexualpartners (Pascal, 1987). Because HIV is communicable and AIDS can be fatal,situations may arise in which the physician or therapist is aware of a dangerposed to a third party, such as a sexual partner. HIV-positive patients must becounseled on their responsibilities and encouraged to voluntarily self-report tothird parties who may be at risk for infection (Pascal, 1987). Some states havepartner notification programs or requirements. If a substance abuse programconsiders it indicated to warn a third party concerning a patient’s HIV status,the patient’s consent or a court order must be obtained to comply with federalconfidentiality regulations. A policy of universal education for all patients,their spouses, significant others, and caregivers is often used and is consistentwith the consensus public health viewpoint that education, prevention, andvoluntary measures are the best approaches to stemming the AIDS epidemic,and that punitive approaches are counterproductive (Pascal, 1987).Single parents of minor children and, especially, pregnant women havespecial issues regarding custody and care should the mother or other primarycaregiver become disabled, incapacitated, or die. At the end stages of illness,patients may experience cognitive deficits; thus, issues of competency and