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Disclosure to a health care provider

Aug 4, 2010

Dr. Bob,

I have seen several queries in this forum concerning the obligation to disclose (or not) but only one that was somewhat related. I am hiv+, on meds with an undetectable VL, and otherwise healthy. Other than for my wife, I have gone to great pains to conceal my status from my family, friends, and coworkers -- mostly for obvious reasons.

I am greatly in need of (yet another) surgery on an ailing knee but am very reticent to disclose my hiv status. This would be the first such procedure since becoming infected. Other family members use the same orthopedic surgeon, my wife works for the hospital system that our insurance would require me to use, and my last name is fairly recognizable. I know that HIPPA rules require confidentiality and all, but from a practical standpoint, the likelihood that it would not get around is virtually zero. The impact of that would be professionally and personally devastating, not only for me but perhaps for my wife as well.

You can probably see where this is heading. My predilection is to not disclose my status but I have misgivings about that as well. On the one hand, one could argue that if disclosure is not obligatory for sex, why should it be so in an environment where practitioners are supposed to use universal precautions. On the other hand, there is a much greater risk that one may come in contact with infected blood (even though the VL may be low). I don't believe that they routinely test orthopedic patients for hiv and have never been tested prior to my other surgeries, but, should they do so this time, that could prove equally embarrassing. I don't want to think of myself as a jerk if I don't disclose, but I also cannot risk the consequences of doing so. I'm not certain just what I'm asking here other than for your thoughts. Thanks.

Response from Dr. Frascino


It is not in your best interests to hide information from your doctors. This information may be crucial in evaluating or treating a medical problem or complication. If you feel you cannot be honest with your health care providers, including being upfront about your HIV-positive status, you should find new health care providers with whom you can work more closely and honestly, even if this means changing health care plans or paying out of pocket. Don't compromise your health. Being honest is never the wrong decision no matter what the immediate consequences may be.

Dr. Bob

Starting over
Am still a bit confused-Syphilis Question (ORAL SEX AND STDs, 2010)

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