Confidentiality and HIV/AIDS: The case of Norma

Norma is a 21 years old college student who immigrated to the United States with her parents from El Salvador when she was 2 years old. She is bicultural in the sense proudly identifies herself as a Latina while at the same time having learned the instrumental behaviors that allow her to be effective and successful in the host culture. She speaks English and has been able to advance educationally to the point that she will soon graduate with a bachelor’s degree. Socially, she interacts with people from different cultures.

Two years ago Norma started dating a young Latino man about her age named Javier. They became close very quickly and started spending a lot of time together. Even though she is aware of the need for protection, they have had sex repeatedly without safety precautions. Javier refuses to engage in safe sex, and Norma has not been able to assert herself in this situation. Although he never went to college, Javier finished high school and was able to keep a job for a while. He was fired when he stopped going to work regularly. About a year ago Norma learned through common friends that Javier has been engaging in antisocial behavior such as dealing drugs and joining groups that commit acts of violence. She has also been the victim of his violent and abusive behavior. Because of his behavior, Norma has been slowly separating herself from Javier, which makes him even angrier. Last semester she attended workshop about HIV and realized that she could be at great risk, so was tested for the virus. To her extreme shock, she found out that she was HIV positive; she became so disturbed that she started seeing a counselor at the university. Norma thinks that Javier may have transmitted this disease to her, but she is not entirely sure as she had sexual relations with other people before Javier (sometimes unprotected).

Soon the counselor realized that she had an ethical dilemma because Norma has not disclosed her condition to Javier, even though she did inform her other partners. Informing Javier would allow him to make a decision about seeking testing andtreatment if necessary. The counselor wonders whether she has the duty to warn Javier about the danger about being infected with the HIV virus. The counselor shared with Norma that she may have to disclose Norma’s condition to Javier, under her duty to warn, unless Norma agreed to do it herself. Norma replies fearfully that if such information is disclosed to Javier she will be in imminent danger of being attacked by him to the point of fearing for her life. This belief is consistent with the history of Javier’s violent behavior as reported by Norma. The counselor realized that this ethical dilemma has suddenly become more complex.

1. A brief analysis of two key confidentiality issues from case study in the ACA Ethical Standards Casebook. Explain why you think these issues are critical elements in a counseling practice. Then, analyze two challenges a counselor could face as he/she adheres to these elements of day-to-day practice. Conclude with an explanation of how you would address these challenges, including which decision-making model guided your decisions.

2. Brief summary of the case and ethical dilemma in case (i.e., the nature of the ethical dilemma you chose from this case study.

3. Potential actions you would take or would have taken as an ethical counselor; what would you have done differently? Consider which decision-making model you would use and why? How would your actions solve the dilemma?

4. Given the actions you noted above, which do you think is the best solution and why?