Best Practices for General Clinical Situations

By Tom Smith, Ph.D.

 

The practitioner must be well informed regarding the law and well educated regarding the transmission, process of infection, testing, prevention and issues with “special populations” in order to not only educate clients, but also to make sound, valid clinical judgments regarding the behavior of their HIV positive patients that can withstand the scrutiny of the law and one’s peers.

As extensively mentioned in this course and the literature, there are fears, biases and prejudice by all parties concerned that are both covert and overt. Thus, the practitioner must be aware of their own fears, biases and prejudices and that of their clients, who may be internalizing the same. Supervision and consultation can benefit the practitioner in becoming aware of their countertransference issues regarding the difficult issues of sexuality, especially of the LGBT community, racism, sexism, IV drug use, lack of education and poverty.

It cannot be over emphasized that the practitioners clearly understand their role and capacity in the treatment of an HIV positive person. Where does one fit in the overall treatment plan? Moreover, it is probably wise to cross consult with a colleague regarding the values, principles, biases, stereotypes, unconscious racism, sexism or bigotry that may lurk underneath the surface and influence treatment decisions. How does the practitioner feel about treating alcoholics, drug addicts, poor or uneducated people who may not be all that compliant or understanding of the gravity of the situation. What are the specific obligations and responsibilities that must be discharged when treating these different populations?

It is imperative that the practitioners know the law in their particular state. If there are questions regarding the law, one must seek out supervision or legal consultation to be clear about what their legal responsibilities in treating the HIV positive individual are and the legal right of those same clients.

Following this, one should have an abiding familiarity with the Codes of Ethics of their particular practice and use them to guide decision-making.

Finally, needless to say, keep careful case notes documenting any discussions regarding issues of confidentiality, the need to protect third parties and informed consent. Be mindful that in some states, “public” case notes are subject to legal subpoena and personal notes are not. If one practices in an agency setting, any and all documentation (this includes “personal” notes kept separate from the client record) are subject to subpoena.

Keeping Informed and Understanding the Situation

Given the practitioner has HIV positive clients in their client base, it behooves the practitioner to stay up-to-date regarding not only the law and the code of ethics of their particular field, but also HIV statistics regarding transmission, race, gender, ethnicity and age as well as treatment alternatives and prevention strategies. In California, this is required by the Board of Behavioral Science Examiners. Moreover, providers are called to understand the client’s situation within an informed context. Certain questions need to be asked. How did the patient become infected? Was it through sexual intercourse or IV drug use? Are they still sexually active and with whom, men, women or both? Are their partners informed? Are they still using needles? Do they use needle exchange to prevent spreading the infection? These and other questions need answers.

The Center for Disease Control is a well spring for information regarding HIV and is listed in the resources section.

References

Department of Health and Human Services: The Center for Disease Control and Prevention HIV/AIDS
http://www.cdc.gov/hiv/

HIV InSite: UCSF Center for HIV Information
http://hivinsite.ucsf.edu/