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May 5, 2010, Vol 303, No. 17 >

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A Piece of My Mind | May 5, 2010

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Rochelle P. Walensky, MD, MPH
JAMA. 2010;303(17):1676-1677. doi:10.1001/jama.2010.535.
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Early in my career, one of my patients with HIV infection, Robin, a recovering heroin addict, had re-enrolled in school and was newly engaged. Her fiancé was unaware that she was HIV infected, and she would not discuss using condoms, let alone her HIV infection, with him. I encouraged her to confide her infection to her fiancé—for the integrity of their relationship and for the value of his health—at each of our clinical encounters. Finally, she did so. He left her. She stopped taking her antiretroviral medications and restarted using heroin. Although the fiancé may have reduced his risk of infection, the consequences of my intervention were tragic for my patient. Robin's case reinforced that disclosure is a risky business because the truth can trigger an unexpected, sometimes devastating chain of reactions.

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