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HIV/AIDS and mental illness: ethical and medico-legal issues for psychiatric services
Abstract
Objectives: To investigate and address some of the ethical and medico-legal issues associated with the HIV/AIDS epidemic in South Africa and the management of people with mental illness.
Design: Qualitative/exploratory/Participatory process.
Setting: The Gauteng Health Department.
Subjects: Key stakeholders.
Outcome measures: Areas of consensus/concern.
Results: Policy guidelines for the province have been written. They include guidelines on HIV testing and treatment and the practice of universal precautions as well as for education programmes for patients and staff, especially with regard to patient sexuality. Confidentiality is considered to be critical, and specific guidelines are suggested regarding when confidentiality may be breached. Special attention is paid to the management of patient exposure to HIV infection through assaults and injuries while in hospital. The issues related to managing children and youth in specialized psychiatric hospitals are highlighted. Many of the difficult issues relate to the degree of capacity of a mentally ill person to give informed consent, as well as the serious implications of a diagnosis of HIV infection.
Conclusions: This work highlights the complexity of the issues involved in the care of mentally ill people who are exposed to HIV infection. It is hoped that the guidelines will help to raise awareness of these issues and guide clinicians and hospital managers in difficult situations.
S Afr Psychiatry Rev 2003;6:18-21
Design: Qualitative/exploratory/Participatory process.
Setting: The Gauteng Health Department.
Subjects: Key stakeholders.
Outcome measures: Areas of consensus/concern.
Results: Policy guidelines for the province have been written. They include guidelines on HIV testing and treatment and the practice of universal precautions as well as for education programmes for patients and staff, especially with regard to patient sexuality. Confidentiality is considered to be critical, and specific guidelines are suggested regarding when confidentiality may be breached. Special attention is paid to the management of patient exposure to HIV infection through assaults and injuries while in hospital. The issues related to managing children and youth in specialized psychiatric hospitals are highlighted. Many of the difficult issues relate to the degree of capacity of a mentally ill person to give informed consent, as well as the serious implications of a diagnosis of HIV infection.
Conclusions: This work highlights the complexity of the issues involved in the care of mentally ill people who are exposed to HIV infection. It is hoped that the guidelines will help to raise awareness of these issues and guide clinicians and hospital managers in difficult situations.
S Afr Psychiatry Rev 2003;6:18-21
