Counselling about HIV serological status disclosure: nursing practice or law enforcement? a Foucauldian reflection

Abstract

Recently, focus groups and qualitative interviews with nurses who provide frontline care for persons living with HIV highlighted the contentiousness surrounding the seemingly innocuous activity of counselling clients about HIV-status disclosure, hereafter disclosure counselling. These empirical studies highlighted that while some nurses felt they should instruct clients to disclose their HIV-positive status if HIV transmission were possible, other nurses were equally adamant that such counselling was outside the nursing scope of practice. A review of these opposing perceptions about disclosure counselling, including an examination of the empirical evidence which supports each point, revealed that the dichotomous arguments needed to be nuanced. The empirical evidence about serostatus disclosure neither supported nor refuted either of these assertions; rather, it substantiated parts of each. To create this understanding, both empirical and theoretical works are used. First, the results of empirical studies about serostatus disclosure, or lack thereof and HIV transmission is presented; as part of this, Marks and Crepaz's HIV disclosure and exposure framework is examined. Second, the work of Michel Foucault on disciplinary and pastoral power is drawn from. The outcome is a nuanced understanding about the interrelationships between disclosure counselling and nursing practice and a final interpretation about what this understanding means for public health practice.

Health prevention in the era of biosocieties: a critical analysis of the ‘Seek‐and‐Treat’ paradigm in HIV/AIDS prevention

“…() and O'Byrne et al. (). These voices are raising important concerns regarding the transformations in prevention strategies and what they mean for population health worldwide.…”

“…Once they are diagnosed they are supposed to behave responsibly, to eschew practices that transmit HIV or else to initiate HAART (O'Byrne et al. ), which targets the virus and its replication and reduces the viral load. STOP initiative supporters argue that the HAART approach to HIV management is supported by many clinical trials and population‐based studies showing that the mortality rate of AIDS or the development of severe symptoms will decrease.…”

“…HIV viral replication is suppressed by highly active antiretroviral therapy (HAART), which decreases the likelihood that an HIV‐positive person can infect an HIV‐negative person when there is the potential for contact with the HIV virus (i.e. pre‐ or postexposure prophylaxis to prevent HIV seroconversion) (O'Byrne, Holmes and Roy ). STOP, under the name ‘Treatment as Prevention’ or ‘Seek and Treat’, has been adopted internationally and became the official UN strategy in 2014.…”

“…increase condom use, have fewer partners) (O'Byrne et al. ). Those identified as infected with HIV are immediately offered the HAART treatment.…”

HIV PEP and Nursing Scholarship: A Review of Critical Theory and Social Justice

“…To address this situation, an approach I adopted was to use research grants to purchase and provide medications to uninsured persons. These studies involved securing external research funds to purchase FTC/TDF and to deliver it as PEP/PrEP in novel ways, for example by nurses in sexually transmitted infection (STI) clinics (O'Byrne, Holmes, & Roy, 2015;. In a purposeful effort to avoid exposing patients to experimental drugs (which is a longstanding ethical issue with drug studies involving minority groups), I evaluated PEP/PrEP delivery by nurses in STI clinics.…”