Position Statement on HIV Disease

Allan Peterkin, MD, FRCPC, CCFP, Henry Chuang, MD, FRCPC, Mark Etkin, MD, FRCPC, CCFP, Stephen Fitzpatrick, MD, FRCPC, Peter DeRoche, MD, FRCPC, Arlette Lefèbvre, MD, FRCPC, Marie-Josée Brouillette, MD, FRCPC, Dawn Ross, MD, FRCPC

This position statement was submitted by the CPA Working Group on HIV Disease and Psychiatry and the Council on Professional Standards and Practice to the CPA Board of Directors and was approved on March 25, 1996.

The term "HIV disease" is used to refer to the entire range of clinical conditions, including Acquired Immune Deficiency Syndrome (AIDS), in children and adults that are caused by the human immunodeficiency virus (HIV).

1. All psychiatrists should educate themselves about the neuropsychiatric, psychological, and social aspects of HIV disease so as to provide appropriate assessment, treatment, and/or referral services in a competent, ethical, and compassionate manner.

2. All psychiatrists have a role in preventing HIV infection, in that they should address the consequences of sexual and drug-related risk behaviours with patients.

3. HIV testing must always be voluntary and must follow informed consent procedures as outlined in the Canadian Medical Association counselling guidelines for HIV testing, 1995.

4. Confidentiality regarding a patient's HIV serologic status must remain protected except in rare circumstances. A framework for confidentiality should be discussed with the patient regarding:

5. No patient should be refused appropriate psychiatric care on the basis of his or her HIV serologic status.

6. The Canadian Psychiatric Association opposes discriminatory actions on the basis of HIV disease or suspected HIV infection in areas of health care, housing, international travel, public transportation, employment, education, citizenship, and insurance.

7. There is a need for ongoing research into many aspects of HIV disease that have an impact on psychiatry including, but not limited to, prevention strategies, the ramifications of HIV testing, neuropsychiatric complications of the disease, psychopharmacologic interventions, neuropsychologic testing, and suicide.

8. All undergraduate and postgraduate psychiatry teaching programs have a responsibility to educate their trainees about the clinical care of persons, as well as their families, living with HIV disease.

Bibliography

1. American Psychiatric Association. Position statements and guidelines on AIDS and HIV disease. Washington (DC): American Psychiatric Association; 1995.

2. Steben M, Hankins CA, Bally GA, O'Shaugnessy MV, Peterkin AD, Walters DJ. Counselling guidelines for human immunodeficiency virus serologic testing. Ottawa: Canadian Medical Association; 1995.

3. Canadian Medical Association. CMA policy summary: HIV infection in the workplace. Can Med Assoc J 1993;148:1800.

4. Tobin MA, Chow FJ, Bowmer MI, Bally GA. Comprehensive guide for the care of persons with HIV disease, module 1: adults--men, women and adolescents. Mississauga (ON): College of Family Physicians of Canada; 1993.

5. Ferris FD, Flannery JS, McNeal H, Morisette MR, Bally GA. A comprehensive guide for the care of persons with HIV disease, module 4: palliative care. Toronto: Mount Sinai Hospital and Casey House; 1995.

6. Steben M, Mensah MN, Bally GA, Taylor P. Practice guidelines for obstetrical and gynaecological care of women living with HIV. Ottawa: The Society of Obstetricians and Gynaecologists of Canada; 1994.

7. Tobin MA, Chow FJ, Bowmer MI, Bally GA. Comprehensive guide for the care of persons with HIV disease, module 2: infants, children and youth. Mississauga (ON): College of Family Physicians of Canada; 1995.