Academic journal article Journal of Counseling and Development : JCD

Counseling to End an Epidemic: Revisiting the Ethics of HIV/AIDS

Academic journal article Journal of Counseling and Development : JCD

Counseling to End an Epidemic: Revisiting the Ethics of HIV/AIDS

Article excerpt

Since the 1980s, HIV and AIDS have contributed to the loss of over 36 million lives worldwide (World Health Organization [WHO], 2016). Estimates of current global HIV prevalence remain close to 35 million, with the majority of individuals living with HIV/AIDS residing in sub-Saharan Africa (WHO, 2016). The United States, however, has not been immune to this epidemic. Domestically, more than 1.2 million individuals are currently living with the virus, nearly 13% of whom are unaware of their HIV status (Centers for Disease Control and Prevention [CDC], 2016e). Although the number of new HIV diagnoses in the United States declined 19% from 2005 to 2014, certain subgroups of the population are disproportionately affected by this illness (CDC, 2016e). Gay, bisexual, and other men who have sex with men (MSM) account for 67% of all HIV diagnoses. However, women now account for 19% of HIV diagnoses, and the Black/African American and Hispanic/Latino communities are disproportionately represented among HIV diagnoses.

Although only 6% of HIV diagnoses are associated with injection drug use, growing concerns about opioid misuse and abuse underscore the need to attend to drug prevention and intervention services to curb both substance abuse and HIV transmission, particularly in nonurban areas where services are scant (CDC, 2016d). Despite available treatment that can effectively curtail the effect of HIV on the immune system, in 2015, more than 18,000 Americans experienced the progression of their illness to the point that they received an AIDS diagnosis (CDC, 2016e). Unfortunately for some individuals living with HIV, what can be a manageable, chronic illness becomes a fatal condition as barriers to treatment and mental health support make treatment adherence and overall wellness difficult.

People living with HIV/AIDS (PLWHA) experience multiple medical and mental health difficulties that are often exacerbated by the social stigma that surrounds the illness (Herek, 2014; Varni, Miller, McCuin, & Solomon, 2012). In addition, social and cultural factors such as poverty, access to health care, and membership in multiple marginalized groups (e.g., identifying as African American, Latino, or gay) intersect to create dynamic challenges for PLWHA in terms of seeking and receiving the necessary care to meet their overall health needs (Rintamaki, Davis, Skripkauskas, Bennett, & Wolf, 2006; Swendeman, Rotheram-Borus, Comulada, Weiss, & Ramos, 2006). Despite medical discoveries that have broadened HIV/AIDS knowledge and improved treatment, misconceptions about the illness remain (Kaiser Family Foundation [KFF], 2012) and shape the experiences of PLWHA both inside and outside the counseling office.

Although HIV/AIDS appeared in the counseling literature as a topic of ethical discourse in the 1980s and 1990s (Cohen, 1990; Gray & Harding, 1988; Harding, Gray, & Neal, 1993; Kain, 1988; Stanard & Hazier, 1995), little has been written about the ethical implications of serving PLWHA in the last two decades. Whereas significant developments in both the medical and social sciences have broadened and deepened the knowledge base regarding HIV/AIDS and its implications on individuals and families, the counseling literature has remained stagnant. Practitioners looking to the literature to inform their ethical practice with PLWHA are likely to find debates regarding confidentiality that took place during a period when HIV and AIDS were indistinguishable and both evoked intense fear within the general population. Within the current context, past discussions regarding counseling ethics and HIV/AIDS are insufficient to address the multiple and multifaceted needs of this vulnerable population, warranting a return to this topic among counseling scholars and practitioners.

When first identified in the 1980s, HIV and AIDS introduced unique ethical concerns for mental health professionals. Primary among those concerns was the challenge of balancing the professional duty to warn and the critical need to protect client privacy (Alghazo, Upton, & Cioe, 2011). …

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