Case Study
You have been seeing Ruben for six weeks. He initiated therapy because his male partner, Jim, recently tested HIV positive and Ruben is anxious about his own health. Ruben and Jim have had a sexual relationship for six months though Ruben does not consider himself gay because he is ‘masculine’ and when he does have sex with other men, he is the ‘active’ or penetrating partner.
Ruben is also married to Elena. They have two children, ages 2 and 5. Ruben and Elena came to the US from Mexico and have been legal residents for seven years. Ruben has been struggling with his feelings for Jim and Elena. He clearly cares for his family, enjoys being a father and speaks openly about the stress of keeping his relationship with Jim a secret. Without offering any explanation, Ruben has cut off all sexual contact with Elena and all contact with Jim since he found out Jim tested HIV positive.
Recently, Ruben tested positive at an anonymous test site. He refuses to tell Elena because the news would hurt her and bring shame to himself and his family. He also fears that if Elena found out, she would find ways to keep the children from him and tell his parents, who would be deeply disappointed.
Ruben continues to avoid sexual relations with Elena. However, during his next visit, he tells you that she has become ‘more seductive’ and hinted that she would like another child. Ruben states that it was too difficult to resist and admitted that he had unprotected sex with Elena twice. He hopes that he ‘got lucky’ and didn’t infect her. He doubts that he can stop having unprotected sex with her but refuses to tell her he is HIV positive. Ruben refuses to seek medical care because he ‘feels fine’ and doesn’t want a doctor to tell Elena his HIV status.
Ruben displays no signs of major mental disorders. He has no history of psychiatric problems or drug or alcohol abuse. Ruben tells you he would never contemplate suicide or abandon his family. You conclude Ruben’s primary defense mechanism is avoidance. He signed a limit of confidentiality statement when he entered treatment with you and he is currently committed to working on his issues in therapy.
In real community social work practice settings there can be complicated forces at work that social work practitioners must manage.
The Domains:
- Professional ethics for social workers which uphold confidentiality, protecting information confided by a client from disclosure to others without client authorization.
- Ohio’s HIV Felonious Assault Law which states you must disclose to anyone with whom you have sex that you are HIV+ before any sex act. These competing demands create a conflict between confidentiality for the client and the duty to protect those who might be harmed by the client’s actions.
- Most social service agencies hold a client’s confidentiality inviolate, i.e., irreproachable and upright, and have clear guidelines around confidentiality.
This case study puts you in an environment which, in practice, requires you to uphold agency policy.
Identify in bullet points:
- What are the consequences if you choose to violate Ruben’s confidentiality?
- What are the consequences if you disclose Ruben’s HIV status to Elena?
- What actions might you take, including consult and with whom, to mitigate, temper or placate the situation?
