Hacker News Reader

Comment by yebyen | Hacker News Reader

There are two sides to the story though (I'm not defending Aetna, I'm saying this is not only a problem for people who live around bigots.)

Some non-zero percent of those 12k people live with a partner who doesn't know their HIV status. It is (edit: could be, if untreated) totally unethical for those people to fail to disclose their status to their partners, but arguably it's much worse for those people to be outed by their health insurance company, who should really be the (#@[expletive](/#@ experts in privacy here.

I'm really not sure it's OK that this letter went out at all, even if they had used the right privacy envelopes!

View on HN

I fully expect to get downvoted for this, but it's an important point that I have to address.

> Some non-zero percent of those 12k people live with a partner who doesn't know their HIV status. It is totally unethical for those people to fail to disclose their status to their partners

This is itself based in old misinformation about HIV that serves to perpetuate harmful stigmas around HIV.

HIV is treatable, and when properly treated, cannot be transmitted[0]. That's not even taking into account other forms of HIV prevention that are practiced to reduce the risk of HIV transmission. While it's advisable for an HIV- to ask their partner's HIV status (and HCV, and other STD statues), a person with HIV under proper treatment should not be expected to proactively disclose that to every partner or potential partner, and it's not "totally unethical" for them to make the decision not to volunteer that information unasked.

[0] Decades of misinformation have drilled the false belief that HIV is always infectious into people's minds, to the point where public health groups are literally launching massive campaigns to correct this belief.

Here's the PARTNER study, which found no HIV transmissions after nearly 900 sero-discordant couples had sex without condoms more than 58,000 times where the HIV-positive partner was using suppressive antiretroviral therapy.

Q&A: http://i-base.info/qa-on-the-partner-study/

Full study: http://jama.jamanetwork.com/article.aspx?articleid=2533066

Huh, TIL. Thank you!

I haven't been personally in this situation, but I've been at a company that was afraid we were gonna lose the contract because of a miscommunication between their office and our office, where "no-contact" request was not honored.

I honestly had no idea what you just told me. My focus was on the illegal disclosure by the trusted health care company, because that was the angle I experienced a (much smaller scale) similar situation from.

(I know HIV clinics have no-contact lists, but I am skeptical whether or not health insurance companies do. This story is just a colossal mess, too many layers of wrong for me to comprehend.)

So then how are people still getting HIV?

When thinking about the ethical implications you have to take the real world into consideration, not the perfect world.

"So then how are people still getting HIV?"

Some folks don't know they have it, and there are big gaps in health care. Not everyone that needs to be tested or should be tested has the means or transportation to do so, let alone afford the medications. Theoretically, we could test this with normal bloodwork and have tax dollars pay for the medications, treating it like a public health cause. We just don't, partially because of outdated views on it, bigotry, and so on.

Granted, this is completely ignoring the world outside the US, where there are other difficulties.

This is the real world you were referring to, right?

It should also be obvious that he's referring to folks that have medication available. HIV isn't the death sentence it used to be because we've made great strides.

Source?

Reply on news.ycombinator.com