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Psychotherapy with Clients with HIV/AIDS

Legal, Ethical, and Clinical Complexities

Clinical Update
By Zur Institute

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As we near almost 30 years of identifiably living with this horrifying disease, we are still deep in crises surrounding the testing, treatment, and prevention of HIV/AIDS.

AIDS is as deadly as ever, yet many young people rationalize and diminish the dangers of having unprotected sex. They often believe such things as, "If I get AIDS, I will just have to take vitamins for the rest of my life." Dangerous misconceptions are reinforced by the fact that, in some segments of industrialized countries, the disease (HIV) has become a chronic, but treatable, ailment Yes, progress has been made. However, the reality remains: we do not have a cure and HIV/AIDS is fatal.

Our HIV/AIDS online course: Ethical, Legal, and Clinical Complexities in Psychotherapy with Clients with HIV/AIDS - 10 CE Credit Hours - Fulfills Law-Ethics requirement - Fulfills HIV/AIDS requirement

This course explores whether treating clients with HIV/AIDS, who are recklessly transmitting, constitutes a Tarasoff situation. It also brings to discussion issues of assisted suicide and many other complex topics.


Consider these recent statistics:
  • 33 million people are living with HIV worldwide.
  • There are 2,700,000 new infections every year.
  • Over one million people are living with HIV in the US, and fully one quarter of them are unaware that they are infected.
  • In San Francisco alone, there are 15,000 people living with HIV.
  • Rate of new infections is growing!

The single most effective way of preventing the spread of HIV/AIDS, is when people acknowledge the disease (especially when they, themselves, are infected), and act appropriately on that information. Unfortunately, an environment of shame, fear, humiliation, degradation of spirit, and marginalization hinders the compassionate treatment of those infected. It encourages those who are at risk to embrace denial, and discourages them from getting tested. Finally, it propels the ongoing spread of HIV/AIDS through a population.

Beyond the medical concerns, HIV/AIDS presents therapists and their clients with a complex of ethical, social, emotional, psychological, and legal issues.

  • To this day, there is confusion regarding what constitutes criminal transmission of HIV.
  • Most therapists are unsure if knowledge that a client with HIV is having unprotected sex constitutes a "Tarasoff situation".
  • There still are healthcare agencies that refuse to treat people infected with HIV.
  • In many parts of the world, those with HIV are still vulnerable to having their civil and human rights taken from them.
  • Some people infected with HIV may behave in repugnant, reprehensible, unethical, but not illegal ways.
  • Men who have sex with men (MSM) remain the highest risk group (48%) for becoming infected and infecting others with HIV.
  • Many men who have sex with other men do NOT identify themselves as "gay" and therefore spread HIV to their heterosexual partners.
  • HIV takes a disproportionate toll on communities of color, with the most severe impact among African-Americans, followed by Hispanics/Latinos. In these communities, fear of discussing issues regarding men having sex with men prevents effective counseling for those who need it.
  • In 2004, African-American youth accounted for an astounding 55% of all infected with HIV among persons 13 - 24 years of age, and these numbers appear to be rising.
  • Research shows that a large proportion of young people are not concerned about becoming infected with HIV.
  • Real or perceived breaches of confidentiality can endanger persons being served who might face stereotyping, social isolation, loss of social or financial support, barriers to accessing housing, employment, and various social and medical services, and physical or emotional abuse.
  • Suicide remains a threat to a client with HIV despite advances in treatment and palliative care.




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