Decisions about disclosure

The opening paragraph of an essay titled, "Disclosure" by Dr. Rochelle P. Walensky of Boston in the May 5, 2010 issue of JAMA was stunning in the author's lack of understanding her role in protecting the general public and specific individuals from serious disease. Others I'd give a break, but she had an MD and MPH after her name! The paragraph really wasn't essential to the thrust of her topic, which was about being a woman (pregnancy, motherhood) in academic medicine. Here's what she wrote:

"Early in my career, one of my patients with HIV infection, Robin, a recovering heroin addict, had re-enrolled in school and was newly engaged. Her fiance was unaware that she was HIV infected and she would not discuss using condoms, let alone her HIV infection, with him. I encouraged her to confide her infection to her fiance--for the integrity of their relationship and for the value of his health--at each of our clinical encounters. Finally, she did so. He left her. She stopped taking her antiretroviral medications and restarted using heroin. Although the fiance may have reduced his risk of infection, the consequences of my intervention were tragic for my patient. Robin's case reinforced that disclosure is a risky business because the truth can trigger an unexpected, sometimes devastating chain of reactions."

No, it wasn't unfortunate that the fiance left her; it probably saved his life, assuming he wasn't already infected. No, Rochelle Walensky's intervention as a doctor and public health official wasn't tragic--it was probably a requirement of her job! No, Robin didn't start using heroin again because her fiance left her--she was an addict and no one, not even the love of a good man could change her if she wasn't up to the tough behavior needed to kick it. No, stopping the antiretroviral meds wasn't a tragedy because she would just become reinfected as the heroin addiction took over her mind. Part of getting well is a behavior change, chastity and monogamy, something she can't do on drugs. And finally, it's just entirely possible that the fiance left her because he realized she valued his life so little, that he would never again be able to trust her.