Confidentiality of Medical Records

Once a person consults a physician about a positive HIV blood test, the results of that test become part of the person’s medical record. Simply excluding the result of HIV blood tests from a medical record is not pos­sible: the results are too important a part of the medical record.

In general, medical records can be reviewed by certain medical per­sonnel. Various authorities also have the legal right to review medical records: third-party payers (such as insurance companies), professional review groups, and the like. Although this sounds alarming to someone worried about breach of confidentiality, the actual number of cases in which confidentiality has been breached is nil. The reason is that the peo­ple who have access to medical records are well aware that they have ethical as well as legal responsibilities to prevent unnecessary or unwar­ranted disclosure.

Similar rules apply to health departments that maintain such infor­mation. All people with AIDS are reported to health authorities by law. Some states require reporting everyone with a positive blood test. To our knowledge, reporting to state or federal health authorities has never once been the source of inappropriate disclosure of the information (see also chapter 9).

In New York State, anyone with a positive test is asked to identify people whom they have placed at risk by sex or shared injection drug use. The health department then contacts the people identified and ad­vises them to obtain testing but does not reveal the source of informa­tion about their exposure. The exception in this policy is a situation in which such disclosure may lead to domestic violence. People with posi­tive tests obviously control this situation by giving only the names they select. But the goal here is simply good public health. The policy is de­signed to counsel those who are infected to stop further transmission and to get people into care at a time when care is highly effective.