One of my patients was recently diagnosed with HIV. He gave an inconsistent history about sexual relations with his wife. When I asked if he'd told her about his HIV diagnosis, he said, "I don't have sex with her, and I haven't had sex with her since long before I got infected." Under these circumstances, should his wife be notified?-M.T., MASS.

Your obligation is first to document your assessment findings according to facility policy. HIV-positive status is a reportable condition for public health, but the hospital's infection control practitioner or the patient's primary care provider are responsible for notifying appropriate authorities according to facility policy and procedure.

Your ethical responsibility to your patient involves listening to him and learning what concerns most distress him now. When you assessed him, your focus and his were worlds apart. You were looking for specific information that might help protect his wife. But he was trying to cope with a new diagnosis that threatens not only his health but also his family life.

Explain to your patient that for public health reasons, he'll be questioned about people he's had sexual relations with who may need to be told about his condition. This may include his wife.

Document and convey his most immediate concerns to the healthcare team. Education about HIV infection, including how to prevent its spread, will be one of your patient's (and his family's) most significant needs from now on.