HIV Confidentiality and PEP Basics

HIV confidentiality and post-exposure prophylaxis (PEP) require two different forms of risk control. Confidentiality prevents stigma, discrimination, and unauthorized disclosure of protected health information. PEP reduces the chance that a recent exposure establishes infection, and its benefit depends heavily on time. HIV status is protected health information under HIPAA. A nurse may share information with clinicians involved in the patient’s care and through disclosures permitted or required by law, but should not discuss the diagnosis in hallways, with uninvolved staff, or with family members who have not been authorized to receive it. HIV infection is reportable to public-health authorities in every US state, although the reporting process and additional confidentiality protections vary by state. Use the designated reporting pathway rather than making informal disclosures. PEP is not indicated for casual contact. It is considered after a substantial exposure involving potentially infectious fluid—such as blood, semen, vaginal or rectal fluid, or breast milk—through a needlestick, mucous membrane, nonintact skin, sexual exposure, or injection-drug equipment. A person who looks well may still need urgent evaluation; symptoms and vital signs do not determine...