Psychology

The upsurge of the spread of HIVAIDS in the world has made the disease a great force for medical practitioners to reckon with. As such, it has become critical to establish the most valuable ways of stopping the epidemic. In the treatment and prevention of HIVAIDS, counseling is regarded as a crucial component of this process. HIV counseling has indeed become a vital element in the all inclusive model of managing health care. It aims at curbing the transmission of the disease and also at offering support to those infected and affected by HIV. HIVAIDS profoundly affects many social, economic and political aspects of communities and peoples lives in general. Therefore, in addressing the epidemic it is fundamental that practitioners are aware of the vast aspects related to the disease.

HIVAIDS Counseling Ethical Considerations in Counseling Clients with HIV
Although this disease does share similar issues with other diseases there is an individual characteristic which often sets this disease apart from the rest. This refers to the fact that HIV transmission is related to behaviors deemed to be quite private and whose exposure to the public would cause personal embarrassment to the affected parties (Hoffman, 1996, p.2). This paper will provide a critical evaluation of the ethical considerations of counseling HIV clients. Ethical issues often arise over a clients concern for confidentiality in the counseling process. Confidentiality will dominate a major part of the papers discussion. This is because concerns for confidentiality are known to arouse other barriers to the counseling process such as anxiety and distrust. The knowhow of ethical issues has been largely insisted on by psychologists and counselors involved in the management of HIVAIDS. Counseling in a widely viewed context is meant to be a principled and especially a profession which is bound by ethics (Silverman, 1997, p. 6). These ethical principles include the utter respect for all individuals, beneficence and fairness.
Respect for clients encompasses the counselors duty to protect the autonomy of the patient and also safeguard those clients who cannot make decisions for themselves. Most importantly, this principle obliges the counselor to maintain confidence and keep any secrets or promises they have made to their clients. Beneficence on the other hand compels the counselor to always act in the best interests of the patient. The counselor must notify the client on any factors which may affect them either negatively or positively. Finally, justice involves the treatment of clients fairly with no discrimination. All these aspects have largely led to the development of literature on the impacts which arise when these principles are neglected or presumed.
Confidentiality is an ethical issue which has received the greatest attention from counselors. Rarely do practitioners violate the clients right to confidentiality but this dilemma concerns most of them. This is because it threatens to destroy the most crucial component of the counseling relationship which is trust. Moreover, counselors are aware of the adversarial role in which they are bound to be placed if they viewed any of their clients to be a danger to others. In counseling, guidelines which have been set indicate that any information which results from the counseling relationship are meant to be kept confidential (Cohen, 2001, p. 282). However, the same guidelines have also been known to indicate that when the counselor does detect any threats to the client or others affected then they are expected to act reasonably. This would reflect that when necessary they are mandated to disclose any information shared by the client. One such instance would be when there is a risk for intended transmission by the client. A client who will not consider disclosing their positive status to their spouses may pose the danger of infection to their partners. At this point the counselor will ultimately consider notifying their clients spouse.
Any breaches of the code of confidence between clients and counselors are however meant to be a last result (Gray et al, 1993, p. 298). This is after the practitioners have considered all other alternatives. It is also made substantially clear in the ethical standards guidelines that clients be made aware of the implications of the confidentiality clause.  This is especially if the counselor senses any anomalies in a clients sexual behavior. Then they must strictly outline the limitations of confidentiality before the counseling process progresses. Despite these stipulations a counselor can freely expose their clients information if the client mandates them to do so. This willful consent must however be strictly analyzed and where possible there should be legal clarifications made. This will protect the counselor from facing any irreparable effects of breaking the code of confidence.
As it can be observed from the above discussion it is clear that the issue of confidentiality imposes major limitations on the practitioners duty to inform others of any impending danger. This has been so mainly as a result of the Tarasoff decision (Hoffman, 1996, p. 208).  This decision provided specific contexts in which confidentiality may be breached. Knapp  VandeCreek (1990), explain that there must be a unique relationship existing between the client and their counselor. This relationship should be highly cemented by trust. They also expound that for any decisions to disclose or protect a clients information there must be evidence of identifiable possible victims. The counselors duty to safeguard only extends to those persons the counselor knows and not to anonymous individuals. Gehring (1982) asserts that the counselor is also mandated to warn others when they know of any imminent danger. Issues also emerge in establishing viable grounds for identifying clients who may pose danger to others. There are various factors which must be followed when doing so. Hoffman (1996, p. 209) claims that there must be utter certainty that a client is infected with the disease. Another consideration involves knowing the clients involvement in risky behaviors which may increase potential for transmission. In addition, the counselor should also be aware of whether their clients are aware and engage in preventive measures for HIV.
These considerations are not really full proof as they also pose further questions on the eligibility of threat factors. These difficulties arise when counselors become concerned over their clients even when they are not aware of their status. This happens when such counselors consider general statistics and in turn label their clients according to their statistical groups. For instance, a gay client may be automatically labeled HIV positive simply because there is a high rate of prevalence amongst the gay population. Furthermore, difficulties may arise because there are different definitions for behaviors considered to be of high risks (Kain, 1988). Some sexual behaviors might not pose any risk or even mandate the counselor to inform the clients spouse.
Some authors like Posey (1998), base their discussion of the issue of confidentiality on the ownership of responsibility (P. 226). When the counselor opts to disclose the clients condition to their partners it may be on the grounds that their clients are facing denial of their condition. As such the counselor is dealt with the responsibility to shoulder the duty of informing other parties. A client is within their rights to engage in the grieving process and thus justified to be in denial. Moreover, there are instances when a clients risky behavior may be mutually exclusive with their partners. As such the counselor must disclose the facts to prohibit the contact of either partner in a bid to prevent further transmission. Stanard and Hazler (1995), showcase the issue of optimal confidentiality. In reference to Gray and Harding (1988), who stipulate that an individuals right to know of any threat of infection highly surpasses ones right to privacy. In essence some practitioners recommend that they must override this right to privacy when they sense danger and should thus automatically inform the concerned parties. However, taking such a stand may also violate many other ethical principles which bind counselors. These counselors are strictly meant to ensure that that they offer support and all kinds of assistance to their clients, yet when they seek to opt for disclosure they are not fulfilling their duties. Also in an era when the HIVAIDS epidemic is accompanied by high levels of discrimination, by breaching confidentiality the counselor will have exposed the client to possible discrimination.
Difficulties of establishing potential dangers also arise due to other complicating aspects. Such aspects include the unreliability of techniques and methods used in diagnosing HIV patients. Lamb et al (1989), asserts that it is possible to be wrongly misdiagnosed and thus presenting a wrong interpretation by the counselor. Also, the development and progress of the disease often happens differently for most people and since it is impossible to predict its course it is also hard to predict potential risk.
Other issues posed by the Tarasoff decision concern the fact that there are difficulties in depicting tangible victims. This is so because there are times when the disease remains dormant in some individuals for a long duration. Also, having to delve into a patients sexual history may prove rather difficult and further complicating the possibility of establishing those who may be infected by the client. The Tarasoff decision was particularly unique due to the presence of verbal threats of infection and this may not always be the case. Counselors face a dilemma when no verbal threats have been made in regard to any individual and if clients have shown no signs of being a threat and thus seek the counselors confidence.  In spite of all the arguments made for and against the guidelines specified by the Tarasoff decision, it is quite clear that it is not possible to establish cause for breach of confidence.
Rohleder (2008) indicates that there are contexts under which confidentiality can be difficult to implement. In a study conducted in a prison setting, it is seen that it can be quite hard to keep information private as there are close relations amongst prisoners and staff members. In cases where there are already aroused suspicions any form of gesture may be interpreted as disclosure. This is illustrated in an incidence cited by Rohleder (2008, p. 282). In an event held in the prisoner prisoners were meant to light candles. To do so, they had to rise up and at this time the nurse happened to nod at three women who were positive. This was meant to nudge them to light a candle but this mere gesture may have been seen as a probable form of disclosure of their HIV status. Practitioners are thus faced with the difficulty of ensuring that they eliminate any potentials of unintended disclosure.
Kell (1999) cautions the use of a collective approach when regarding issues of confidentiality. There are instances where HIV counseling can only be conducted through groups and not individual sessions. In such circumstances establishing confidence amongst all clients and the counselor can be a very daunting task. This is because even though such a group might be bound by a common objective their motives might be affected by many diverse factors. Also, this cohesiveness might be broken in ways which could prompt others to disclose an individuals information. Another factor involves cases where clients are not in any way involved in the decision making process. Prisoners are often not allowed the benefit of having informed consent when counseling measures are taken. It is vital to get the consent of clients in engaging in the counseling process as the alternative results to the on start of major ethical and legal dilemmas.
There are other ethical issues which may arise in respect to counseling clients who are infected by HIV. These issues include concerns for spirituality and discrimination. Holt et al (1999), emphasizes the need for counselors to aid clients in reconciling their spirituality as a vital component in furthering their progress in counseling. Often clients are faced with the imminent fear of death when they are diagnosed as HIV positive. While some accept their status instantly others are laden with great denial which may arouse feelings of fear and anxiety. These issues may impede the counseling process if counselors do not devise ways of discarding these fears. It is in trying to do so that ethical issues may come up. There are counselors who develop impatient tendencies towards their clients fears. This factor may cause counselors to push clients beyond their limits. This is done when a counselor nudges the client to discuss issues which are difficult to relate. Even though a counselor is expected to help clients to deal with their underlying problems it is important that they recognize and accept when clients cannot provide any more information.
Another ethical issue which may arise in counseling is the concept of judgment. Clients are often exposed to a counselors judgment in regard to their behaviors, lifestyle and moral tendencies. A counselor may relate their client to a particular set of people due to predisposing factors which they might observe in the client. However, these factors are not always true and may cause wrongful diagnosis of a clients problems. Burke and Miller (1996), assert that a counselors feelings and judgments when exposed to a client may result to irreparable damage. HIV positive clients need to gain their lost self esteem and get rid of any built up emotions on elements of discrimination they may have experienced. Therefore, it is not right that they have to face the same reservations from their counselors. It is crucial that counselors who have strong opinions about such issues refrain from counseling those particular patients. Working with clients whom a counselor considers as immoral or any other biased factor is unethical.
Instilling spirituality in HIV infected clients often involves guiding them to focus on their faith and aspects which offer substantial meaning in their lives. Religion plays a great role in developing a sense of belonging. Through religion, clients can establish an avenue which provides elements that they truly relate to and identify with. When a counselor has different religious beliefs from their clients ethical issues may result in their relations. In order to prevent the formation of barriers in the counseling process, counselor must restrain themselves from voicing their opinions. If not so, they may end up imposing their beliefs on the client who in turn may develop a false sense of meaning.
In order to prevent the development of such ethical issues which may bar the counseling process it is important for counselors to conduct thorough assessments of their clients history. This assessment should range from the clients spiritual background to their opinions regarding such concepts like morality and religion among others. In doing so, counselors are able to establish issues which may cause distress to the clients and work towards avoiding them. Clients may have experienced discrimination over their beliefs in their past and this may affect how they relate to issues regarding spirituality. With this knowledge, a counselor can know how to navigate the issue and rebuild the clients former confidence in their faith. In addition, counselors should devise ways of introducing the concept of spirituality to clients whose initial concern is not on spirituality.
Creating a free environment for clients allows them to discuss their problems freely without having to restrict themselves from self expression. This is only possible when a counselor accepts the circumstances in which the client is in. By embracing the entirety of the client regardless of their beliefs, opinions or feelings, counselors become the ultimate spiritual providers for individuals infected with HIV. They proceed to provide hope to the infected and affected individuals and also helping them develop purpose in life.
Cartwright et al (1999), provides a study which seeks to establish ethical dilemmas related to clients living with HIVAIDS. The decision making model which has been illustrated clearly indicates that there are many factors which lead to ethical dilemmas. These factors either concern the clients behavior or the counselors. Conflict will arise when their areas of interest collide. As such it is difficult to determine the specific factors which may result to ethical issues in regard to a specific client. Crucial to this discussion is the insistence on the need for professionals to establish these factors and make related decisions which are considerate of the clients welfare.
This paper has sought to analyze the ethical considerations involved in counseling clients with HIV. It is evident that confidentiality is a major ethical consideration as it springs from the core element of counseling. Confidentiality has been seen to face major obstacles which must be carefully addressed. Other ethical issues discussed are in regard to spirituality and discrimination. In establishing a sense of purpose and belonging, ethical issues arise due to the presence of biasness and judgment on the part of the counselor. Counseling does play a major role in HIV prevention and treatment and should be addressed with utter care in order to ensure its success. Moreover, addressing the ensuing ethical issues will ease the counseling process.