Therapeutic reactivity to confidentiality with HIV positive clients: bias or epidemiology?

Therapeutic reactivity among psychology trainees (N=68) was ascertained by their response to 10 clinical vignettes depicting clients with HIV who are sexually active with uninformed partners. This construct accounts for the relative change in decisions to maintain the confidentiality of clients who acknowledge safe versus unsafe sexual behavior. As anticipated, an analysis of variance revealed a significant main effect for safety and a significant 3-way interaction (Sexual Orientation X Safety X Gender). Subsequent analyses revealed that trainees exhibit the highest level of therapeutic reactivity toward heterosexual male clients, and the lowest reactive stance toward heterosexual female clients. Although the decisional pattern evidenced toward heterosexuals seems congruent with epidemiological estimates of risk, the decisions toward lesbians and gay males appear more likely a function of bias. The ethical implications of these findings are discussed.