HIV public policy and psychiatry. An examination of ethical issues and professional guidelines

The authors examine the interfaces among public policy, legal issues, ethical issues, and physician responsibility for the human immunodeficiency virus (HIV)-infected psychiatric patient within the realms of civil liberties and public health. Current professional guidelines on caring for HIV-infected psychiatric patients are discussed, including discussion of psychotherapy and the potential for behavioral change. The impact of the Tarasoff decision on confidentiality is reviewed, including discussion of whether a precedent was set mandating that a psychiatrist warn identifiable third persons at risk of becoming infected by his or her patient. The management of HIV-infected psychiatric inpatients who continue to put other patients at risk and the impact of HIV carriers on ward milieu are also addressed, as are difficulties encountered with the chronically mentally ill.