Scenario You are working at a physician’s

Scenario You are working at a physician’s office, and you have just taken CQ, a 38 y.o. woman, into the consultation room. CQ has been divorced for 5 years, has 2 daughters (ages 14 and 16), and works full time as a legal secretary. She is here for a routine physical examination and requested that a human immunodeficiency virus (HIV) test be performed. CQ stated that she is in a serious relationship, is contemplating marriage, and just wants to make certain she is “okay”. No abnormalities were noted during CQ’s physical exam, and blood was drawn for routine blood chemistries and hematology studies. The physician requests you perform a rapid HIV test, which is an antibody test. Within 20 minutes, the results are available and are positive. 1. Does a positive rapid HIV test mean that CQ definitely has HIV? If it is negative, does it mean she definitely doesn’t have HIV? 2. What counseling do you need to provide to CQ? Case Study Progress The physician informs you that CQ’s Western blot test results confirm that she is HIV positive; he requests that you be present when he talks to her. Before leaving CQ’s room, the physician requests that you give CQ verbal and written information about local HIV support groups and help CQ call a friend to accompany her home this evening. She looks at you through her tears and states, “I can’t believe it. J. is the only man I’ve had sex with since my divorce. He told me I had nothing to worry about. I can’t believe he would do this to me.” 3. CQ’s statement is based on 3 assumptions: 1) J is HIV positive; 2) he intentionally withheld the information from her; and 3) he intentionally transmitted the HIV to her through unprotected sex. Based on your knowledge of HIV infection, how would you counsel CQ? 4. In addition to offering alternative explanations and exploring options, what is your most important role at this time? 5. CQ asks you whether she has AIDS. What do you tell her? 6. Why is it a good idea for CQ to have someone she trusts transport her home this evening? 7. CQ gives you the name and phone number of a relative she wants you to call. You remain with her until she leaves with her relative. Has CQ’s right to privacy been violated? Explain why or why not. Case Study Progress CQ returns to the office 4 days later to discuss her diagnosis. 8. What are your goals for CQ at this time? 9. What additional laboratory tests would you anticipate for CQ? 10. CQ asks whether there is any treatment available. How would you respond? 11. CQ asks why she has to take so many drugs instead of a “big dose” of one drug. What would you tell her? 12. The physician starts CQ on a regimen of Truvada (tenofovir and emtricitabine), Reyataz (atazanavir), and Norvir (ritonavir). What general information will you give CQ about ART therapy? 13. What other issues will you discuss with CQ at this visit? 14. Does CQ have a legal responsibility to inform J of her HIV status? Case Study Progress Two weeks later, CQ visits the office and asks to speak to you in private. She thanks you for talking to her the day she received the news of her diagnosis. She tells you the J confessed to her that he was afraid to tell her about his hemophilia because she might leave him. J tested positive in the 1980s after being infected through contaminated recombinant factor products. CQ tells you that they are going to get married.

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