Background

The 2014 General Council resolution GC14-65 — The Canadian Medical Association will review its policies on human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) — prompted a review of the CMA Policy on Acquired Immunodeficiency Syndrome (AIDS). There have been considerable scientific advancements since the policy was released in 2000, and as a result the current policy requires substantive revision. Advances in science and medicine have significantly enhanced the life expectancy and quality of life of people living with HIV, reduced the risks of virus transmission and diminished the likelihood of disease progression to AIDS. Nevertheless, the HIV epidemic remains a serious public health challenge affecting Canadian society.

The new HIV/ AIDS draft policy was developed to reflect scientific and medical advancements in the diagnosis and treatment of HIV/AIDS and to address contemporary challenges associated with HIV/AIDS in the Canadian health care context. The new draft policy has been reviewed by the CMA Committee on Ethics. In addition to this, stakeholders were invited to share their feedback on the draft policy between Jan. 14 – Mar. 6, 2019.

Scope

This policy aims to provide guidance to physicians, policy-makers and the general public on issues related to the prevention, testing and treatment of HIV/AIDS. It also addresses the physician’s ethical obligations and society’s moral obligations in the national response to HIV.

Specifically, as part of this revision, the CMA was interested in hearing your views on partner notification. Partner notification — also referred to as contact tracing — aims to identify the sexual partners of someone with an HIV infection, inform these partners of their potential exposure and encourage them to seek testing or treatment.

The new draft policy on HIV/AIDS states: The disclosure of a patient’s HIV status to a spouse or current sexual partner may not be unethical and, indeed, may be indicated when physicians are confronted with an HIV-infected patient who is unwilling to inform the person at risk. Under Article 4.2 of the draft policy, such disclosure may be justified when all of the following conditions are met:

  1. the partner is at risk of infection with HIV and has no other reasonable means of knowing the risk;
  2. the patient has refused to inform his or her sexual partner;
  3. the patient refused an offer of assistance by the physician to do so on the patient’s behalf; and
  4. the physician has informed the patient of his or her intention to disclose the information to the partner.

In 2017, the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) issued a joint statement on testing for HIV, which stated that “partner notification must be voluntary and confidentiality must be ensured” and that “notification of the partners of a person living with HIV must only be undertaken with the person’s voluntary consent. The notification process must maintain the confidentiality of the person living with HIV and their partners.”

According to the Public Health Agency of Canada’s HIV Screening and Testing Guide, “partner notification is an important public health strategy designed to prevent further HIV transmission and reduce morbidity and mortality associated with HIV and AIDS.” While the guide acknowledges that full disclosure to current or former partners is voluntary and may be dependent on the degree to which a client feels that their anonymity can and will be protected, the guide instructs care providers to report, in accordance with provincial and territorial public health legislation, “when they have a reason to believe that the actions or behaviours of a client present a risk of infection to others. Public Health is equipped to work with those individuals who are unwilling or unable to disclose their HIV-positive status to sexual or drug-equipment sharing partners.”

Feedback

This consultation period to provide feedback is now closed.