Describe your course of action.
The scenario
You are a general practitioner and have recently explained to one of your patients that he has been diagnosed with HIV. He tells you he has not told his partner and does not want her to find out.
How to structure your answer
Work down the list. Each step is one thing to actually say.
Encourage him to tell her himself
Explain why being transparent matters, because his partner can only take precautions, get tested and access treatment if she knows. Frame it as your duty to protect and promote the health of patients and the public, and put it in terms of her wellbeing rather than as a threat.
Understand what is stopping him
Assess why he is not keen to tell his partner, whether that is fear of the relationship ending, stigma, worry about how the infection was acquired, or fear for his own safety.
Offer the clinical options
Suggest antiretroviral therapy for him and pre-exposure prophylaxis for his partner.
Get the notifiable disease point right
Note that HIV is not a notifiable disease by default, unlike tuberculosis or meningitis, but that disclosure may still be necessary on public interest or serious harm grounds.
Keep disclosure as a genuine last resort
If he continues to refuse and there is a real risk of transmission to his partner, you would break confidentiality.
Be transparent about it and seek advice
Tell him beforehand and explain your reasoning, and seek advice from other GPs, the BMA, medico-legal services or the Caldicott Guardian.
Model answer
My starting position would be that I want him to tell her, and that my job is to make that as achievable as possible rather than to go around him. I would begin by explaining why transparency matters here. His partner may already have been exposed, and she can only take precautions, get tested and access treatment if she knows. That is a direct part of my duty to protect and promote the health of patients and the public, and I would put it to him in terms of her wellbeing and his own relationship rather than as a threat. Second, I would try to understand the barrier. Reluctance to disclose usually has a reason: fear of the relationship ending, fear of stigma, worry about how the infection was acquired, or sometimes fear for his own safety. I cannot help him until I know which it is, and I would offer to be present when he tells her, or to have her seen at the practice so it is discussed with support. Third, I would cover the clinical options, which often change the emotional weight of the conversation. Antiretroviral therapy for him can suppress the virus and dramatically reduce transmission risk, and pre-exposure prophylaxis is available for his partner. HIV is a manageable long-term condition now, and saying that clearly can make disclosure feel less catastrophic. On the law, HIV is not a notifiable disease by default, unlike tuberculosis or meningitis, so there is no automatic reporting duty. But that does not settle it, because disclosure can still be justified on public interest or serious harm grounds. So if he ultimately refused, and there was a real and ongoing risk of transmission to an identifiable partner, I would be prepared to break confidentiality as a last resort. I would tell him first, explain my reasoning, and disclose only what was necessary. I would not make that decision alone: I would discuss it with colleagues in the practice, the BMA, medico-legal services and the Caldicott Guardian.
Anything in square brackets is a prompt for your own example. Use your own experience there rather than reciting someone else's.
Terms explained
Use the proper term in your answer. This is what each one means.
- Antiretroviral therapy
- Daily medication that suppresses HIV in the body, keeping the person well and reducing the chance of passing it on.
- Pre-exposure prophylaxis
- Medication taken by someone who does not have HIV, often shortened to PrEP, to stop them catching it from a partner who does.
- Notifiable disease
- An infection that doctors are legally required to report to public health authorities, such as tuberculosis or meningitis, so outbreaks can be controlled.
- Caldicott Guardian
- A senior person in every NHS organisation responsible for protecting patient information and advising on when sharing it is justified.
- Public interest
- The benefit to society as a whole, which can occasionally outweigh one patient's right to privacy.