Teens, Sex and HIV – a True Story

One of the medical journals I subscribe to arrived the other day and included an ethical dilemma directed at doctors who treat adolescents. The actual case was presented just as you see it below, followed by the opinions of two experts in the field.

The issues are difficult and complicated, but they’re important to wrestle with if you’re the parent of a teen, a soon-to-be teen, or an ever-to-be teen.

Privacy. Autonomy. Parental rights. Children’s rights. Maturity. Sexuality. Coming of age. Confidentiality. Family secrets. These are just some of the issues that jump off the page.

What would you do? As a parent? As a doctor? As a teen?

Share your thoughts with us if you’re willing. I will withhold my opinion, and the opinions of the experts, to give you a chance to formulate your own. Read on …

Lisa, a fifteen-year-old who recently moved to a different state, is being seen today for the first time by a new physician for a well-child check. He has not yet received her medical records from her former doctor.

In the exam room, she tells her new physician that she is healthy and takes no medications, only vitamins. She says she is an honors student, swims, and plays the violin. When the physician asks whether she is sexually active, she says no, but admits that she is thinking about it because she is in love with a boy from her old school. The two have been dating for a year and have recently started talking about having sex.

The physician asks if they have talked about birth control, too. Lisa says they have and tells him that she started taking birth control pills a few months ago. The physician mentions the necessity of using a condom as well to guard against sexually transmitted diseases, but Lisa replies that they are both virgins, so neither has to worry about that.

Lisa’s physician briefly leaves the room to let her get undressed for the exam. In the hallway, he sees Lisa’s parents, who have accompanied her to the clinic. They say they must speak to him immediately and in confidence. He is surprised, but shows them to his office. There, they tell him that Lisa has congenital HIV and has been taking HIV medications that were prescribed by her former pediatrician. They also tell him that she does not know this—they have told her the medications are vitamins.

Without mentioning anything that Lisa told him in confidence, the physician tells her parents that he thinks it’s time they told her she has HIV. Her parents get very angry. They insist that Lisa is still a child, and there is no reason to tell her yet. The physician mentions Lisa’s boyfriend and the length of their relationship. He reminds them that Lisa’s boyfriend will be at risk if he and Lisa have sexual contact.

Lisa’s parents say they know all about her boyfriend, but they insist the relationship is not mature enough for them to be thinking about sex—all they do is play video games together. They adamantly disagree with the physician’s view that Lisa is old enough to know her HIV status and say they will sue him if he tells her without their permission.

What should Lisa’s physician do?

Comment below to get your opinion heard. I’ll get back with you next week.

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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?

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3 responses to “Teens, Sex and HIV – a True Story”

  1. Lauri De Cicco

    Does the client/patient confidentiality extend to minors or is the doctor open to discuss what the girl actually said with her parents? It isn’t the responsibility of the doctor to protect other people from his patients’ conditions. However, it seems to be the “right” thing to do considering the age of the patients, maturity level, and the fact that a young boy could be infected with a deadly disease. I’m very interested to know what the experts perspectives are.

  2. Shannon

    At least here in Canada, someone can be convicted of aggravated sexual assault for having unprotected sex with someone else while aware of their HIV-positive status. I would think that there could be serious legal ramifications for both the parents and the doctor should Lisa unknowingly, due to their failure to inform her of her condition, pass on HIV to her boyfriend. I’d also wonder at the concept of informed consent — at the age of 15, a patient should have some say in their treatment. Again, in Canada, at such an age a child can be considered a mature minor and have some independent say in their health care decisions. It seems obvious that Lisa must be informed of her HIV positive status, either by her parents or the doctor, or preferably by all working together.

  3. The Experts Weigh In — A Teen With HIV

    […] Read last week’s post here. […]

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