Ontario public health counseling practice following the criminalization of HIV non-disclosure: A contribution to the sociology of public health.
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文摘
Background and Approach: In Canada,criminalizing HIV non-disclosure has become a hot button issue in HIV prevention. To date,however,few studies have closely analyzed whether and how it affects frontline public health work. This dissertation examines the "subtle" impact of criminalization on the reasoning and practices of public health nurses who counsel HIV-positive clients about disclosure and the criminal law. It draws on qualitative interviews with thirty nurses at four Ontario public health units,eight interviews with community activists,ethnographic observation,archival research,and analysis of public health counseling guidelines. This study makes original contributions to the "medico-legal borderland" conceptual framework Timmermans and Gabe 2003),the sociology of public health,and the applied intemational literature on the public health effect of criminalizing HIV transmission,exposure,and non-disclosure. Research Questions: This study addresses four questions: First,does the public health focus on disclosure reflect a new or an existing standard of practice? Second,how are clients advised about their obligation to disclose and what information informs counseling practice? Third,how is the nurse-client relationship impacted by the requirement to discuss disclosure and criminalization? Finally,what do these developments suggest about how external state institutions,like the criminal justice system,influence local public health settings and HIV prevention work? Findings: First,nurses counseling practices have shifted in response to biomedical innovation,tensions with HIV/AIDS activists,sensational media reportage,and concerns about liability in criminal and civil courts. Second,public health counseling guidelines indicate an interpretation of disclosure that extends beyond the language of the criminal law. Analysis also shows an emphasis on disclosure that focuses on notions of HIV prevention that are not widely supported in the professional literatures. Third,analysis indicates that criminalization has a subtle yet harmful impact on the counseling relationship. Nurses must carefully manage tensions in order to foster open dialogue about risk behavior and disclosure,while also collecting important contact information on sexual partners. Finally,the threat of health records being subpoenaed has led to variation in how nurses advise clients about the limits of confidentiality,which in turn presents challenges to ethical counseling practice.