Confidentiality vis-à-vis HIV/AIDS and Other Related Issues: A Case Study in Light of Islamic Medical Jurisprudence

Case Scenario

A young South African Muslim became HIV-positive and did not inform his wife prior to their nikah (marriage). This man was working for an engineering company in a neighbouring country, namely Botswana, when he became ill with tuberculosis and was diagnosed with AIDS. This information was not disclosed to his 21-year-old wife, who was living with her parents-in-law in a middle-class suburb area of Johannesburg. He came back to South Africa on sick leave. His parents wanted them to start a family, but his wife thought it would be better to wait until he had recovered. However, she fell pregnant and came to know that her husband had full blown AIDS and the dangers it posed only when she was eight months pregnant and at that time he was seriously ill. Her husband died some three months after the baby was born and she went back to her parents’ home in Durban. Both of them, mother and baby, were HIV-positive and living at the mercy of others since her parents were old and on government pension.

Questions

1. 1. If a Muslim doctor were to become aware that the young Muslim husband was HIV-positive, would it be necessary for him/her to breach the confidentiality of his/her patient and notify his spouse of her husband’s HIV status?

2. 2. What about HIV antibody testing prior to nikah for both the prospective husband and wife?

3. 3. What options would the wife have had if she had known of the HIV status of her husband, prior to their nikah (marriage) or during the course of their marriage?

4. 4. Since antiretroviral treatment is beyond the scope of the infected mother and baby, what type of charity could be used in order to procure the necessary therapy for them?

5. 5. How should Muslims interact with HIV/AIDS patients?

Introduction

Humankind has made tremendous strides towards enhancing the quality of life, yet we are faced with some serious challenges which threaten our very existence on this planet. Some of these challenges are the resurgence of malaria and the deadly Ebola fever on the African continent and the greatest scourge of all is the escalation of the human immunodeficiency virus (HIV) leading to acquired immunodeficiency syndrome (AIDS). It is alarming to note that since the first cases of AIDS were reported in 1981, infection with HIV has assumed pandemic proportions, resulting in 65 million people across the world succumbing to HIV infections, 25 million of whom have since died. In 2006, 39.5 million people were living with HIV, of whom 4.3 million persons became newly infected with HIV. By the end of 2006, 2.9 million people died from AIDS.² The status of HIV in South Africa is alarming,³ although to a lesser degree, Muslims across the globe too have been and are victims of this deadly disease.

In what follows, all the questions which pertain to the case scenario are dealt with under different headings in light of Islamic Medical Jurisprudence.

Right to Privacy

In South Africa, every person has a right to privacy and it is important to note that HIV/AIDS is not a notifiable disease.⁴ Thus, it follows that HIV-positive people cannot be forced to disclose their HIV status to anyone, except in rare instances. The Health Professionals Council of South Africa (HPCSA) has recommended that healthcare workers should not disclose the HIV status of an individual to third parties (including family, sexual partners and employers) unless the patient has provided informed consent (i.e., knows the consequences of their status being disclosed). However, the UN, World Health Organization (WHO) and Health Professionals Council of South Africa (HPCSA) have initiated certain guidelines which do make provision for “disclosure without consent” especially when patients refuse to tell their partners that they are HIV-infected and there is a real risk of infecting their sexual partners.⁵

Doctor and patient confidentiality is vital and devolves on trust. It...