I work at a shelter for pregnant and parenting teens. Recently, we had a young lady who had HIV, but staff was not told about it because the director thought staff did not need to know. We eventually found out, and there was an uproar. He told staff that you could have sex with an infected person several times and even share needles several times before there was a chance you would be infected by a person with HIV. Is that true? The director says he is a certified HIV counselor.

M.C.

The situation you outlined raises several issues we should discuss. In my opinion, the staff was inappropriately "in an uproar." Because HIV (the virus that causes AIDS) is not transmitted through casual contact, there generally is no need to notify employees about another worker's or a client's HIV status. I do not expect any of the staff would have had any significant exposure to the young lady who is infected with HIV. The virus can be transmitted by intimate contact with blood from a person infected with HIV (such as through a cut or open sore), by sharing contaminated needles and syringes (as occurs among people who abuse drugs), and through sexual contact. It is not spread by handshakes, non-intimate kisses, toilet seats or bugs (such as mosquitoes).

When a patient with HIV enters the hospital, his or her HIV status is noted in the medical chart, but it is not announced to the hospital staff, such as maintenance workers and secretaries. They do not need to know, so they are not told. In fact, it is not even crucial that nurses know. Every patient should be treated with the same precautions, whether or not that individual has HIV.

The director of your shelter has made several mistakes. First, he should have ensured that the client's HIV status did not become known to anyone who did not absolutely need to know. Confidentiality about HIV status is extremely important. The fact that your staff was upset that they had to work with a person infected with HIV illustrates that there is discrimination against such patients. If discrimination exists even in a shelter for disadvantaged women, imagine what often happens in a typical work setting. Confidentiality is particularly crucial in a shelter such as yours. If a woman is worried that her secret regarding her HIV status will become public, she will be less likely to seek out such needed services.

Your director also misstates many facts about HIV. He is correct that it is not easy to transmit the virus through non-intimate means, but he has overstated the case. While it is true that a single sex act is not very likely to transmit the virus, the risk is not zero. Many people have been infected by sharing needles once or having sex with an infected person a single time. I am not sure what it means to be a certified HIV counselor, but someone who counsels those at risk for HIV should know that you can become infected by committing a single mistake. That is why it is so important for people to never share needles and to always use protection (such as a condom) during sex.