HIPAA Confidentiality
Rhonda Hogan
HCR/220
Fonzette Mixon
April 3, 2011

HIV and AIDS affect millions of people worldwide. Some of these people have HIV, only testing positive, whereas others already are diagnosed with AIDS. Still others who have not yet been diagnosed at all may be suffering inside and have no idea he or she is inflicted with this horrible disease. Confidentiality becomes more sensitive when interacting with HIV or AIDS patients. The Health Insurance Portability and Accountability Act (HIPAA) is the law that was enacted “in response to growing concerns about individual’s health information potentially being used inappropriately, causing barriers to health care coverage, and related job mobility impediments” (Biel-Cunningham, 2003). Acquired immunodeficiency syndrome (AIDS) is exactly what it states, an immunodeficiency (HIV) turned syndrome that is acquired. In other words, AIDS is caused by and acquired from HIV. The virus enters the body, via blood, semen, or an infected mother during birth, whereby attaches onto T-cells while working to grow inside. After replicating and destroying the T-cell, the virus moves onto other healthy T-cells until they have been taken over. Once enough T-cells are destroyed, the person’s immune system no longer functions. When acquiring a serious infection, the body’s lack of fight for the infection is because of an extreme low T-cell count, and a diagnosis of AIDS will be determined. As far back as the Hippocratic Oath, physicians have been required to keep knowledge of individual patients a secret. “Personal health information is maintained not only by physicians, but also in the records and/or databases of hospitals and clinics that provide treatment or diagnostic services, laboratories that perform tests, pharmacies, and insurance companies and managed care organizations to which claims are submitted or coverage is made” (AHIMA, 2008). The law mandates that patient’s health information is to be private as well as secure and is known as the Health Information Portability and Accountability Act of 1996. HIPAA consists of four parts: Portability, Transaction, Privacy, and Security. Portability indicates the protection of an individual to obtain health insurance under a pre-existing medical condition. Transaction regulates how information is reported regarding enrollment, eligibility, claims, and payment. Privacy provides standards for protected health information, such as name, address, phone number, medical record and social security numbers, and so forth. Security defines “who has access to PHI and how much of the patient information is accessible” (Biel-Cunningham, 2003). Concerning the health information of some illnesses and sicknesses, sensitivity is not as frequent as with patients diagnosed with HIV or AIDS. Breaching of protected health information, especially HIV or AIDS related, is more than just a blatant disregard for the law but can bring forth unnecessary grief and hardship for the suffering person. Even though there may not be visible signs and symptoms, a person may not want his or her condition revealed. “The need to collect sensitive data on HIV infection and AIDS has drawn attention to the issues of authority and confidentiality in public health” (CDC, n.d.). There must be a balance regarding individuals’ privacy rights in comparison to forewarning of others regarding the potential of HIV exposure. Most states require that AIDS and HIV positive test results be reported; however there are several variances. A person’s identity, the certainty of a positive diagnosis, and penalties imposed for breaches in confidentiality are a few of the state law variances regarding reporting requirements. Whenever a person visits a physician’s office, the receptionist asks the patient to complete or update his or her paperwork. A good deal of the time, people pay very little attention to what the paperwork is for, they just fill it out and usually complain. Providing the most private of personal information requires a high standard of privacy and security once the paperwork is turned in for processing. This includes safeguarding computer screens so no one else can see the PHI. Fax transmissions must contain a confidential communication clause on the cover sheet to comply with HIPAA rules and regulations. Information of individuals suffering from HIV or AIDS is highly sensitive because of all the stigmatism associated with these diseases. Homosexuality and drug-users become the social stigma for anyone with HIV or AIDS. If diagnosed with HIV or AIDS, most of the public will pre-judge. An automatic fixation on the negative side of acquiring this disease is the focus when people discover one’s HIV status. People will wonder if this person does drugs, or is a homosexual, rather than thinking about a botched bag of blood the person received a few years ago from an automobile accident or maybe had unprotected sex after a party with someone already HIV positive. “Disclosure of information has led to discrimination in housing, employment, and insurance as well as to loss friends, family and community support” (CDC, n.d.). These are only some of the hardships and grief brought about from improperly releasing confidential information. “According to an article published in AIDS Care in 2001, fears of breaches in confidentiality resulted in individuals actually not accessing treatment in order to prevent the release of sensitive information” (Biel-Cunningham, 2003). To prevent the release of sensitive information is one of the very reasons HIPAA passed into law. Whether legal or illegal, HIV positive individuals as well as with AIDS suffers from discrimination when their disease is made public. Because these diseases are a sensitive subject, there are social ramifications when PHI is wrongly disclosed. Not only does discrimination creep into play, but people who do not have the disease live in fear that they may “catch” it. Of course, unless spread by blood, semen, or bodily fluid transaction, HIV or AIDS is not contagious, such as the common cold or flu. What was once thought of as friends turn into strangers that have faded away with time. Word of mouth, or gossip, about HIV status or AIDS can ruin a person’s social environment. The legal ramifications can be severe if PHI is improperly disclosed. These legal ramifications include protection from an employer’s discrimination as well as protection from the medical professionals not practicing honesty and integrity. For example, when faxing medical records to a patient’s new health care provider, a mistake happened when the records were faxed to the patient’s employer instead. Of course this is only an example, but depending on who looked at the fax on the employer’s end is anyone’s guess. The patient received several apologies, but the medical employee received a written disciplinary warning as well as the office received training on proper faxing procedures. Receiving a written disciplinary warning may appear to be a slap on the wrist for such a mistake. For some people, a disciplinary warning would be considered a minor offense, but for the patient, his or her world may come crumbling down. Safeguards within medical facilities must follow all HIPAA rules and regulations, no matter how minute. Fines can become quite steep, and if convicted, jail time may be required. Loss of licensure for physicians can occur if offenses are repetitious, which could ultimately close down a facility. HIV and AIDS also affect the employer as well as the patient, and there are many laws passed and implemented to protect both. With the age spread of 25-44 for people infected with HIV, these particular individuals are found in the workplace, so it is important to know the laws that will help protect the patient as well as the employer. For instance, “the Americans with Disabilities Act of 1990 (ADA) prohibits employment discrimination on the basis of disability” (The Body, n.d.). The Occupational Safety and Health Administration (OSHA) saves lives, prevents injuries, and protects American workers’ health by mandating safety precautions for health care workers when interacting with patients who have been diagnosed with HIV or AIDS. The Family Medical Leave Act of 1993 (FMLA) allows eligible employees entitlement to a total of 12 weeks of unpaid leave during any 12-month period to care for an immediate family member, including HIV/AIDS. With so many people in the world inflicted with a positive HIV status or AIDS, the need for confidentiality regarding protected health information is of vital importance. Not only will improper disclosure be a disregard for the law but can inflict additional pain and grief on the already suffering individual. The social ramifications are many, such as exclusion, discrimination, and rejection from family, friends, and co-workers that can bring forth unnecessary grief and hardships. A code of ethics must always be followed when working in the health care field that requires honesty and integrity at all times. Legal ramifications include warnings, terminations, fines, incarceration, and loss of licensure. Put in place to protect the confidentiality of patient information, HIPAA rules and regulations must be followed and enforced on a continual basis, no matter if an individual is suffering from this season’s flu, HIV, or AIDS.

References
AHIMA. (2008). Confidentiality of Medical Records. Retrieved from http://library.ahima.org/xpedio/groups/public/documents/ahima/bok2
Biel-Cunningham, S. (2003). HIPAA: Understanding Your Rights of Insurance Portability and Privacy. The Body: The Complete HIV/AIDS Resource. Retrieved from http://www.thebody.com/content/art32201.html
CD. (n.d.). Issues concerning HIV and AIDS. Retrieved from http://www2a.cdc.gov/phtn/legal-basis/Mod2.pdf
The Body. (n.d.). Basic Facts about HIV and the Law. The Body: the Complete HIV/AIDS Resource. Retrieved from http://www.the body.com/content/art45205.html