“We write as little as we have to”: charting practices and documenting disclosure in response to HIV criminalization in Canada

ABSTRACT

The criminalization of HIV nondisclosure is reshaping the landscape of support and care for people living with HIV/AIDS (PLWHA). Focusing on Canada, this article examines how criminalization is reshaping the relationships between frontline AIDS Service Organization (ASO) workers and their HIV-positive service users. Using data gleaned through semi-structured interviews with N = 62 frontline ASO staff members across Canada that were coded using thematic analysis, we describe how ASO workers are rethinking and altering their notetaking practices in light of fears about criminalization and how their charts may be used by legal actors. Specifically, we identified three main themes. First, awareness that their notes can be subpoenaed and used against their clients in criminal proceedings is leading ASO staff to keep less detailed records of their conversations with PLWHA, although there were variations by the type of position held. Participants with professional obligations (doctors, nurses, social workers) reported that they continue to keep more detailed charting records than other frontline ASO staff (peer counselors, educators, etc.). Second, participants acknowledged that criminalization threatens the trust dynamic in the therapeutic relationship and that by taking less detailed notes they risk the quality of care provided. Third, we found that evolving knowledge about risk and responsibility in light of criminalization is impacting the type of counsel ASO workers offer to PLWHA regarding how to document disclosure. The article concludes by reflecting on the challenges associated with navigating the “medico-legal borderland”, as ASO staff balance their commitments to serving PLWHA with the realities created by the harsh climate of criminalization. Greater political attention should be paid to the risks that criminalization poses to frontline HIV support work and efforts to support PLWHA, who already face significant stigma, without the additional stigma of the criminal label.

KEYWORDS:

• Criminalization of HIV nondisclosure
• disclosure documentation practices
• AIDS service organizations (ASO)
• notetaking practices
• Canada

Acknowledgements

We thank the anonymous reviewers and Richard Elliott and Ryan Peck for their helpful comments on this article. We thank research assistants Peter Balogh and Katarina Bogosavljevic for participating in the interview and coding processes.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 In Canada, an individual who is convicted of such a charge is automatically designated a sex offender and must register in the National Sex Offender Registry. http://www.aidslaw.ca/site/sex-offender-registries-fact-sheet/?lang=en.

2 The basic question with all evidence, whether from a peer navigator or a registered professional, is whether it is credible and reliable.

Additional information

Funding

This research was funded by a Catalyst Grant in Bioethics from the Canadian Institutes of Health Research (220829-190399).