title: Boundaries of confidentiality in nursing care for mother and child in HIV programmes.
abstract: BACKGROUND
  Confidentiality lies at the core of medical ethics and is the cornerstone for developing and keeping a trusting relationship between nurses and patients. In the wake of the HIV epidemic, there has been a heightened focus on confidentiality in healthcare contexts. Nurses' follow-up of HIV-positive women and their susceptible HIV-exposed children has proved to be challenging in this regard, but the ethical dilemmas concerning confidentiality that emerge in the process of ensuring HIV-free survival of the third party - the child - have attracted limited attention.
  
  
  OBJECTIVE
  The study explores challenges of confidentiality linked to a third party in nurse-patient relationships in a rural Tanzanian HIV/AIDS context.
  
  
  OBJECTIVE
  The study was carried out in rural and semi-urban settings of Tanzania where the population is largely agro-pastoral, the formal educational level is low and poverty is rife. The HIV prevalence of 1.5% is low compared to the national prevalence of 5.1%.
  
  
  METHODS
  Data were collected during 9 months of ethnographic fieldwork and consisted of participant observation in clinical settings and during home visits combined with in-depth interviews. The main categories of informants were nurses employed in prevention of mother-to-child transmission of HIV programmes and HIV-positive women enrolled in these programmes.
  
  
  METHODS
  Based on information about the study aims, all informants consented to participate. Ethical approval was granted by ethics review boards in Tanzania and Norway.
  
  
  CONCLUSIONS
  The material indicates a delicate balance between the nurses' attempt to secure the HIV-free survival of the babies and the mothers' desire to preserve confidentiality. Profound confidentiality-related dilemmas emerged in actual practice, and indications of a lack of thorough consideration of the implication of a patient's restricted disclosure came to light during follow-up of the HIV-positive women and the third party - the child who is at risk of HIV infection through mother's milk. World Health Organization's substantial focus on infant survival (Millennium Development Goal-4) and the strong calls for disclosure among the HIV-positive are reflected on in the discussion.
authors.affiliation: University of Bergen, Norway; University of Stavanger, Norway Bodil.B.Vaga@uis.no.
authors.forename: Bodil Bø
authors.initials: BB
authors.lastname: Våga
authors.affiliation: University of Bergen, Norway; University of Stavanger, NorwayUniversity of Bergen, Norway.
authors.forename: Karen Marie
authors.initials: KM
authors.lastname: Moland
authors.affiliation: University of Bergen, Norway.
authors.forename: Astrid
authors.initials: A
authors.lastname: Blystad
mesh_terms: D001942:Breast Feeding / Q000009:adverse effects; D003219:Confidentiality / Q000941:ethics*; D015658:HIV Infections / Q000451:nursing* / Q000517:prevention & control / Q000523:psychology; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000941:ethics* / Q000517:prevention & control; D007407:Interviews as Topic; D009723:Nurse-Patient Relations / Q000941:ethics*; D057545:Social Stigma; D013636:Tanzania; D014342:Truth Disclosure / Q000941:ethics*
keywords: Confidentiality; Tanzania; disclosure; nursing; prevention of mother-to-child transmission of HIV programmes; qualitative research; third-party dilemma