HIV, confidentiality, and duty to protect: Considerations for psychotherapists in the age of treatment as prevention

Confidentiality and duty to protect are complex issues for psychotherapists treating clients with HIV. The application of the Tarasoff ruling to situations involving HIV has long been debated with questions about how the Tarasoff principles of identifiability of the victim, foreseeability of harm, and necessary protective action apply to HIV within the context of psychotherapeutic relationships. The complexity of these debates is compounded by advances in HIV medicine including the availability of antiretroviral therapy and pre- and postexposure prophylaxis in addition to the current state of knowledge about treatment as prevention. The purpose of this article is to revisit Chenneville’s (2000) decision-making model on HIV, confidentiality, and duty to protect in the age of pre- and postexposure prophylaxis and antiretroviral therapy. This revised model may serve as a critical framework for psychotherapists providing services to clients with HIV.