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ADVANCE MEDICAL DIRECTIVES What are Advance Medical Directives? BEFORE YOU TELL COMBATING DISCRIMINATION: CONFIDENTIALITY VS. DISCLOSURE HIV-related discrimination remains a very real problem. Many people, possibly including your employer, co-worker, landlord, neighbors, teachers, or health-care providers are irrationally afraid of even casual contact with someone who has HIV. Their fear can cause you and those close to you to be denied a wide range of opportunities and services. Some people with HIV/AIDS are choosing to combat this discrimination, and its underlying stereotypes, and fears, by "going public" about their condition. In showing the public that people with HIV are ordinary people, not dangerous or evil, they have greatly changed general attitudes. The more people who are open about having HIV, the better the situation will become. However, before you disclose to anyone, you must carefully examine the possible consequences. You should determine what types of discrimination you may face and the likelihood that it will occur. If you are unsure of what could happen, consult AIDSLaw or your local AIDS service organization. For some, there are few or no adverse consequences to disclosure. Others may find themselves in the front lines of this battle. Although much of this discrimination is illegal, the law does not always offer quick or effective protection. If you are unable or unwilling to deal with the discrimination you may face, you need to maintain the confidentiality of your HIV status. The simple rule is: DO NOT TELL ANYONE unless there is a strong reason why that person needs to know and unless you are sure the information will go no further. Some rules for specific situation are: TESTING Be tested anonymously, i.e., without giving your name. A so-called "confidential" test result will be part of your medical record. This can be looked at by your current health insurer, by any insurance company to whom you apply for a new policy, by your employer if he processes your medical bills, and by any doctor or hospital who treats you for any condition. Also, many insurance companies will share with each other any unusual medical information they obtain about you. If you are tested anonymously, only you will be told the result and you can control when and if others learn about it. DOCTORS You will need to tell a doctor, but do not automatically go to your usual or family physician. You need a doctor with experience in treating HIV-infection and who understands the importance of true confidentiality. Your current doctor may have neither of these qualifications and may in fact be afraid of treating people with HIV. Your local AIDS service organization can refer you to a qualified physician. When first meeting with a doctor, you should discuss what HIV-related information will be put in your medical record and who will have access to it. Also, your doctor only needs to know that you are infected; you do not need to say when you found out you were infected EMPLOYMENT Be very careful in deciding to tell your employer or your co-workers. Many people who have expected a sympathetic response have instead been harassed or fired. Even employers who are not AIDS-phobic have tried to fire people with HIV in order to control health insurance costs or because of fears about how customers would react. If your employer asks generally about your medical history or specifically about HIV, try to delay answering until after you have spoken to an AIDSLaw attorney. If you miss work often or need to go on sick leave or disability, you will have to explain why. Check with an attorney to determine what information to provide your employer and when. INSURANCE Always check with an attorney before letting an existing policy lapse or before changing jobs, even if you believe you can get better coverage. If you lose your job, in most cases you can still retain your coverage for a period of 18 months under federal law (COBRA) but you have to pay the premiums. If you are designated as medically disabled, your coverage under COBRA can be extended for an additional 11 months, for a total of 29 months. If you have difficulty paying the premiums, talk to your case manager about programs that will help you pay these premiums. Check with an attorney before filing an HIV-related claim. Properly timing your first claim can help limit premium increases, preserve benefit levels and reduce the chance your insurer will try to rescind your policy. Furthermore, if your insurer is slow to pay or tries to terminate your coverage for any reason, talk to an attorney. SPOUSES/LOVERS/FRIENDS Louisiana law requires that you warn anyone whom you may be exposing to HIV. (infection is not necessary). If you expose someone, you can go to jail for 10 years at hard labor. The law has yet to define clearly what constitutes "exposure" to HIV. However, to protect yourself from this charge, you should, at a minimum, inform partners of your status and strictly follow safer-sex guidelines. If you are unsure of the guidelines or feel uncomfortable broaching the subject with sexual partners, contact your local AIDS services organization for instruction and counseling. Everyone whom you have already exposed needs to know, both to monitor their health and to keep from spreading the virus to others. If you can't tell them directly, your doctor or a public health officer can do so without identifying you. If you need to talk about what you are going through, but aren't sure your friends can keep this secret, ask your local AIDS organization about counselors and support groups. AIDSLaw SERVICES AIDSLaw of Louisiana, Inc. provides free assistance with HIV-related legal problems. This brochure is designed to provide general information. Although this brochure is prepared by professionals, it should not be used as a substitute for professional services. If legal or other professional advice is required, the services of a professional should be sought. AIDSLaw can provide legal assistance or referrals to persons needing services. In addition to the issues of confidentiality and discrimination discussed in this booklet, HIV-infection makes it important for you to think about several other issues, such as confidentiality and discrimination, estate planning, child custody, and insurance and financial planning. The AIDSLaw staff can provide you with additional information on these subjects and, when necessary, refer you to an HIV-sensitive and experienced attorney. If you are unable to afford an attorney, we will arrange for you to see one on a reduced or no cost basis. AIDSLaw of Louisiana, Inc., is here to help with any HIV-related legal problem or need you may have.