As a result of the unique concerns that have emerged through the AIDS crisis, the GMC first introduced specific guidelines concerning HIV infection and confidentiality in August 1988. These relied upon the need to safeguard confidentiality in relation to sensitive areas of health care. As such they built upon the National Health Service (Venereal Diseases) Regulations 1974 (SI 1974 No. 29). The issue is most recently addressed by the GMC’s guidance on Serious Communicable Diseases (October 1997), which “particularly concerns, but is not limited to, infections such as human immunodeficiency virus (HIV), tuberculosis and hepatitis B and C.”

The guidance addresses confidentiality as follows. (As regards paragraph 20, it should be noted that HIV infection and AIDS are not regarded as notifiable diseases).

Informing other health care professionals

• 18. If you diagnose a patient as having a serious communicable disease, you should explain to the patient:

a) The nature of the disease and its medical, social and occupational implications, as appropriate.

b) Ways of protecting others from infection.

c) The importance to effective care of giving the professionals who will be providing care information which they need to know about the patient's disease or condition. In particular you must make sure that patient understands that general practitioners cannot provide adequate clinical management and care without knowledge of their patients' conditions.

• 19. If patients still refuse to allow other health care workers to be informed, you must respect the patients' wishes except where you judge that failure to disclose the information would put a health care worker or other patient at serious risk of death or serious harm. Such situations may arise, for example, when dealing with violent patients with severe mentally illness or disability. If you are in doubt about whether disclosure is appropriate, you should seek advice from an experienced colleague. You should inform patients before disclosing information. Such occasions are likely to arise rarely and you must be prepared to justify a decision to disclose information against a patient's wishes.

Disclosures to others

• 20. You must disclose information about serious communicable diseases in accordance with the law. For example, the appropriate authority must be informed where a notifiable disease is diagnosed. Where a communicable disease contributed to the cause of death, this must be recorded on the death certificate. You should also pass information about serious communicable diseases to the relevant authorities for the purpose of communicable disease control and surveillance.
• 21. As the GMC booklet Confidentiality makes clear, a patient's death does not of itself release a doctor from the obligation to maintain confidentiality. But in some circumstances disclosures can be justified because they protect other people from serious harm or because they are required by law.

Giving information to close contacts

• 22. You may disclose information about a patient, whether living or dead, in order to protect a person from risk of death or serious harm. For example, you may disclose information to a known sexual contact of a patient with HIV where you have reason to think that the patient has not informed that person, and cannot be persuaded to do so. In such circumstances you should tell the patient before you make the disclosure, and you must be prepared to justify a decision to disclose information.
• 23. You must not disclose information to others, for example relatives, who have not been, and are not, at risk of infection.

The Department of Health published Guidance on the notification of partners in December 1992 (PL/CO (92) 5). It states:

2. Partner notification (contact tracing) for sexually transmitted disease (STD) has been a central activity in the control of STDs in the UK for more than 40 years. In the early years of the HIV epidemic, when many of those infected had multiple partners over many years, it was the view of some experts that it was impractical and unproductive as a method of limiting the spread of the infection. Nevertheless, the majority of physicians have always counselled those infected with HIV about the need to inform their sexual or drug injecting partners.

3. Because of the advent of therapies which delay the progression of HIV disease and also because of changes in the nature of the epidemic (i.e. spread to heterosexuals in low prevalence areas where those infected might not perceive themselves at risk) there has been increasing discussion about, and research into, the importance of partner notification, including notification by clinic staff.

4. While most physicians actively encourage partner notification by or with the consent of the infected person, practice varies, most partner notification being undertaken by the infected person with the support of the clinic.