You are a nursing student. You are also HIV positive because of some high-risk behaviors you engaged in a decade ago. (It seems like a lifetime ago.) You are now in a committed, monogamous relationship, and your partner is aware of your HIV status. You have experienced relatively few side effects from the antiretroviral drugs you take, and you appear to be healthy. You have not shared your sexual preferences, past sexual history, or HIV status with any of your classmates, primarily because you do not feel that it is their business and because you fear being ostracized in the local community, which is fairly conservative.

Today, in the clinical setting, one of the students accidentally stuck herself with a needle right before she injected it into a patient. Laboratory follow-up was ordered to ensure that the patient was not exposed to any blood-borne disease from the student. Tonight, for the first time, you recognize that no matter how careful you are, there is at least a small risk that you could inadvertently expose patients to your bodily fluids and thus to some risk.

DQ: Decide what you will do. Is there a need to share your HIV status with the school? With future employers? With patients? What determines whether there is “a need to tell” and a “need to know”? What objective weighted most heavily in your decision?