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发表于 2004-8-18 09:27
以下资料由战友 becrazy (蜜蜂) 在水木清华 AntiHBV版提供：
什么时候泄露你的HBV感染？
http://www.hcvadvocate.org/hepatitis/hepB/HBV_Disclosure_FS.html
When to Disclose Your HBV Infection
Christine M. Kukka
HBV Project Manager;
Alan Franciscus
Editor-in-Chief
Revealing a hepatitis B infection to family members, friends, coworkers, and current or prospective sexual partners can cause lots of anxiety. Much is at stake, many people have misconceptions about hepatitis B and how it is transmitted, and they may shun you after hearing about your infection.
While a safe and effective vaccine exists, many teens and adults have not yet been immunized.
If you or your child is newly diagnosed with hepatitis B, you may feel a great need to talk about it with everyone around you, including friends, teachers and coworkers. But during this early period, try to tell as few people as possible. There are support groups available whose members are ready to listen and share their experience with disclosure, including the Hepatitis B Information and Support E-mail List at www.hblist.org.
You do not have to tell anyone about your hepatitis B virus (HBV) infection unless they are at risk of infection through blood or body fluid exposure. For example, household members and sexual partners should be told and encouraged to be tested for HBV and immunized.
If you are embarking on a medical career that potentially exposes your patients to your blood (through needlesticks or surgery), then you must tell your supervisor. But if there is no risk of blood exposure in your work duties, federal law says disclosure is neither necessary nor legally required.
How Standard Precautions Protect Your Privacy
The Occupational Safety and Health Administration (OSHA) and CDC require teachers, daycare providers, and a host of other employers to use standard precautions with every student or employee, no matter what their infectious disease status. This across-the-board mandate exists because many people infected with hepatitis B or C or HIV do not know they are infected. As a result, OSHA requires anyone who might have contact with blood or body fluids to be trained in standard precautions, and assume everyone’s blood is infectious.
Because of this requirement, parents don’t have to tell teachers or daycare providers if a child is infected with viral hepatitis, and workers don’t have to tell their employers. In fact, employers are barred by the Americans with Disabilities Act (ADA) from asking prospective or current employees about infectious diseases, unless the infection can be transmitted during the course of regular work activities.
Disclosure at Work
If your hepatitis B hinders your ability to work, especially if you are receiving treatment and need to take time off work or to cut back on work hours, you may want to talk to your human resources manager or supervisor. Remember, you cannot be fired because you have hepatitis B. The ADA requires employers with 15 or more employees to provide reasonable accommodations and give you time off if you need it. The key is ‘reasonable’ and the accommodations must not cause undue hardship on the employer. These accommodations could include time off for doctors’ appointments, providing additional unpaid leave or job restructuring, and granting a flexible working schedule.
Your decision to disclose your infection in the workplace must take into consideration subtle discrimination. For example, some persons with hepatitis B may be passed over for promotions because of a perception that they are chronically fatigued. Another potential problem is discrimination from co-workers because they fear exposure to hepatitis B.
Some questions to ask yourself when considering disclosing HBV at work are:
? How will it affect your day-to-day work environment?
? How will it affect future promotions?
? How will it affect your relationships with co-workers?
? Is it really necessary to disclose?
Employees who feel reasonable accommodations are not being made, or that discrimination is occurring, can call 1-800-949-4232 for more information. Many states also have civil rights laws that offer broader protections than the ADA. For more information, contact your local disability office.
那些觉得没有得到合理安排或受到歧视的人可以打1-800-949-4232获得更多信息。很多州也有各自的当地权利法提供除ADA(美国残疾人协会)外的更广泛的保护。如果你想得到更多信息，请和当地残疾人办公室联系。
Telling Friends or Family Members
Telling family members about hepatitis B is important, but it can be difficult if not properly considered. First, you must take immediate action to make sure your household members are not at risk of HBV infection, including practicing safer sex, implementing standard precautions and making sure household and immediate family members are tested for HBV and vaccinated.
You must also feel emotionally ready and have enough facts before divulging your status. The need for emotional support and the potential risk of exposure makes spouses and significant others the first people you will tell. However, it is important to be cautious and think carefully beforehand. Telling loved ones can be a traumatic experience for everyone involved. A family member or loved one may have a difficult time and need emotional support that you, having been just diagnosed, can’t provide.
Here are some questions to consider before disclosing:
? Do you have enough facts to answer their basic questions?
? Why are you telling them?
? What is the worst thing that could happen? The best thing?
? Are you ready to take on the emotional issues that can result?
? How has this person reacted in the past to intense disclosures?
? Do they deserve your trust?
? Is there someone you trust who can be with you when you disclose?
? Will it be more difficult to disclose to this person, or keep it secret?
Sharing fears and feeling supported can be extremely important. Preparation with facts about hepatitis B and sharing educational material will be helpful.
Telling friends and non-household family members should be considered carefully. Many people with hepatitis B say they regret having told so many people about their infection when they were diagnosed. Unless there is a real risk of exposure to HBV, many people recommend you do not tell friends or family about your or your child’s HBV infection.
Telling Current/Prospective Sexual Partners
It is important that anyone you are involved with physically and romantically knows your diagnosis. You may fear he or she won’t want to be with you anymore or will be angry that you have kept it a secret. It is hard to know how a person will react, but if you trust the person enough to be with him or her, then you must trust the person with the truth. If the person reacts negatively, then at least you have protected your health and his or hers by your honesty.
Having to lie to someone you are close with can be depressing and exhausting. If the person does accept your diagnosis and wants to continue the relationship, you will probably feel relieved and even closer to the person. Also, sharing the responsibility for protecting yourselves can make it a lot easier.
Working up the nerve takes effort, so try practicing your disclosure ahead of time. You may want to say something like, “This is incredibly hard for me to do, but before our relationship goes any further, there’s something about me I think you should know. I have hepatitis B, and I am working hard to stay healthy. I am telling you because I want you to stay healthy too.”
The person may have lots of questions about how you became infected, how HBV is transmitted and treated, and whom you have told. You should answer these questions to the extent that you feel comfortable. You don’t have to tell any more than you want to. A good idea would be to give information about how you can and can’t transmit HBV. Give your partner space and be open to additional communication.
Talk about your feelings and how frightening it was for you to share this information. Let the person try to understand what you are going through. You may also want to ask the person not to tell anyone else about your diagnosis. Remind the person that you trusted him or her with this information.
If your partner is at risk of hepatitis B because of your past sexual activity, you should encourage him or her to get tested. If the person has never been immunized against hepatitis B, he or she should immediately be vaccinated. If you begin or continue to have sexual relations, you both must discuss and take appropriate safeguards to prevention infection. It may feel funny to plan sex so thoroughly, and it may be embarrassing to discuss condom use and immunization ahead of time, but remember you are protecting your health and your partner’s.
If you fear your partner will react violently to your disclosure, or if he or she has been violent in the past, you should have someone with you who can protect you when you disclose, or at least tell the person in a relatively public place. Telling the person over the phone may also be an option, to give the person time to digest the information before you meet face to face.
Finding out you have transmitted hepatitis B to your partner or your child can be very difficult to deal with. You should do everything you can to prevent this from happening. If this does happen, it can make for a very difficult time. You may feel a sense of shock and guilt, which are perfectly normal feelings in this situation. The best thing to do is to get help from a mental health counselor who can help you and your partner deal with your feelings and take steps to find appropriate medical care.
Denial
Denial is a very important psychological mechanism that has good and bad consequences. It can be a good way to allow people to slowly accept an HBV diagnosis. When the time is right, they will be more prepared to deal with the realities of disclosing their HBV to family, friends and business relationships. At the same time, denial can prevent someone from seeking the necessary medical care and making lifestyle adjustments to stay healthy.
Conclusion
Disclosing hepatitis B is a personal decision that each person should weigh carefully. Care and support from friends and loved ones can be very beneficial in learning to live well with this infection. However, unnecessary, premature, or poorly thought out disclosure may cause problems now or in the future.
Accurate and reliable information about hepatitis B is an important tool when making disclosure. Talking over the benefits and difficulties of disclosure with a therapist and/or others who are living with hepatitis B may be helpful before making any decisions.
Remember, you don’t have to tell anyone until you are ready as long as they are not at risk of infection. And if you are a parent of an infected child, remember nearly every child has been immunized against hepatitis B and every teacher and childcare provider must use standard precautions with every child.
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※ 修改:·becrazy 于 Aug 12 15:47:32 修改本文·[FROM: 211.94.155.*]
※ 来源:·BBS 水木清华站 smth.org·[FROM: 211.94.155.*]
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