Under Chilean law, wide discretion is given to employers in selection and retention of employees. This has permitted widespread abuse of HIV tests by private businesses. In the late 1980s, when companies realised HIV could be detected, they quickly moved to avoid the costs and complications presented by HIV-positive employees. The government was slow to react and did not forbid testing. Even now the government only weakly suggests that there are "no technical reasons" to fire people living with HIV/AIDS (PLWHAs) from their jobs. Almost all employers in Chile now require job applicants to test negative for HIV.

Those Chileans who want an HIV test without risking their privacy or livelihood also face considerable obstacles. HIV testing is confidential in the public health system, using a code containing the individual's date of birth, initials and part of his/her national identity number. However, HIV tests are usually offered by STI clinics and blood banks in public hospitals, which must simultaneously also test for syphilis. The syphilis test requires that the client provide his/her identity as well as an address. Although clients can give a false name for the test, they must use their real identity to obtain medical care from public hospitals. As a result, most of those who rely on public health -- 75% of the population -- simply agree to use their real names. 

When doctors notify epidemiologists at Chile's National AIDS Commission about cases of HIV or AIDS they are forbidden to include patients' names; they are limited to using the codes. The Commission has launched training programmes in all 26 public health services for staff involved with HIV/AIDS programmes, including confidentiality issues to reinforce this regulation.

Nevertheless, information does leak out along the way. Doubts about the ability of the system to maintain confidentiality lead more well-to-do Chileans to obtain tests and even treatment outside the country. Their doubts appear to have some basis. One of the first organisations of PLWHAs, known as CAPVIH, complained to the news media in 1994 that one of its members was fired from his company as a result of his HIV-positive status. Later, another company that had somehow acquired the same information turned him down for a job.

Many accidental breaches of confidentiality may occur at the hospital or clinics where staff are insensitive to people's care needs and oblivious of their rights. Edison, a foreigner married to a Chilean woman, came to our offices after learning from his workmates that he was HIV-positive. They had been told the news before he received it himself. When Edison sought care at a local public health clinic, a nurse called him in to his second visit by stating in a loud voice, "Your test is confirmed positive, and your wife's is too." Most disturbingly, this clinic has had years of experience in treating PLWHAs.

Prudence and respect in handling confidentiality do not develop automatically. Patients, advocacy groups, human rights activists and health care administrators must pay attention to the many ways -- some outrageous, others more subtle -- in which confidentiality is breached. Training, persuasion and formal complaints when errors occur must be used to push standards higher and avoid wrecking individuals' lives.

Rodrigo, whose story appears at the beginning of this article, had just begun to experiment with a gay lifestyle when his employers secretly tested him for HIV. After the incident, he tried to recover a relationship with his first boyfriend but was turned down and remained in a deep depression.  After his first visit, we never saw him again.

There is some hope. The House of Deputies recently voted in favour of a law which specifically prohibits discrimination of PLWHAs and HIV testing for jobs. The measure is expected to pass the senate and be signed into law. Although a law does not produce new behaviour immediately, it would be a strong signal that PLWHAs' rights to confidentiality may not be breached.