伴侶風險告知侵害感染者隱私？論愛滋接觸者追蹤與公衛人員之保密義務

發現愛滋感染者之後的接觸者追蹤（contact tracing）或稱伴侶風險告知（partner notification），對感染者本身、感染者的伴侶及社會大眾三方面都有重大實益。但當感染者瞭解接觸者告知之必要，卻在合理時間內遲不告知，若公衛人員合理相信接觸者有高度感染風險、告知風險對接觸者有醫療上利益時，公衛人員應如何處理，始能符合維護感染者人格及隱私的法律要求？為探究公衛實務上如何平衡維護公眾健康與保護感染者資訊秘密性，本文分析公衛人員對感染者資訊保密義務之內容及界限。本文認為，公衛人員對於因通報、訪視感染者、與感染者討論接觸者追蹤計畫的過程中所蒐集到的資訊，負有保密義務，因此原則上在未得感染者同意前，這些資訊不能揭露予第三人。然而，保密義務並非絕對，在有正當理由的情形下，公衛人員可依照最小揭示原則揭露感染者的資訊。基此，公衛人員利用感染者提供的資訊追蹤其後續治療情形，固然正當，但當公衛人員將資訊運用於疫情調查及接觸者追蹤前，應讓感染者知悉並給予合理時間使其自行告知接觸者；若公衛人員合理相信感染者不自行告知接觸者感染風險，基於保護接觸者知悉風險的利益，公衛人員得在通知感染者後，與接觸者聯繫並告知感染風險。但接觸者追蹤的目的是使接觸者知悉可能感染的風險，揭露感染者身分或可識別身分資訊的必要，逾越了合理揭示的界限。公衛人員應避免提供、揭露感染者的身分，以免違反保密義務之要求。
Partner services offer substantial benefits to three main groups: persons infected with a HIV/STD, their partners and the community. But how should public health workers conduct contact tracing without intruding privacy or breaching the duty of confidentiality? What if a patient who says s/he will notify a partner and does not follow through? To articulate how to balance the need to inform partners while preserve confidentiality of patients’ information, this paper analyzed the duty of confidentiality public health workers owed to patients and the limits of this duty. This article argues that HIV-related information obtained by public health workers through reporting and interviewing with patients is confidential. Public health workers are prohibited from disclosing the information to third parties without patients’ consent. But the duty of confidentiality is not absolute; public health workers may disclose confidential information according to the minimal disclosure principle if is a legitimate justification. Public health workers may disclose HIV-related confidential when they reasonably believe a significant risk of infection exists to the contact, the patient has been counseled to notify his/her contacts and public health workers reasonably believe the patient will not inform the contacts, and the patients has been informed of public health workers’ intent to disclose. However, since the purpose of contact tracing is to reach people who have been exposed to disease, and then providing an appropriate intervention, the identity of the patient shall not be disclosed to the contact.