"I cannot tell this to my wife doctor".

" I cannot tell this to my wife doctor.She will explode and may even take her own life".
A 43 year old man was telling this to me in my clinic.
He is HIV positive.He know about this for last 3 years.
I was asking him if he had tested his wife for HIV.
No he had not tested his wife.He had not told his wife yet. He is working in a far away place and visits his family only occasionally.

Are you using condom when you are with your wife? I asked.
'No' was his answer.

I did not know what to say.I had seen him 3 years ago when he was first found 'positive'.I had given a detailed lecture to him about what to do and what not to do.I had asked him to tell his wife about his 'positive' state.I had stressed on use of Condoms.
He had neither told his wife nor used condoms while having sex with her.

I was angry. "I can't treat you if you do not follow my advise". I threw his papers on the table. He and his friend who accompanied him started pleading.

" I cannot tell this to my wife doctor.She will explode and may even take her own life".

"What are you doing? You are now giving her infection and killing her.And you still say you are afraid she will commit suicide?"
I cannot ethically decline treating him. So what should I do?

I was confused. His CD4 cell counts are low and he should be started on ART. He is so afraid of stigma and discrimination that he is not willing to go to Government ART centre.

There is a law that says the doctor have to reveal the result to the spouse if she/he asks. I told him about it. From his face I could make out that he is mentally resolving never to bring his wife to me.

I had an idea.I should make him realise that telling his wife and testing her is also important for his health.

"I have to start you on anti viral medicines now.With in few months the number of viruses in your body will become very small.But if your wife is positive and you are having sex with her without condom the viral load will not decrease as your wife will transmit the virus to you."

He was confused first, I explained again to make him understand. Slowly he realised that it is important for his health that his wife is tested and given treatment if needed.Also the fact that having unsafe sex is unsafe not only for his wife but also for him.

He agreed to take his wife for testing. I gave prescription for 2 weeks and asked him to come back with the result of his wife's test. Will he do as I advised? I do not know.
But what a selfish man?