Truth-telling to the patient, family, and the sexual partner: a rights approach to the role of healthcare providers in adult HIV disclosure in China.

Patients' rights are central in today's legislation and social policies related to health care, including HIV care, in not only Western countries but around the world. However, given obvious socio-cultural differences it is often asked how or to what extent patients' rights should be respected in non-Western societies such as China. In this paper, it is argued that the patients' rights framework is compatible with Chinese culture, and that from the perspective of contemporary patient rights healthcare providers have a duty to disclose truthfully the diagnosis and prognosis to their patients, that the Chinese cultural practice of involving families in care should - with consent from the patient - be promoted out of respect for patients' rights and well-being, and that healthcare providers should be prepared to address the issue of disclosing a patient's HIV status to sexual partner(s). Legally, the provider should be permitted to disclose without consent from the patient but not obliged to in all cases. The decision to do this should be taken with trained sensitivity to a range of ethically relevant considerations. Post-disclosure counseling or psychological support should be in place to address the concerns of potentially adverse consequences of provider-initiated disclosure and to maximize the psychosocial and medical benefits of the disclosure. There is an urgent need for healthcare providers to receive training in ethics and disclosure skills. This paper concludes also with some suggestions for improving the centerpiece Chinese legislation, State Council's "Regulations on AIDS Prevention and Control" (2006), to further safeguard the rights and well-being of HIV patients

Affection, virtue, pleasure, and profit: Developing an understanding of friendship closeness and intimacy in western and Asian societies

The development of friendship understanding has rarely been explored from a cross-cultural perspective. In this study, children and adolescents from Iceland, China, Russia, and the former East Germany were investigated in one longitudinal and three cross-sectional samples. Children from three different Chinese ecologies were interviewed to account for within-culture variation. Participants were interviewed about friendship closeness and intimacy at ages 7, 9, 12, and 15 years. Their statements were scored according to (a) structural-developmental stages and (b) content aspects of friendship reasoning. Results reveal that the development of friendship reasoning of participants from all societies could be captured by the cognitive-structural stages and content categories developed in western cultures. At the same time, distinct cultural differences emerged, especially between the Russian and Chinese participants, on the one hand, and the Icelandic and East German participants, on the other hand. The within-China analyses reveal little differences for the content aspects of friendship understanding between the three ecologies, but differences in the cognitive-structural aspects of friendship reasoning were found. © 2008 The International Society for the Study of Behavioural Development