Can you keep a secret? Pretences of confidentiality in HIV/AIDS counseling and treatment in Eastern Indonesia.

A critical feature of contemporary interventions of HIV is the provision of voluntary counseling and testing. Protecting the confidentiality of the client is a lynchpin of successful counseling. This article explores the teaching and implementation of the concept of confidentiality in highlands Papua, Eastern Indonesia. Results of participant observation and in-depth interviews with clinic staff in 2009 and 2010 show that confidentiality is an ideal poorly taught and systematically violated in practice. Identifying, labeling, and regulating HIV-positive persons appears more important than enacting the humanitarian and moral imperative of protecting client rights. Confidentiality becomes the means to enact dividing practices and to create categories of persons-those who choose to adhere to therapies and those who do not. The implications of this pattern are discussed with reference to wider humanitarian initiatives.