Annual and cumulative incidences of HIV + and AIDS in patients reported by the AIDS Surveillance Committee of the Ministry of Health and Welfare are cited to illustrate some characteristics in Japan: nearly 59% of either HIV + or AIDS patients were infected through injection of blood products or by blood transfusion. A number of plaintiffs have sued the Japanese government and pharmaceutical companies since 1989, but no judicial decisions have yet been made. The incidence of HIV decreases for each (...) of the following routes of infection: the second highest route of transmission being heterosexual, followed by bisexual and unconfirmed or unknown cases, and less frequently homosexual, drug use and lastly via vertical transmission. The most serious bioethical problems with HIV + and AIDs patients in Japan is the social segregation of these patients. There are many emotional fears among the general public and medical personnel about AIDS because of their inadequate scientific knowledge of this disease. The Japan Hospital Association is doing The Stop AIDS Campaign and made several surveys. Japan has become increasingly aware of the importance of AIDS education and a great deal of effort is being made to enhance bioethical considerations. (shrink)

Annual and cumulative incidences of HIV+ and AIDS in patients reported by the AIDS Surveillance Committee of the Ministry of Health and Welfare are cited to illustrate some characteristics in Japan: nearly 59% of either HIV+ or AIDS patients were infected through injection of blood products or by blood transfusion. A number of plaintiffs have sued the Japanese government and pharmaceutical companies since 1989, but no judicial decisions have yet been made. The incidence of HIV decreases for each of the (...) following routes of infection: the second highest route of transmission being heterosexual, followed by bisexual and unconfirmed or unknown cases, and less frequently homosexual, drug use and lastly via vertical transmission. The most serious bioethical problems with HIV+ and AIDS patients in Japan is the social segregation of these patients. There are many emotional fears among the general public and medical personnel about AIDS because of their inadequate scientific knowledge of this disease. The Japan Hospital Association is doing The Stop AIDS Campaign and made several surveys. Japan has become increasingly aware of the importance of AIDS education and a great deal of effort is being made to enhance bioethical consideration. (shrink)

An Institute of Medical Ethics working party argues that an ethically desirable relationship of mutual empowerment between patient and clinician is more likely to be achieved if patients understand the ground rules of medical confidentiality. It identifies and illustrates ambiguities in the General Medical Council's guidance on AIDS and confidentiality, and relates this to the practice of different doctors and specialties. Matters might be clarified, it suggests, by identifying moral factors which tend to recur in medical decisions about maintaining or (...) breaching confidentiality. The working party argues that two such factors are particularly important: the patient's need to exercise informed choice and the doctor's primary responsibility to his or her own patients. (shrink)

This chapter contains sections titled: HIV Testing HIV Infection: Harm to Self or Harm to Others Access to Experimental Drugs and the Ethics of Research Clinical Trials Developing Preventive Vaccines Affordable Access to Life‐preserving Medication HIV Infection in Health‐care Professionals and Patients Final Remarks References Further reading.

In few other areas of bioethical inquiry exists as close a connection between bioethical professional advice and policy development as is the case with HIV and AIDS. Historically, the reasons for this have much to do with one of the groups initially affected most severely by HIV and AIDS, namely well-educated middle-class gay men in developed countries. This particular group of people, highly sophisticated and used to political activism in its pursuit of civil rights-related objectives, engaged the medical profession as (...) well as regulatory agencies such as the US Food and Drug Administration, and legislators (more so in the USA than in other countries) in a number of bioethically interesting policy areas. Many of the controversies of the times were framed as civil rights and/or ethical disputes. The initial areas of concern and inquiry focused on: informed consent to HIV testing and trial participation, the confidentiality of HIV test results, access to trials as a means of access to experimental drugs, the length of time it took to get an experimental drug to the market approval stage, and end-of-life decision-making. This line-up of issues explains why AIDS has become such an interesting topic for bioethicists. Bioethicists concerned about the traditional breadand- butter themes of medical ethics themes of the doctor - patient relationship (e.g., Daniels, 1991; Boyd, 1992), as well as bioethicists more concerned about policy and regulatory issues in the drug research and approval process (e.g., Edgar & Rothman, 1990; Salisbury & Schechter, 1990), found research topics worthy of vigorous pursuit. No surprise, then, that HIV/AIDS led to a probably unprecedented number of books and articles in professional journals (Manuel et al., 1990). HIV/AIDS has become a permanent fixture in all major mainstream bioethics textbooks (e.g., Kuhse & Singer, 1998; Arras & Steinbock, 1999). Reference series in medicine, ethics and law provide for dedicated volumes on AIDS.1 Even specialist bioethics textbooks, for instance those directed at dentistry students, carry chapters on HIV/AIDS (Ozar & Sokol, 2002). 128 Udo Schuklenk AIDS, designated by the medical profession a pandemic lives up to its classification. It did not stop at the borders of developed countries. As one would expect of a primarily sexually transmitted illness in the age of globalisation, it spread rapidly across the globe. Indeed, in many countries it has become one of the main causes of death, as in sub- Saharan Africa (Shisana & Simbayi, 2002). Dramatic increases in the number of AIDS cases are predicted for many Eastern European countries as well as for the two most populous nations on earth, India and China. Some of the HIV/AIDS-related bioethical and policy issues of concern to developed countries remain the same for developing countries. However, in ethically important ways they are dwarfed by concerns over drug prices, intellectual property rights, and affordable access to essential AIDS drugs for the impoverished masses of infected people in such countries. Of increasing importance have become ethical issues pertaining to the ever-growing research industry associated with clinical trials undertaken in developing countries. Indeed, major funding initiatives both in the USA and UK have brought clinical research in developing countries into focus. Some have questioned whether this attention is appropriate, considering other bioethical problems of arguably greater importance to developing countries (Chadwick & Schuklenk, 2003). Standards of clinical care in a study, and after a trial has concluded, as well as community benefits and access to the trial regime after the trial’s conclusion remain contentious issues. It is worth noting that more often than not it was an AIDS-related trial or policy decision that led to a great deal of bioethical analysis, yet the issues discussed almost always have ramifications far beyond AIDS. For instance, decisions about the question of what (if any) standards of care failures in preventive trials (of HIV vaccines or microbicides) ought to receive have important implications for non-AIDS prevention trials. (shrink)

In 1882, Tommaso de Amicis, dermatologist and venereologist at the University of Naples, Italy, published a description of twelve cases of Kaposi's sarcoma. This article is the second report about the above-mentioned disease after the first description of five cases by Moritz Kaposi ten years earlier. The publication by De Amicis was organized as a collection of case reports followed by a section containing general considerations about the etiopathogenesis, pathology, diagnosis and therapy of Kaposi's sarcoma. Ten cases are typical of (...) the so-called 'classic' form of the disease, that has a peculiar indolent chronic course, while two out of the twelve cases strongly resemble the clinical form of Kaposi's sarcoma currently recognized as that associated with the acquired immunodeficiency syndrome (AIDS). The nature of Kaposi's sarcoma is still being debated, but current evidence suggests that it is a viral-associated, if not viral-induced, tumor and its relationship with AIDS is that of an opportunistic disease. Thus, the presence of the clinical form of AIDS-related Kaposi's sarcoma can be used as a marker of the presence of sporadic cases of AIDS much earlier than its pandemic diffusion. (shrink)

AIDS is an example of the global threat. In my article I would like to present the most important ethical dilemmas related to global outspreading of AIDS/HIV epidemic in the world and also make an attempt of finding a possible solution. I assume that the dilemmas could be described in three basic dimensions: The first discussed ethical problem is related to treating sick people by the healthy people. We observe the discrimination of people suffering from AIDS/HIV and it stands in (...) opposition to Christianity and Church which commands to accept sick people, to respect and help them. The second discussed aspect concerns ethical challenges that modern medicine must face regarding the outspread of AIDS and HIV. On one hand, medical stuff who have contact with blood must incessantly confront their fear of infection with duty of helping people and providing medical care. On the other hand, medical professionals may encounter the moral dilemma how to keep medical records in secret and protect interests of people who are exposed to infection. The last important ethical dimension of global AIDS epidemic and other civilisation illnesses, which has been recently observed, is the polarization of the world in the field of health. (shrink)

The word “epidemic” seems inadequate to describe the spread of the HIV virus in sub-Saharan Africa. The latest estimates suggest that 28.5 million people in this region are infected, including 5 million in South Africa alone. The HIV and AIDS pandemic, with infection rates of over 20 percent in seven African countries, rivals the worst of history's disease outbreaks, including the bubonic plague of medieval times. The devastating effects of the disease on the continent are compounded by extreme poverty in (...) the region and the lack of medical infrastructure essential for delivering the full range of available treatments for HIV infection, AIDS, and the opportunistic infections associated with the disease. Of the 40 million people infected with HIV worldwide, only 730,000 receive combination antiretroviral therapies. In the entire African continent, only 30,000 infected people currently receive such forms of treatment. (shrink)

BackgroundWhile most studies on HIV/AIDS often identify stigmatization and patients’ unwillingness to access health care as critical problems in the control of the pandemic, very few studies have focused on the possible consequences of accessing health care by sero-positives. This paper examines the socio-psychological trauma patients experience in their desire to access health care in two health facilities in the Ashanti Region of Ghana.MethodsThrough participant observation, informal conversation and in-depth interviews, data were collected from health workers and clients of the (...) voluntary counselling and antiretroviral therapy units in the two hospitals.The data gathered were analysed and categorized into themes and supported with illustrative quotes obtained from health workers and clients.ResultsThe study found that the mere presence of a person at the HIV counselling centre or clinic is enough for the person to be labelled as or suspected to be HIV patient. It demonstrates that stigmatization may occur not only in the community but also overtly or covertly, in the health facility itself. Consequently, for many HIV/AIDS patients, access to antiretroviral therapy and treatment of related nosocomial infections are problematic. Besides, the study found that many clients and potential users of services were uncomfortable with the quality of care given by some health workers, especially as they overtly and covertly breached confidentiality about their clients’ health status. This has compelled many patients and potential users of the services to adopt a modus vivendi that provides them access to some care services while protecting their identity.ConclusionThe paper argues that by examining issues relating to privacy and confidentiality in the provision of care for and use of services by seropositives, more light will be shed on the whys of the limited uptake of HIV-related health care services in Ghana. (shrink)

In little more than a decade, the AIDS epidemic has exerted a profound effect on morbidity and mortality among young adults and children in many parts of the world. One of the more dramatic aspects of AIDS is that it seems to have arisen almost spontaneously as a new epidemic, spreading rapidly within at-risk populations in a way that is unprecedented for the serious infectious diseases of recent memory. Tuberculosis, on the other hand, had only recently been considered a disease (...) of historical importance but of diminishing relevance to current public health priorities, especially in industrialized countries. Over the past decade, however, and in parallel with the AIDS epidemic, there has been a resurgence of tuberculosis in many of the same populations most affected by HIV infection. This has had important implications for clinical practice, public health, and the development of appropriate health policy. A number of elements have converged to promote the development of HIV-related tuberculosis, including biologic, social, and environmental factors. These will be discussed both to provide a context for understanding the relationship between the two epidemics, and as a basis for suggesting strategies for tuberculosis control in the AIDS era. (shrink)

Primary research on HIV/AIDS in India has predominantly focused on known risk groups such as sex workers, STI clinic attendees and long-distance truck drivers, and has largely been undertaken in urban areas. There is evidence of HIV spreading to rural areas but very little is known about the context of the infection or about issues relating to health and social impact on people living with HIV/AIDS. In-depth interviews with nineteen men and women infected with HIV who live in rural areas (...) were used to collect experiences of testing and treatment, the social impacts of living with HIV and differential impacts on women and men. Eight focus group discussions with groups drawn from the general population in the four villages were used to provide an analysis of community level views about HIV/AIDS. While men reported contracting HIV from sex workers in the cities, women considered their husbands to be the source of their infection. Correct knowledge about HIV transmission co-existed with misconceptions. Men and women tested for HIV reported inadequate counselling and sought treatment from traditional healers as well as professionals. Owing to the general pattern of husbands being the first to contract HIV women faced a substantial burden, with few resources remaining for their own or their children’s care after meeting the needs of sick husbands. Stigma and social isolation following widowhood were common, with an enforced return to the natal home. Implications for potential educational and service interventions are discussed within the context of gender and social relations. (shrink)

In an interview just before his death, Issan Dorsey, an American Zen priest and abbot of the Hartford Street Zen Center, stated, “AIDS is not fatal. Life is fatal. If you have AIDS, you are alive.” Although infected with AIDS, Issan worked to establish the Maitri Hospice for those dying from complications related to AIDS in the San Francisco Castro District, the heart of the gay and lesbian community. His efforts reflect the statement–although the body may be diseased, one can (...) continue to give abundantly and tirelessly, articulated by Vimalakirti in the Vimalakirtinirdesa Sutra. (shrink)

Since the beginning of the AIDS epidemic, the proportion of AIDS cases among women has continued to rise. Women constituted 23 percent of the AIDS cases reported to the Centers for Disease Control and Prevention in 1995, and 81 percent of these women were of childbearing age. It was not until 1991, however, that epidemiological studies of women were initiated. By comparison, the representation of HIV-infected women in clinical trials gradually has grown. Undoubtedly, a consequence of the increased numbers of (...) women in clinical and epidemiological research is the earlier identification of and more appropriate treatments for HIV-related syndromes when women present in the clinical setting. Despite this expanded focus on women, however, clear information to guide the treatment of HIV-infected women who are pregnant is still lagging behind. (shrink)

SEXUALITY, BETWEEN SPEECH AND STAGES IN LIFE, OF HIV-INFECTED SUBJECTS AIDS, that union between death and sexuality, makes the latter non-representable and has deeply modified the world of sexual imagination. The article seeks to show how the emergence of HIV has re-defined the current norm within individuals’ sexuality and then goes on to analyse the different stages HIV positive subjects have to confront as they go through life, with the need to re-organise their sexuality ; it then evokes the transgressive (...) aspect of sexuality for some sectors of the population and, finally, gives HIV positive women the opportunity to speak out on how they come to grips with their bodies in relation to partners – soiled bodies henceforth disentitled, deprived of pleasure. HIV infection has the effect of sowing confusion between the different registers such as death, life and sex, and causes in the subject feelings of shame and guilt : so many effects that the therapist has to take on board to render the feeling that they exist in full to the subject. (shrink)

This study is a contribution to Chinese-Western dialogue of bioethics but perhaps the first one of its kind. From a Chinese-Western comparative ethical perspective, this work brings Chinese ethical theories, especially Confucian ethics, into a contemporary context of the epidemic of HIV/AIDS, and to see how the deeply-rooted thoughts of Confucius interact, compete, or integrate with concepts from Western ethical traditions. An underlying belief is that some ideas in Confucian ethics are important and insightful beyond their cultural and historical origins (...) in China and other Confucianism influenced societies.Methodologically, this thesis employs two approaches, conceptual normative analysis combined with critical interpretation. The ‘interpretive’ approach I employ, as an important methodology supplementing my normative analysis, not only deals with Chinese ancient texts, but also explains specific beliefs and practices in China.With a critical eye, this thesis carefully examines a number of key topics in the ethics of AIDS in China from a cross-cultural perspective. Topics including: views on personhood and the vulnerability of People Living with HIV/AIDS; prioritising and balancing the role of ‘harm reduction’ and the role of ‘eradication of deviant behaviour’ in AIDS policy in China; rights-based opt-out approach and duty-based family-centred approach in HIV testing and Biobanking; blood donation; moral responsibility and personal responsibility for health; and the popular rhetoric of ‘innocent infection’ versus ‘guilty infection’ in AIDS. My overall aim in this work is to present a cross-cultural bioethics study through the investigation of some ethical issues in AIDS in China from a Chinese-Western comparative perspective and also attempt to suggest a humane and effective policy for HIV/AIDS which I believe is appropriate to both traditions. I believe this work has contributed to our knowledge in three related but independent areas: the control of the epidemic of HIV/AIDS in China; medical ethics in China; and to both the methods and the utility of cross-cultural study of bioethics between China and the West. (shrink)

BackgroundCarefully planned research is critical to developing policies and interventions that counter physical, psychological and social challenges faced by young people living with HIV/aids, without increasing burdens. Such studies, however, must navigate a ‘vulnerability paradox’, since including potentially vulnerable groups also risks unintentionally worsening their situation. Through embedded social science research, linked to a cohort study involving Adolescents Living with HIV/aids (ALH) in Kenya, we develop an account of researchers’ responsibilities towards young people, incorporating concepts of vulnerability, resilience, and agency (...) as ‘interacting layers’.MethodsUsing a qualitative, iterative approach across three linked data collection phases including interviews, group discussions, observations and a participatory workshop, we explored stakeholders’ perspectives on vulnerability and resilience of young people living with HIV/aids, in relation to home and community, school, health care and health research participation. A total of 62 policy, provider, research, and community-based stakeholders were involved, including 27 ALH participating in a longitudinal cohort study. Data analysis drew on a Framework Analysis approach; ethical analysis adapts Luna’s layered account of vulnerability.ResultsALH experienced forms of vulnerability and resilience in their daily lives in which socioeconomic context, institutional policies, organisational systems and interpersonal relations were key, interrelated influences. Anticipated and experienced forms of stigma and discrimination in schools, health clinics and communities were linked to actions undermining ART adherence, worsening physical and mental health, and poor educational outcomes, indicating cascading forms of vulnerability, resulting in worsened vulnerabilities. Positive inputs within and across sectors could build resilience, improve outcomes, and support positive research experiences.ConclusionsThe most serious forms of vulnerability faced by ALH in the cohort study were related to structural, inter-sectoral influences, unrelated to study participation and underscored by constraints to their agency. Vulnerabilities, including cascading forms, were potentially responsive to policy-based and interpersonal actions. Stakeholder engagement supported cohort design and implementation, building privacy, stakeholder understanding, interpersonal relations and ancillary care policies. Structural forms of vulnerability underscore researchers’ responsibilities to work within multi-sectoral partnerships to plan and implement studies involving ALH, share findings in a timely way and contribute to policies addressing known causes of vulnerabilities. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Closing the Gaps in Pediatric HIV/AIDS Care, One Step at a TimeLisa V. Adams, Helga Naburi, Goodluck Lyatuu, Paul Palumbo, and C. Fordham von ReynFatuma's* doctors were completely perplexed. It was 2003 and she had returned to the DARDAR clinic in her hometown of Dar es Salaam, Tanzania three times that week with vague complaints of various pains and aches. Her doctors were considering whether these symptoms were due (...) to the initiation of her recent treatment with antiretroviral medications for her HIV infection or related to the last administration of the investigational tuberculosis (TB) vaccine that the DARDAR Health Study was evaluating. Fatuma's doctor, Dr. Lillian Mtei, consulted with Dartmouth's chief of Infectious Disease, Dr. Ford von Reyn, who happened to be in Dar that week on a site visit. Neither physician could determine the basis for her symptoms. Dr. Mtei returned to the exam room once more and this time emerged with the answer: Fatuma had just learned that her three year old daughter was HIV-infected, likely contracted from Fatuma during or shortly after she gave birth to her daughter. Fatuma believed that her HIV diagnosis was a death sentence for her daughter since antiretroviral therapy was not widely available for children.Dr. von Reyn, Dartmouth's lead clinical researcher in Africa and a father, knew too well the harsh reality of inequities in a resource-limited country. He turned to Dr. Mtei and said decidedly, "we need to do something about this."Thus the DARDAR Pediatric Program was born.Pediatric HIV: A Neglected DiseaseThe need for HIV treatment among children in Tanzania, as in most of sub-Saharan Africa, is compelling. At the end of 2009, approximately 160,000 children aged zero to fourteen in Tanzania were living with HIV (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2011). Even with successful roll out of prevention of mother to child transmission programs in Tanzania, there were nearly 29,000 perinatal infections in 2009. As of December 2010, only 18% of these were enrolled in HIV treatment programs (UNAIDS, 2011; World Health Organization [WHO], 2011). Without antiretroviral therapy (ART), one-half of HIV-infected children will die before their second birthday. Since clinical research to determine efficacy and safety of new medical treatments is conducted almost exclusively in adults, provision of new medical treatments to [End Page 75] children always lags behind advances for adults. Furthermore, children are often underrepresented in programs for antiretroviral drugs for the following reasons: 1) they are not prioritized for care; 2) facilities lack infant diagnostic capabilities; 3) there is limited pediatric HIV training and consequently, a shortage of pediatric providers; and 4) pediatric antiretroviral formulations are frequently unavailable. The unacceptable delays in pediatric HIV drug development and treatment access led the international organization Drugs for Neglected Diseases initiative to publish an editorial in which they referred to pediatric HIV as a "neglected disease" (Lallemant, Chang, Cohen, & Pecoul, 2011).The Tip of the Iceberg: More than Just MedicinesWith a grant from the New York-based Foundation for the Treatment of Children with AIDS, the DARDAR Pediatric Program, a joint collaboration between Geisel School of Medicine at Dartmouth and Muhimbili University of Health and Allied Sciences, began seeing patients in May 2006. It was the first dedicated pediatric HIV Care and Treatment Center in Tanzania and operates in accordance with Tanzania's National AIDS Control Programme's guidance. Testing for both children and infants (the latter of which requires a more sophisticated assay) is available.The day the clinic opened we celebrated this collaborative effort that would provide HIV-infected children in Dar es Salaam access to antiretroviral treatment. One of our first patients was a six-year-old boy whose mother, like Fatuma, was a participant in our TB vaccine trial. She had been advised to bring her son to us for HIV screening. Her son looked healthy so she was surprised and understandably distraught when his test results indicated that not only was he HIV-infected, but his CD4 percentage was very low. His mother was reluctant to have him started on antiretrovirals given his general appearance and young age—and that he was... (shrink)

Behavior change is the only available means of curtailing new HIV infections in South Africa. This study investigated the relationship between sexual risk taking and attitudes to AIDS precautions. The participants were about 25% white, about 30% colored/mixed blood and 45% black in their second year in polytechnics (413 females and 402 males). Participants responded to the 40-item HIV-related knowledge, attitudes and behaviors. Data indicated that young women showed more positive attitudes to AIDS precautions than young men (reflecting in (...) part the stereotypic negative attitudes of young men toward condoms). In general, most males and females were found to have less knowledge about HIV transmission and less favorable attitudes toward safe sex behavior than their counterparts in the west. Also young men with more partners expressed more fatalistic attitudes toward AIDS. The possibility that a finergrained multivariate analysis of attitudes to AIDS and safe-sex behaviour is something that needs to be taken seriously in future research, however. (shrink)

Statutes criminalizing behavior that risks transmission of HIV/AIDS exemplify use of the criminal law against individuals who are victims of infectious disease. These statutes, despite their frequency, are misguided in terms of the goals of the criminal law and the public health aim of reducing overall burdens of disease, for at least three important reasons. First, they identify individual offenders for punishment, a paradigm that is misplaced in the most typical contexts of transmission of infectious disease and even for HIV/AIDS, (...) despite claims of AIDS exceptionalism. Second, although there are examples of individuals who transmit infectious disease in a manner that fits the criminal law paradigm of identification of individual offenders for deterrence or retribution, these examples are limited and can be accommodated by existing criminal laws not devoted specifically to infectious disease. Third, and most importantly, the current criminal laws regarding HIV/AIDS, like many other criminal laws applied to infectious disease transmission, have been misguided in focusing on punishment of the diseased individual as a wrongful transmitter. Instead of individual offenders, activities that enhance the scale of disease transmission—behaviors that might be characterized as ‘transmission facilitation’—are a more appropriate target for the criminal law. Examples are trafficking in human beings (including sex trafficking, organ trafficking, and labor trafficking), suppression of information about the emergence of infection in circumstances in which there is a legally established obligation to disclose, and intentional or reckless activities to discourage disease treatment or prevention. Difficulties remain with justifications for criminalizing even these behaviors, however, most importantly the need for trust in reducing overall burdens of disease, problems in identifying individual responsible offenders, and potential misalignment between static criminal law and the changing nature of infectious disease. (shrink)

Perhaps no other population exposes the clinician to more moral and legal dilemmas than clients with an HIV-positive diagnosis. What does the therapist do about the HIV positive patient who is having sex with unnamed partners and refuses to stop? What should be said in end-of-life decisions? What of the adolescent who is HIV positive but whose guardian does not wish the youth to be informed of his status?

HIV/AIDS continues to constitute a serious threat to the social and physical wellbeing of African mothers and their babies. In the hardest hit countries of sub-Saharan Africa, more than 60% of all new HIV infections are occurring in women, infants and young children. Mother-to-child transmission constitutes 90% of new HIV infections among infants and young children. Most of these infections can be prevented. However, the social stigma of HIV/AIDS insidiously continues to undermine the success of prevention programs. (...) Ironically, some attributes or characteristics of prevention of mother-to-child transmission programs may in fact serve as catalysts to the stigmatization process. This paper identifies and discusses six potential initiators: Routine HIV testing, Six months exclusive breastfeeding, Incentives, Home visits, Location of PMTCT program, and PMTCT terminology. In all these areas, there are practical strategies that may be applied to reduce the chances of being stigmatized. These strategies are introduced and discussed. (shrink)

This article focuses on the ways that sexual risk behaviors are related to race, class, and gender among low-income, culturally diverse women in South Florida. Data concerning sexual risk and gender are presented in terms of race and class variations. Results indicate that, in general, these women have a high degree of knowledge about acquired immune deficiency syndrome, a quite contemporary awareness of women's gendered subordination, and a lack of trust in heterosexual relationships. Attitudes, beliefs, and knowledge, however, are not (...) translated into sexual behaviors with men partners that would reduce their vulnerability to infection with the human immunodeficiency virus. The data indicate that race is a major factor that places women into an underclass position. Consequently, without socioeconomic resources, gendered behaviors have a direct influence on sexual risk. Multivariate analyses indicate that those women who are sex workers are significantly more likely to negotiate safe sex with clients than with main partners. The research not only challenges mainstream thinking about race, class, and gender but also provides overdue information on the vulnerability of women to HIV infection. (shrink)

The aim of this study is to undertake an in-depth conceptual and ethical analysis of African philosophy of sex and the HIV/AIDS epidemic in Africa by taking the Oromo of Ethiopia as an example. The continent with just 10% of the world’s population is home to over 70% of the world’s HIV/AIDS infection. HIV/AIDS is a social, economic, demographic and moral problem as well as a health care issue. Some scholars hypothesise that the unique nature of African sexuality, sexual promiscuity, (...) the prevalence of other ailments, and the unique nature of the viral subtypes (known as clades) are the major reasons for Africa’s AIDS prevalence. However, there is little substance to their hypotheses. As of today there is no sound explanation for the prevalence of HIV/AIDS in Africa. So far the HIVintervention has largely focused on behaviours, systems and structures which are visible without fully taking into account culture, values, norms and traditions which are invisible but have a strong influence on visible aspects of individual behaviours and societal structures. Thus, this issue requires further research into people’s philosophy of sex and indigenous moral values. This study and the contributions of many scholars have shown that Africans have a diverse spectrum of sexual behaviour ranging from the very restrictive to the permissive. Although some ethnic groups have developed a profound philosophy of ex that can curb the expansion of HIV/AIDS, there have been some sexual and religious norms and expectations in Africa that have contributed to the rapid spread of HIV/AIDS. Social, economical, and political forces have also shaped the HIV/AIDS epidemic. This paper thus suggests that global fight against HIV/AIDS should go beyond a narrow focus on the behavioural and biological, and consider broader structural and underlying factors such as poverty, homelessness, widespread sex work, rural to urban migration, instability, a high rate of unemployment, unequal gender relations, harmful traditional practice and global injustice that have facilitated the spread of HIV/AIDS. African governments should involve the local people and civil society organisations in the fight against HIV/AIDS by using a wide range of participatory methodologies and culturally sensitive advocacy strategies. This study thus suggests that a multi-faceted approach is needed to deal with the challenges of the 21st century and address the HIV/AIDS epidemic in our world. This study relies on literature review, interviews and personal observation. (shrink)

No healthcare issue has generated as much ethical debate on the relationship between the individual and society as HIV Infection. In this debate, an appeal is most often made to such principles as autonomy and confidentiality to protect individuals who are HIV positive or who have AIDS from an invasion of privacy thought to be justified by society's need for information. In the first years, this emphasis on the protection of the individual was essential. Even today, there are risks in (...) disclosing one's HIV status. However, as more and more persons become Infected, live longer, and move within the healthcare industry for non-HIV related care, as both patients and healthcare workers, the terms of the debate need to be redefined. (shrink)

Amit Sharma, Rajesh Ramanathan, Marc Posner, Robert A Fisher Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA: Pediatric kidney transplantation is the preferred treatment for children with end-stage renal disease. The most common indications for transplantation in children are renal developmental anomalies, obstructive uropathy, and focal segmental glomerulosclerosis. Living donor kidney transplants are often performed pre-emptively and offer excellent graft function. Policy changes in deceased-donor kidney allocation have increased the proportion of such transplants in pediatric recipients. Adequate pretransplant workup (...) along with evaluation of urologic abnormalities is imperative in achieving good outcomes. Overall, patient and graft outcomes after kidney transplantation have improved, with five-year deceased donor and living donor graft survivals of 78.8% and 84.3%, respectively. Improvements in induction and maintenance immunosuppression have contributed to the gradual improvement in outcomes. Unique challenges in pediatric recipients include increased graft thrombosis, adverse growth, and abnormal development relating to immunosuppression, increased rejection due to nonadherence, increased susceptibility to opportunistic infections, and post-transplant malignancy. This review focuses on the current practices and outcomes in pediatric kidney transplantation in North America. We discuss the indications for transplantation, the evaluation process, some key surgical and immunologic considerations, and the common risk factors for graft dysfunction. Keywords: pediatric kidney transplantation, end-stage renal disease, dialysis, organ donors, immunosuppression. (shrink)

This impressive and informative book deserves a wider readership than it is likely to get. Unfortunately there are still too many people who consider they have no need to read anything about the virus as it will, to their way of thinking, never touch them. In addition there will be those who think that a volume by Catholic ethicists will be too narrow in outlook to be worthwhile. Both sets of people are mistaken: HIV is here to stay, there is (...) no cure nor is there likely to be and sooner or later it will affect, let alone infect, millions across the world. On the second count readers will be surprised and energised by the clear and honest debate concerning the teachings of the Catholic Church. The first and longest section is made up of a series of case studies ranging from needle exchange in Puerto Rico, to confronting social stigma in Uganda, and matters relating to confidentiality in Australia. The second consists of seven …. (shrink)

Briefly stated my point is that the well-being of each person in a community conceived abstractly may be all too easily sacrificed for the sake of the abstraction. Physicians may offer critically ill patients places in programs of experimental treatment, but there is commonly a catch to the offer. To take part in a program of clinical experiment a patient must not only risk a possible failure of a fresh drug and the chance of destructive side effects from the drug, (...) but the patients must risk only getting the traditional treatment along with a placebo rather than the experimental drug. Placebo control, double blind critical protocols for testing effects of fresh drugs on critically ill patients are a commonplace. I question the scientific objectivity of the protocols and the underlying ethic, and suggest use of alternate protocols. Experimental tests in the treatment gram-negative bacteria blood infections, muscular dystrophy, and AIDS and AIDS-related diseases are examples. (shrink)

Despite global acknowledgement of HIV/AIDS reaching pandemic proportions with 37.8 million people (WHO/UNAIDS 2004) living with the infection, progress towards developing effective international responses to curb its spread has been slow. The focus of current debate tends to focus on the medical treatment and prevention of HIV/AIDS, leading to emphasis being placed on the rapid increase in HIV infection as well as opportunistic diseases such as tuberculosis and malaria. The traditional view of responding to these challenges has been probing (...) the high cost factors associated with antiretroviral treatment and burgeoning medical care needs. This article argues that these responses are limited in their effect as they have a narrow, medical focus. This article presents a broader perspective. It investigates the implications of HIV/AIDS to the goals of national sustainable development using theoretical standpoints provided by reflexive modernization, namely, the concepts of risk and reflexive judgement. Attention is given to those regions of the world—Africa and Asia—where HIV/AIDS are acute policy issues. (shrink)

In Canada, there have been a growing number of criminal HIV nondisclosure cases where public health records have been subpoenaed to aid in police investigations and/or to be presented in court as evidence against HIV-positive persons. This has led some to suggest that nurses provide explicit warnings about the limits of confidentiality in relation to crimes related to HIV nondisclosure, while others maintain that a robust account of the limits of confidentiality will undermine the nurse–client relationship and the public health (...) goals of reducing HIV/sexually transmitted infection transmission. This article engages with this issue by exploring whether and how public health nurses endeavor to control information about the limits of confidentiality at the outset of HIV posttest counseling. The data indicate variation in practices, as nurses pragmatically balance ethical and professional concerns; although some nurses intentionally withhold information about the risk of subpoena, others report talking to clients about confidentiality in ways that focus on the risk of harm associated with criminalization. The discussion argues that practice variation also illuminates medico-legal relations between health care and the criminal justice system. Data are drawn from qualitative interviews with 30 nurses working at four public health units in Ontario. (shrink)

Paying research participants in developing countries like Uganda raises ethical concerns over potential for undue inducement. This article, based on an exploratory study, reviewed 49 research protocols from a national HIV/AIDS research ethics committee database. Payments mainly adhered to the reimbursement and compensation payment models. Offers made were diverse but basic in order to limit undue inducement. Implications in terms of undue inducement and possible impact on participants and research are discussed. We end by recommending standardization across comparable studies in (...) the interests of promoting high-quality research, altruism, voluntariness, and restraining unfair reimbursement practices in research. (shrink)

The Tuskegee Syphilis Study is often cited as a major reason for low research participation rates among racial/ethnic minorities. We use data from a random-digit-dial telephone survey of 510 African Americans and 253 Latinos drawn from low income Los Angeles neighborhoods to investigate associations between knowledge of the study and endorsement of HIV/aids conspiracy theories. Results indicate African Americans were significantly more likely than Latinos to endorse HIV/aids conspiracy theories and were more aware of the study. Nevertheless, few Americans and (...) Latinos had ever heard of Syphilis Study suggesting that awareness is not a major factor in low participation rates. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:preface In this issue, one cluster of articles presents scholarly and creative work focused on Latin American queer politics. Each article reveals queer challenges—theoretical, aesthetic, political, ideological, libidinal, corporeal—to prevailing logics of heteronormativity and neoliberalism, and to asymmetrical processes of knowledge production and circulation. Rafael de la Dehesa examines how political responses to AIDS in Brazil enabled surprising alliances between NGOs, activists, and the state, which produced radical social (...) change and, at times, engendered exclusion and vulnerability. Christine Keating and Amy Lind’s essay explores indigenous and transfeminist efforts to transform the Ecuadorian constitution, producing new conceptions of both state and family. Constanza Tabbush and Melina Gaona trace the rise and fall of a neighborhood organization in Argentina called Tupac Amaru, which provided a space of encounter for lesbian, non-gender normative, and marginalized women. In a review of recent work on Latin American sexualities, Juan Camilo Galeano Sánchez finds LGBT people across Latin America and the diaspora deploying “queer revolutionary gestures” as a form of resistance to social, political, and economic marginalization. María Amelia Viteri’s commentary examines the intellectual trajectories of a network of queer scholars from across the Americas. The art essay by Tara Daly engages Iquitos artist Christian Bendayán’s visual efforts to queer prevailing conceptions of the Amazon, and tatiana de la tierra’s* poems offer a deep celebration of female eroticism. * We have spelled tatiana de la tierra’s name in lower case in accordance with the wishes of her literary executors. 256Preface Another cluster of essays highlights reproductive rights and race in Mexico, Central America, and the Caribbean. Gabriela Arguedas Ramírez and Lynn M. Morgan study the tactics that right-wing, US-based organizations deploy against sexual and reproductive rights in Mexico and Central America. Jennifer L. Shoaff examines the Dominican cultural construction of the Haitian mother as “beggar-mother,” which shores up ideas of pathological black maternity. Ana-Maurine Lara’s article considers the gendered and sexual logics of anti-blackness, and anti-Haitianism, in the Dominican Republic. The provocation for our cluster on representations of queer identities and politics in Latin America came, broadly, from developments in Latin America in recent decades: the wave of LGBT organizing around issues from same-sex marriage to transgender rights, alongside the continued, if not escalated, violence against trans, travestis, and other queer people in countries throughout the region. More immediately, it came from a symposium on Latin American/Latin@ queer and sexuality studies, cosponsored by the Center for Latin American, Caribbean, and Latino Studies (CLACLS) and the Women, Gender, Sexuality Studies Department at the University of Massachusetts (UMass), Amherst, in March 2013. Several of the papers published here were initially presented at that event and have been complemented and extended by other analytical essays and creative material on similar questions. Based on their familiarity with the debates, Sonia Alvarez, UMass CLACLS Director and professor of political science, and Amy Lind, head of the Department of Women’s, Gender, and Sexuality Studies at the University of Cincinnati, offered invaluable input for this issue, and we thank them for their intellectual generosity and collaborative spirit. Three of the articles in the cluster take us inside the complex relations between queer movements and neoliberal institutions, illustrating the distinctive ways these dynamics play out in different national contexts and political configurations. In “NGOs, Governmentality, and the Brazilian Response to AIDS: A Multistranded Genealogy of the Current Crisis,” Rafael de la Dehesa argues that the AIDS crisis served as a “doorway to the state” for marginalized actors, such as sex workers and LGBT activists. These groups pushed for and won a national AIDS program that dramatically reduced rates of mortality and new infections in Brazil in the 1990s through universal access to treatment and a nonstigmatizing approach to prevention. Its success was based, in part, on World Bank Preface 257 loans and, in part, on a participatory model of public-private partnerships characteristic of neoliberal government. De la Dehesa argues that, “Far from encapsulating activism in a seamless web of biopolitical management... nodes of articulation between officials and activists became sites of conflict and productive tension.” However, while the alliances between NGOs... (shrink)

INTRODUCTIONIs the non-therapeutic circumcision of infant males morally permissible? The most recent major development in this long-simmering debate was the 2012 release of a policy statement and technical report on circumcision by the American Academy of Pediatrics . In these documents, the US paediatricians’ organisation claimed that the potential health benefits of infant circumcision now outweigh the risks and costs. They went on to suggest that their analysis could be taken to justify the decision of parents to choose circumcision for (...) their incompetent children.1Circumcision and ‘health benefits’The AAP's pronouncement unleashed a firestorm of commentary, much of it censorious. In this issue, human rights attorney J Steven Svoboda and Professor of Clinical Paediatrics Robert Van Howe take the AAP to taski for committing numerous significant errors, both in their analysis of relevant evidence and in basic medical-ethical reasoning.3 In addition, an independent international panel—composed of 38 leading paediatricians, paediatric surgeons, urologists, medical ethicists and heads of hospital boards and children's health societies—has likewise condemned the findings of the AAP. Writing in the journal Pediatrics, these authors state: "Only one of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.4"My own analysis of the AAP documents—and of ‘health benefits’ defences of circumcision generally—can be found elsewhere.5 Let me turn my attention in this editorial, then, to …. (shrink)

Ethical challenges surrounding the implementation of male circumcision as an HIV prevention strategyResearchers have been exploring the possibility of a correlation between male circumcision and lowered risk of HIV infection almost since the beginning of the HIV/AIDS epidemic.1 Results from a randomised controlled trial in South Africa in 2005 indicate that male circumcision protects men against the acquisition of HIV through heterosexual intercourse,2 confirming the findings from 20 years of observational studies.3 Circumcised men in the South African trial were 60% (...) less likely to acquire HIV than their uncircumcised counterparts. A mathematical modelling study, based on the South African trial, estimates that the practice of male circumcision could avert two million new HIV infections and 300 000 HIV-related deaths over the next 10 years in sub-Saharan Africa.4 More recently, two randomised controlled trials in Kisumu, Kenya and Rakai, Uganda showed, respectively, 53% and 48% reductions in HIV acquisition among circumcised men than uncircumcised men in the trial.5 These results strongly suggest that male circumcision could play an important role in the struggle against the continued rise in new HIV infections. However, as observers noted at the 2006 XVI International AIDS Conference in Toronto, Canada, excitement about the potential epidemiological impact has overshadowed the debate over the difficult translation of research on male circumcision, into policy and practice.6 Similar calls for caution have been raised before and elsewhere.7,8The topic of male circumcision carries an enormous amount of ethical baggage. Male infants, worldwide, are circumcised for various medical, social and/or religious reasons. Circumcision is a cultural act and a surgical procedure; medical reasons are not the only reasons to circumcise that people have found and continue to find as compelling. Benatar and Benatar9 have argued that—when …. (shrink)

Background: Confidentiality lies at the core of medical ethics and is the cornerstone for developing and keeping a trusting relationship between nurses and patients. In the wake of the HIV epidemic, there has been a heightened focus on confidentiality in healthcare contexts. Nurses’ follow-up of HIV-positive women and their susceptible HIV-exposed children has proved to be challenging in this regard, but the ethical dilemmas concerning confidentiality that emerge in the process of ensuring HIV-free survival of the third party – the (...) child – have attracted limited attention. Objective: The study explores challenges of confidentiality linked to a third party in nurse–patient relationships in a rural Tanzanian HIV/AIDS context. Study context: The study was carried out in rural and semi-urban settings of Tanzania where the population is largely agro-pastoral, the formal educational level is low and poverty is rife. The HIV prevalence of 1.5% is low compared to the national prevalence of 5.1%. Methods: Data were collected during 9 months of ethnographic fieldwork and consisted of participant observation in clinical settings and during home visits combined with in-depth interviews. The main categories of informants were nurses employed in prevention of mother-to-child transmission of HIV programmes and HIV-positive women enrolled in these programmes. Ethical considerations: Based on information about the study aims, all informants consented to participate. Ethical approval was granted by ethics review boards in Tanzania and Norway. Findings and discussion: The material indicates a delicate balance between the nurses’ attempt to secure the HIV-free survival of the babies and the mothers’ desire to preserve confidentiality. Profound confidentiality-related dilemmas emerged in actual practice, and indications of a lack of thorough consideration of the implication of a patient’s restricted disclosure came to light during follow-up of the HIV-positive women and the third party – the child who is at risk of HIV infection through mother’s milk. World Health Organization’s substantial focus on infant survival (Millennium Development Goal-4) and the strong calls for disclosure among the HIV-positive are reflected on in the discussion. (shrink)

Despite abundant evidence associating CD38 overexpression and CD4 T cell depletion in HIV infection, no causal relation has been investigated. To address this issue, a series of mechanisms are proposed, supported by evidence from different fields, by which CD38 overexpression can facilitate CD4 T cell depletion in HIV infection. According to this model, increased catalytic activity of CD38 may reduce CD4 T cells’ cytoplasmic nicotin‐amide adenine dinucleotide (NAD), leading to a chronic Warburg effect. This will reduce mitochondrial function. Simultaneously, CD38's (...) catalytic products ADPR and cADPR may be transported to the cytoplasm, where they can activate calcium channels and increase cytoplasmic Ca2+ concentrations, further altering mitochondrial integrity. These mechanisms will decrease the viability and regenerative capacity of CD4 T cells. These hypotheses can be tested experimentally, and might reveal novel therapeutic targets. (shrink)

The way Cambodian patients and health professionals judge the priority of HIV-infected patients in relation to the allocation of antiretroviral drugs was examined. Participants were either HIV-infected patients attending the HIV/AIDS Care and Support Centre for People Living with HIV/AIDS in Phnom Penh (29 females and 21 males) or members of the staff (9 physicians, 6 pharmacists and 15 health counsellors and health educators). They were presented with stories of a few lines depicting a patient's situation and were instructed to (...) judge the extent to which the patient should be given priority for HIV drugs. The stories were composed according to a four within-subject factor design: (a) the patient's family responsibilities, (b) the severity of infection, (c) the time elapsed since the first consultation, and (d) the financial difficulties of the family. Most patients expressed the view that the drugs should be used for the patients who are most important from a familial point of view, namely, when the family contains small children and/or is already in a precarious financial condition. (shrink)

Studies of non-standard, project-based forms of work prevalent in the creative industries have typically theorized the relational dynamics of work as a competitive process of social capital accumulation involving an individualistic, self-enterprising, zero-sum, and winner-takes-all struggle for favourable social network-positioning. Problematizing this prevailing conceptualization, our empirical case study draws on fifty in-depth interviews and two focus groups with creative workers in Ghana to show how relations of mutual aid, including elaborate efforts to live harmoniously with others, are intricately intertwined with (...) economic practices of getting by and getting ahead. Our analysis abductively mobilizes insights from Afro-communitarian ethics to theorize the mutual aid we observed as a complex socio-economic practice of relational resource redistribution contingent on degrees of social proximity. In applying “a theory from the South” to foreground the role of moral obligations, social harmony, and hands-on practices of mutual aid in non-standard forms of work, we contribute a “decolonial critique” of relationality of relevance to scholars of creative work and business ethicists. (shrink)

IN THE UNITED STATES, 25 PERCENT OF PEOPLE LIVING WITH HIV/AIDS HAVE spent time in the correctional system. HIV is known to spread among incarcerated individuals through high-risk behaviors including unprotected sex, injection drug use, tattooing, and body piercing. When released from prison, persons living with HIV can spread the disease in the wider community. This essay explores the complex problem of HIV infection among US prisoners from a common good approach rooted in Catholic social teachings by examining available data (...) on US prison populations, describing recent trends in the prosecution of drug-related crimes, and proposing concrete policy recommendations for HIV prevention interventions in US prisons. (shrink)

Despite decades of prevention efforts, millions of persons worldwide continue to become infected by the human immunodeficiency virus (HIV) every year. This urgent problem of global epidemic control has recently lead to significant changes in HIV testing policies. Provider-initiated approaches to HIV testing have been embraced by the Centers for Disease Control and Prevention and the World Health Organization, such as those that routinely inform persons that they will be tested for HIV unless they explicitly refuse ('opt out'). While these (...) policies appear to increase uptake of testing, they raise a number of ethical concerns that have been debated in journals and at international AIDS conferences. However, one special form of 'provider-initiated' testing is being practiced and promoted in various parts of the world, and has advocates within international health agencies, but has received little attention in the bioethical literature: mandatory premarital HIV testing. This article analyses some of the key ethical issues related to mandatory premarital HIV testing in resource-poor settings with generalized HIV epidemics. We will first briefly mention some mandatory HIV premarital testing proposals, policies and practices worldwide, and offer a number of conceptual and factual distinctions to help distinguish different types of mandatory testing policies. Using premarital testing in Goma (Democratic Republic of Congo) as a point of departure, we will use influential public health ethics principles to evaluate different forms of mandatory testing. We conclude by making concrete recommendations concerning the place of mandatory premarital testing in the struggle against HIV/AIDS. (shrink)

We develop and use mathematical models that describe changes in the South African population over the last decades, brought on by HIV and AIDS. We do not model all the phases in HIV progression but rather, we show that a relatively simple model is sufficient to represent the data and allows us to investigate important aspects of HIV infection: firstly, we are able to investigate the effect of awareness on the prevalence of HIV and secondly, it enables us to make (...) a comparison between South Africa and Botswana. A comparison is made between two models: a model that does not reflect awareness of the devastating impact of HIV and AIDS, and a model with an added psychological awareness factor. Both models are fitted to data that reflects the incidence of HIV and AIDS within South Africa. This allows us to examine the impact of psychological awareness. We show that inclusion of the effect of awareness is absolutely necessary to arrive at a model description that satisfactorily fits the available HIV and AIDS data for South Africa. We also show that a relatively simple modelling of awareness (as opposed to more complex mathematical techniques that have been used in past studies) is sufficient to accurately describe the observed patterns in the data. Even though awareness alone is not sufficient to eradicate any disease and other control strategies should be explored and implemented concurrently with educational campaigns, we are able to conclude (through thorough model analyses procedures) that the current level of awareness in South Africa is far below the level that is effectively required to eradicate HIV from the South African population. The awareness model is also fitted to HIV-related data for Botswana and we compare the results with the South African case. Though the effect of awareness is currently estimated at a much higher level in Botswana, other factors such as poorer health care and cultural differences may play a role in limiting the ability of awareness to combat HIV in Botswana. (shrink)

The COVID-19 pandemic has had pronounced effects on individuals' psychological well-being around the world. Concerns regarding the consequences of infection, as well as the general uncertainty and governmental regulations have resulted in increased psychological distress among many populations and cultures. In this regard, research has shown that the manner by which individuals perceive such large-scale threats and appraise them significantly contributes to the psychological consequences of such events. According to the Hostile-World Scenario model, negative engagement with such threats weakens one's (...) competence and coping abilities, whereas positive engagement facilitates resilience and enhances psychological adjustment. Accordingly, the current study examines the moderating role of both NE and PE in the connections of two main features of the current pandemic, COVID-19-related worries and loneliness, with anxiety. Data were collected between March 16 and April 14, 2020, from 1,112 Israelis, who provided information regarding COVID-19 health worries, loneliness, and anxiety. A special measure assembled items pertinent to the HWS-NE and HWS-PE throughout the survey. Results demonstrated that both HWS-NE and HWS-PE were significant moderators. COVID-19-related health worries/loneliness were linked with anxiety only among individuals with high HWS-NE, and were non-significant among those with low HWS-NE. Moreover, the positive association between loneliness and anxiety was significantly mitigated by high HWS-PE. The discussion highlights the importance of the HWS for understanding the psychological consequences of COVID-19 and offers practical suggestions, which may aid mental health practitioners in providing assistance and support to the general population. (shrink)