Since the first diagnosis of an HIV infection in 1956, the number of victims infected with the virus has dramatically increased to 40.3 million in 2005. The countries of sub-Saharan Africa carry the largest burden of HIV/AIDS worldwide. Various programs against the spread of the epidemic in this region have been promised. The objective of this article is to analyze to what extent these programs can achieve a sustainable effect. This article examines in detail the sustainability of thirteen programmes (...) initiated by large American and European pharmaceutical companies. It finds that none of the examined programs offers a fully sustainable solution. However, programs that were organized in cooperation with local authorities or organizations appear suitable to reach sustainable effects in high-prevalencecountries. As a result, cooperation seems to be an important prerequisite to implement the infrastructural measures necessary to guarantee sustainable effects in sub-Saharan Africa. (shrink)

O estudo descreve e analisa práticas preventivas adotadas por 15 casais heterossexuais estáveis nos períodos anterior e posterior à testagem para HIV, realizadas voluntariamente em um serviço de saúde pública. Utilizou-se uma entrevista semiestruturada para avaliar se a possibilidade real de infecçã..

HIV/AIDS strikes with the greatest frequency in sub-Saharan Africa, a region lacking resources to deal with this epidemic. To keep millions more people from dying, wealthy countries must provide more help. Yet deeply ingrained biases may distance the sick from those who could provide far more aid. One such prejudice is viewing disease as punishment for sin. This 'punishment theory of disease" ascribes moral blame to those who get sick or those with special relations to them. Religious versions hold (...) that God punishes them in order to castigate, encourage virtue, warn, rehabilitate, or maintain some cosmic order. Its various religious and secular forms are untenable; they lack cogency, risk blaming people unjustly, and jeopardize compassionate care for people. These views are not only irrational but also dangerous because they influence policies and cost lives. We need to cooperate and respond as befits this global public-health disaster and not engage in the misguided and bad faith activity of dividing the world into the blameworthy and blameless. (shrink)

A senior physician with a government role in Japan made a widely reported and misleading statement about Thailand’s policy on HIV/AIDS patients. He claimed that in Thailand the policy is to spend public money on the prevention of HIV infection while allowing AIDS patients to die untreated. The author, a community nursing specialist in Japan with first-hand knowledge of HIV/AIDS policy in Thailand, thought that this statement would influence attitudes negatively in Japan. However, speaking out about this (...) misrepresentation of the facts carried certain risks. Although freedom of expression is valued in Japan, in practice it is not easy to contradict senior medical professionals. The author uses his experience of this difficult professional situation to teach nurses how to approach speaking out in the public interest. (shrink)

The text examines the article 11 of the Universal Declaration on Bioethics and Human Rights of UNESCO that deals with the principle of non-discrimination and non-stigmatization. Both concepts are related to the theme of human dignity, while discrimination is an inherent part of stigma: stigma does not exist if there is no discrimination. In this context, this paper aims to study the relationship between stigma, discrimination and HIV / AIDS. The study argues that to loosen the bonds that hold (...) the subjects that are attached to them is necessary questioning the broader forces - social, cultural, political and economic - that structure stigma, stigmatization and discrimination as social processes directly linked to production and reproduction of structural inequalities. (shrink)

This article’s central aim is to debunk the overly simplified, paradigmatic, and essentialist description of certain types of Muslim sexuality, arguing that such essentialist characterization of Muslims ignores the nonunique social determinants (poverty, education, and sociostructural exclusions) of HIV/aids risk in an increasingly globalized world. To support this argument, we rely on a thematic and comparative analysis. A reoccurring theme in this project is that issues of public health, human rights, justice, and social empowerment are inextricably intertwined. Having established (...) a conceptual framework linking health and human rights, we use a comparative analysis of the cases of Iran, Indonesia, and Bangladesh in an attempt to single out similarities and differences among these cases. All these cases hold a majority Muslim population (at 98%, 86%, and 89%, respectively) and are also representative of the two primary strands of Islam: Shi’a and Sunni. Additionally, each of these states has signed the Declaration of Commitment on HIV/aids and reports the progress of their HIV/aids treatment and prevention efforts to United Nations Program on HIV/aids, the United Nations organization tasked with monitoring and combating the spread of HIV/aids. (shrink)

Intense scientific work on HIV/AIDS has led to the development of effective combination drug therapies and there is hope that effective vaccines will soon be produced. However, the majority of people with HIV/AIDS in the world are not benefiting from such advances because of extreme poverty. This article focuses on the pandemic as a reflection of a complex trajectory of social and economic forces that create widening global disparities in wealth and health and concomitant ecological niches for the (...) emergence of new infectious diseases. While the biomedical approach to HIV/AIDS is necessary, has prolonged the lives of many individuals and could offer much at the level of population health, it cannot, in isolation, improve the health of populations. To achieve the latter will require understanding and addressing the deeper social causes of pandemics. Broadening the discourse on ethics to include public health ethics and the ethics of international relations could contribute to reducing the impact of the pandemic and to preventing the emergence of new infectious diseases in the future. (shrink)

The response to the HIV/AIDS pandemic in Africa has so far ignored important traditional African values and attitudes toward disease and commerce. These values and attitudes are significantly different from the libertarian, market-driven, profit-oriented values and practices of important sectors of the Western world. To deal with this epidemic, the world should consider respect for, and possibly even adoption of those African values, which provide for people in genuine need, irrespective of their ability to pay. HIV/AIDS vaccine research (...) indigenous to Africa is also not always taken seriously, and struggles to find adequate funding for such research within or outside of the continent have been extremely difficult. A better appreciation of knowledge systems and values indigenous to the African experience is important in the fight against the HIV/AIDS pandemic. (shrink)

HIV/AIDS prevention campaigns have been overshadowed by conflicting, competing, and contradictory views between those who support condom use as a last resort and those who are against it for fear of promoting sexual immorality. We argue that abstinence and faithfulness to one partner are the best available moral solutions to the HIV/AIDS pandemic. Of course, deontologists may argue that condom use might appear useful and effective in controlling HIV/AIDS; however, not everything that is useful is always good. (...) In principle, all schools of thought and faith seem to agree on the question of faithfulness for married couples and abstinence for those who are not married. But they differ on condom use. On the ground, the situation is far more complex. We simply lack a single, entirely reliable way to resolve all disagreements regarding HIV/AIDS prevention strategies. (shrink)

The principle of individual medical confidentiality is one of the moral principles that Africa inherited unquestioningly from the West as part of Western medicine. The HIV/AIDS pandemic in Southern Africa has reduced the relevance of the principle of individual medical confidentiality. Individual medical confidentiality has especially presented challenges for practitioners among the Bantu communities that are well known for their social inter-connectedness and the way they value their extended family relations. Individual confidentiality has raised several unforeseen problems for persons (...) living with HIV/AIDS, ranging from stigma and isolation to feelings of dejection as it drives them away from their families as a way of trying to keep information about their conditions confidential. The involvement of family members in treatment decisions is in line with the philosophy of Ubuntu and serves to respect patients’ and families’ autonomy while at the same time benefiting the individual patient. (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)

HIV/aids can now be considered a pandemic as it affects all parts of the world. As attentive as scholars have been to the biomedical and epidemiological aspects of the disease, they have been slower to try to understand it as a disease of transnational significations or meanings. This article looks to the ways that the conceptual categories of HIV/aids came to India in the biomedical literature, the approaches that the media in the United States and India took in (...) contending with these meanings, and how these categories travel globally in dominant and negotiated realms of discourse. Throughout this analysis, attention is paid to ways that high-risk groupings obscure alternative approaches based on understandings of the dynamics of poverty, history, gender, and culture. Finally, this article argues that critical approaches to science and medicine are essential to help produce a more complex science. (shrink)

This article utilizes a political system framework to trace the political sources of business risk stemming from the unfolding HIV/AIDS generalized epidemic in South Africa. The article integrates relevant dimensions of the fields of international business and political science to facilitate the assessment of such risks for firms. Risk formation and updating is a sequential process. The conditions from which business risk emerges, the politicization of the generalized (i.e., widespread) epidemic through boundary-crossing activities, and “inputs” are explored. The transformation (...) of HIV/AIDS from an epidemic to a business threat is underscored by the South African government’s tendency to view the issue as part of the public agenda rather than part of its formal agenda. Governmental inaction, as well as action, led to an array of risks for firms operating in South Africa (e.g., operations, asset impairment, competitive, franchise). Mitigating strategies for managers are discussed, including avoidance, offsetting, transference, sharing, remedy, and anticipation. (shrink)

The COVID-19 pandemic is not the first pandemic that many of us have faced in our lives. The HIV/AIDS pandemic continues to affect women, racialized people, and LGBTQ2S+ people around the world today, and there are significantly fewer resources to address, and less political will and news coverage of, this other pandemic.1 Although many see COVID-19 as an unprecedented public health crisis that is challenging our societies and our relationships with each other in unique ways, I argue that we (...) actually have a lot to learn from our responses to HIV/AIDS and that feminist bioethicists can help us understand how the present situation is actually an extension of several underlying medical and social issues and... (shrink)

In this essay I explore the heuristic value of the concept of ethics of complexity, chaos, and contingency by applying its framework to the analysis of the HIV/AIDS pandemic. Everyday human moral choices are outcomes of a moral impulse, and such an impulse is grounded in moral competence shaped by moral literacy. This literacy is constructed on the basis of a body of knowledge of culture, social context, environment, and the universe. It also includes the knowledge of religions and (...) religious and secular ethical codes. I also distinguish between the social and cultural aspects of ethical systems. Both societies and cultures provide resources and constraints for the development of literacy and competence. An intentionally developed multifaith and multidisciplinary coalition may help us move away from various forms of social speciation and toward sociological mindfulness. This could help us remake the world into one that has more courage to care. (shrink)

O trabalho teve como objetivo investigar a qualidade de vida em mulheres portadoras de HIV/AIDS, em destaque as relações sociais e a sexualidade. Foram analisados também aspectos sociodemográficos e situação clínica (marcadores biológicos CD4+ e carga viral) de 63 mulheres entre 18 e 65 anos em uso ..

Se realizó un estudio de intervencisn educativa, con el objetivo de determinar el nivel de conocimientos acerca del VIH/sida en estudiantes de la ESBU "Marcos Rammrez Rodrmguez" en el permodo comprendido desde el 1ro de marzo al 30 de mayo del 2010. Se estudiaron 150 adolescentes, escogidos de un universo de 347, a travis de un muestreo por conglomerado bietapico. Inicialmente se aplics una encuesta previamente sometida al mitodo de expertos (Delphi) y evaluada de muy adecuada, donde se determins que (...) el 82 % tenman conocimientos generales inadecuados Despuis de la intervencisn educativa -evaluada de muy adecuada por el mitodo de expertos- el 98,7 % de los adolescentes alcanzaron un nivel de conocimientos adecuados. El analisis estadmstico utilizando la prueba de McNemar, evidencis la asociacisn estadmsticamente significativa (p=0.0000) entre el nivel de conocimiento que tenman los estudiantes antes y despuis de la intervencisn, lo que demostrs que el modelo educativo-participativo empleado aumenta el nivel de conocimientos en los adolescentes. A study of educational intervention was carried out in order to determine the level of knowledge about HIV/AIDS in students of Marcos Rammrez Rodrmguez ESBU in the period from March 1th to May 30th 2010. 150 Teenagers, selected from a universe of 347, were studied through a conglomerate two sampling. Initially, a survey previously submitted to method of expert (Delphi) was applied and properly assessed. It was determined that 82 % had inadequate general knowledge. After the educational intervention - assessed fairly by the method of expert - 98, 7% of teenagers achieved an adequate level of knowledge. Statistical analysis using the McNemar test, showed a statistically significant association (p = 0.0000) between the level of knowledge that students had before and after the intervention, which demonstrated that the educational participative model used increases the level of knowledge among adolescents. (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 a recent edition of the Medical Journal of Australia, Greg Dore and David Cooper called on persons in developed nations like Australia to bridge the divide between resource-rich countries to nations in the developing world, where therapies to ease or halt the ravages of the virus are nonexistent or in short supply.

ABSTRACT Objective: To contrast relief efforts for the 26 December 2004 tsunami with current global HIV/aids relief efforts and analyse possible reasons for the disparity. Methods: Literature review and ethical analysis. Results: Just over 273,000 people died in the tsunami, resulting in relief efforts of more than US$10 bn, which is sufficient to achieve the United Nation’s long‐term recovery plan for South East Asia. In contrast, 14 times more people died from HIV/aids in 2004, with UNAIDS predicting a (...) US$8 bn funding gap for HIV/aids in developing nations between now and 2007. This disparity raises two important ethical questions. First, what is it that motivates a more empathic response to the victims of the tsunami than to those affected by HIV/AIDS? Second, is there a morally relevant difference between the two tragedies that justifies the difference in the international response? The principle of justice requires that two cases similarly situated be treated similarly. For the difference in the international response to the tsunami and HIV/aids to be justified, the tragedies have to be shown to be dissimilar in some relevant respect. Are the tragedies of the tsunami disaster and the HIV/aids pandemic sufficiently different, in relevant respects, to justify the difference in scope of the response by the international community? Conclusion: We detected no morally relevant distinction between the tsunami and the HIV/aids pandemic that justifies the disparity. Therefore, we must conclude that the international response to HIV/aids violates the fundamental principles of justice and fairness. (shrink)

Of the scientific concepts that the American philosopher, Charles S. Peirce, analyzed in his work, two of the less commonly investigated have been those of guessing and of scientific economy. Peirce argued that guessing was the initial moment of hypothesis-formation. He also argued that economic factors play a significant role in the development and acceptance of hypotheses; however, the relationship between these two concepts has been neglected in most philosophical and scientific literature. In the following, I provide an analysis of (...) how guessing and economic considerations contribute to hypothesis-formation. This analysis focuses primarily upon medical science; specifically, the epidemiology of HIV/AIDS. By using the first case studies in medical research that led to the ‘discovery’ of HIV/AIDS, I will argue that guessing is a tool utilized by researchers that is determined, at least in part, by implicit bias and economic considerations, which ultimately effect the trajectory of hypothesis-formation and the ensuing scientific research founded upon those hypotheses. In this particular case, both the biases of researchers and their effect upon economic considerations in the initial moments of guessing led to problematic hypotheses concerning the disease, populations susceptible to the disease, and how it was transmitted within that population. By recognizing how guessing and economy relate in this particular case and the functions of these conceptual tools as they relate to the isolation and discovery of disease, we can better understand epidemiological investigations and facilitate overcoming detrimental biases in such investigations. (shrink)

This paper focuses on the set of problems regarding the HIV/AIDS crisis in the specific domain of corporate moral responsibility within a context of the Levinasian notion of proximity (infinite responsibility) and the Third. Against a totalitarian, homogeneous society, Levinas opens the way to a social pluralism, which has its sources in the disquiet provoked by the strangeness of the Other's face. Corporate responsibility, understood from this point of view, would not reduce institutional relations to an anonymous world of (...) neutrality. Corporate responsibility is unconditional in the sense that to be responsible is not a question of choice, but one of deep liberty, the liberty of taking the burden of the infinite responsibility for the Other customers, employees, the public at large and those who suffer in the world. This paper argues that it would then also mean that society (individuals, NGOs and governments) in accordance with the spirit of the Levinasian philosophy of infinite responsibility could exert pressure on corporations, such as pharmaceutical companies. Owing to their power, they could change their present responsibility policies to a more affirmative and engaged responsibility with regard to those who are ill and who suffer death or debilitation from HIV/AIDS and other prevalent diseases in the poorest parts of the world today. (shrink)

Keeping the diagnosis of a client confidential is one of the cornerstones of professional practice. In the case of a diagnosis such as HIV/AIDS, however, the ethics of this action may be challenged. Such a decision has a range of negative effects, for example, the blaming of others, supporting the denial of the client, and complicating the health education and care of the patient. It is suggested that the four ethical principles should be used to explore the ethics of (...) such decisions, and that professional regulatory bodies and organizations should support professionals in situations where the client’s sexual partner is informed against the wishes of the client. (shrink)

HIV/AIDS is the leading cause of morbidity and mortality in the southern African country of Malawi. At the largest referral health facility in Blantyre, the Queen Elizabeth Central Hospital, the majority of patients hospitalized in medical wards and up to a third of those in the maternity unit are infected with HIV. Many patients in the surgical wards also have HIV/AIDS. Health professionals in Blantyre, however, often choose not to write down the diagnosis of HIV or AIDS; (...) rather, they prefer to use ‘SGOT’, ‘ELISA’ and ‘spot test’ to represent the HIV test, while ‘immunosuppression’, ‘↓ CD4 disease’ and ‘ARC’ are preferred instead of ‘AIDS’. It is possible that health professionals’ belief that mentioning HIV and/or AIDS will harm patients is encouraging them to use these euphemisms. The use of less than exact terms to label HIV and AIDS may not be without cost. For instance, future attempts to conduct retrospective case study research may be hampered by this practice, which is not in accordance with the international classification of diseases. It is suggested that, although stigmatization and discrimination could be important driving factors in the use of cryptic language, it may be more worthy to fight discrimination and stigmatization head-on, rather than create avenues where these reactions may be perpetuated. (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)

The advent of HIV focussed broad social attention on the group of people most affected by it in Australia, the so-called ‘gay community’. However, what a gay community actually was, and what kind of rights and duties were being attached to it remained unclear. However, it is obvious that such a community — or communities — did not fit the model proposed by communitarian writers like Michael Sandel and Charles Taylor, whereby subjects cannot stand outside their own constitutive attachments. I (...) also consider the common criticism of communitarianism, and see what kinds of collectives can in fact be considered ethical.The first part of this paper looks at the ethical issues surrounding community attachment of this kind in Australia in relation to the ethics of HIV/aids clinical research. In particular I examine the way in which certain forms of gay community attachment can be used to strengthen personal autonomy and check exploitation within the prevention and research process.The second part of this paper draws upon the issues just discussed. In particular I focus on the use of ‘community’ in the research process in developing countries, and suggest ways in which cultural considerations might strengthen autonomy. However, I go on to suggest that in many cases the idea of community has served the opposite purpose, and has in fact been used to oppress certain individuals and groups within the developing world, in the so-called interests of the greater good. In order to avoid this, I suggest a model of social and ethical research whereby all subjects and researchers in the clinical process might stand in greater relationships of equality with each other. (shrink)

In April 2009 a Cochrane review was published assessing the effectiveness of male circumcision in preventing acquisition of HIV. It concluded that there was strong evidence that male circumcision, performed in a medical setting, reduces the acquisition of HIV by men engaging in heterosexual sex. Yet, importantly, the review noted that further research was required to assess the feasibility, desirability and cost-effectiveness of implementation within local contexts. This paper endorses the need for such research and suggests that, in its absence, (...) it is premature to promote circumcision as a reliable strategy for combating HIV. Since articles in leading medical journals as well as the popular press continue to do so, scientific researchers should think carefully about how their conclusions may be translated both to policy makers and to a more general audience. The importance of addressing ethico-legal concerns that such trials may raise is highlighted. The understandable haste to find a solution to the HIV pandemic means that the promise offered by preliminary and specific research studies may be overstated. This may mean that ethical concerns are marginalised. Such haste may also obscure the need to be attentive to local cultural sensitivities, which vary from one African region to another, in formulating policy concerning circumcision. (shrink)

Objectives: To describe the concerns and priorities of key stakeholders in a developing country regarding ethical obligations held by researchers and perceptions of equity or “what is fair” for study participants in an HIV/AIDS clinical drug trial. Design: Qualitative study with focus groups. Setting: Teaching and referral hospital and rural health centre in western Kenya. Participants: Potential HIV/AIDS clinical trial participants, clinician researchers, and administrators. Results: Eighty nine individuals participated in a total of 11 focus groups over a (...) four month period. The desire for continued drug therapy, most often life long, following an HIV/AIDS clinical trial was the most common priority expressed in all focus groups. Patients with and without HIV/AIDS also thought subsidisation of drug therapies and education were critical forms of compensation for clinical trial participation. Financial incentives were considered important primarily for purchasing drug therapy as well as obtaining food. Patients noted a concern for the potential mismanagement of any money offered. Clinician researchers and administrators felt strongly that researchers have a moral obligation to participants following a trial to provide continued drug therapy, adverse event monitoring, and primary care. Finally, clinician researchers and administrators stressed the need for thorough informed consent to avoid coercion of study participants. Conclusions: Kenyan patients, clinician researchers, and administrators believe that it would be unfair to stop antiretroviral therapy following an HIV/AIDS clinical trial and that researchers have a long term obligation to participants. (shrink)

Problems posed by HIV/AIDS differ from those ofpast epidemics by virtue of unique propertiesof the causative agent, dramatic societalchanges of the late 20th century, and thetransition of medical practice from aprofessional ethic to a technology-dependentbusiness ethic. HIV/AIDS struck during thecoming-of-age of molecular biology and also ofbioethics, and the epidemic stimulated thegrowth of both disciplines. The number ofarticles published about AIDS and ethics (asidentified by a MEDLINE search) peaked in 1990,just before the peak incidence of AIDS in (...) theUnited States. The character of ethicaldialogue has now shifted from familiar moralquandaries such as civil liberty versus publicwelfare to concerns about vaccine trials andpublic policy toward the developing world.Physicians and other health care workers whowere involved from the onset endured somethingof an emotional roller coaster. Theircompassion-based work ethic was to a largeextent replaced by a competence-based workethic after the introduction in 1996 of highlyactive antiretroviral therapy. The abundantrecent literature on ``professionalism'' inmedicine makes scant mention of AIDS/HIV. Thedisruptive effect of AIDS/HIV on society wouldhave been substantially greater had relevanttechnology such as the ability to isolateretroviruses and potent therapy againsttuberculosis not been in place. This soberingconsideration, along with such recent events asthe use of bioterrorism against civilianpopulations, suggests new relevance forPotter's definition of ``bioethics'' as a scienceof survival in which the biology of ecosystemsmust be taken into account. (shrink)

While the WHO, public health experts, and political leaders have referenced solidarity as an important part of our responses to COVID‐19, I consider how we build solidarity during pandemics in order to improve the effectiveness of our responses. I use Prainsack and Buyx's definition of solidarity, which highlights three different tiers: (1) interpersonal solidarity, (2) group solidarity, and (3) institutional solidarity. Each tier of solidarity importantly depends on the actions and norms established at the lower tiers. Although empathy and solidarity (...) are distinct moral concepts, I argue that the affective component of solidarity is important for motivating solidaristic action, and empathetic accounts of solidarity help us understand how we actually build solidarity from tier to tier. During pandemics, public health responses draw on different tiers of solidarity depending on the nature, scope, and timeline of the pandemic. Therefore, I analyze both COVID‐19 and HIV/AIDS using this framework to learn lessons about how solidarity can more effectively contribute to our ongoing public health responses during pandemics. Whereas we used institutional solidarity during COVID‐19 in a top‐down approach to building solidarity that often overlooked interpersonal and group solidarity, we used those lower tiers during HIV/AIDS in a bottom‐up approach because governments and public health institutions were initially unresponsive to the crisis. Thus, we need to ensure that we have a strong foundation of respect, trust, and so forth, on which to build solidarity from tier to tier and promote whichever tiers of solidarity are lacking during a given pandemic to improve our responses. (shrink)

The journey metaphor used by Nie and colleagues (2016) can be analyzed in terms of the way in which health care professionals can support well-being and attend to the aspects of illness that often...

Southern African countries have the highest HIV infection rates in the world. In most of the countries in the region, the rate among adults is at least 10%. The fight against HIV/AIDS has mostly been inadequate owing to the lack of proper consideration of ethical and cultural issues. In this article, the authors discuss the ethical and cultural dilemmas concerning HIV/AIDS, with Malawi as a case in point. It is argued that increasing financial resources alone, as exemplified by (...) the Global Fund to Fight AIDS, Tuberculosis and Malaria initiative, without proper attention to ethical issues, morals and appropriate legal obligations, are unlikely to reduce the spread of HIV in southern Africa. (shrink)

This paper analyses the way in which being in possession of an adequate range of options is an essential component of autonomy. I discuss the way in which the conceptualisation of options in terms of basic rights might assist this argument, and apply these ideas to HIV/AIDS clinical research in the developing world. Finally, I suggest that mechanisms should be put in place through which vulnerable research participants can express their views about the relationship between the research in which (...) they are involved, and needs of a worthwhile life. (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 considerations. (shrink)