She was to a degree the tool of her husband. However, despite the fact she was under his influence to a degree she cannot escape if the Bank took all reasonable steps to ensure that she had appreciated and understood what she was signing. It may be that Mrs Wright-Bailey did not have an adequate comprehension of the nature of the charge... [E]ven if she did not, the Bank did take all reasonable steps.

This paper is the first to critically analyse how the newly enacted Chinese Civil Code addresses gender equality in the intersection of family and commercial contracting. It proposes ‘marriage transmitted debt’ (MTD) in China as a new concept as opposed to ‘sexually transmitted debt’ (STD) documented in English and Australian jurisprudence. MTD refers to the debt incurred by one spouse but transmitted to the other spouse due to the status of the marriage. Supported (...) by empirical statistics, it shows that while the statutory language of MTD regulation in China is neutral, wives are still disadvantaged. Although this has been partly addressed by shifting the onus of proof to creditors, the meaning of debt incurred for the daily life of a family or the joint life of the couple in the Code needs further judicial development. The Code is the beginning of a solution rather than the end to achieving gender equality in China. (shrink)

This article offers a feminist perspective on contract theories in law,economics and law-and-economics. It identifies masculine traits presentcontract theories in all three disciplines. It then describes andassesses some developments that appear to be ‘feminising’: Therecognition of the importance of social norms in contract theory andtheories of contract as relationship. The article's main claim is that amasculine model of decision-making persists even within the less overtlymasculine models of contract. The problem of sexually transmitted debtresulting from a surety contract is (...) analysed in detail as a specificexample supporting the article's general argument. The article concludesthat the way forward is to be found in a recognition of other ways ofmaking decisions. (shrink)

This study set out to investigate the influence of male circumcision and other factors on sexually transmitted infections in Botswana. A syndromic approach, which diagnoses a sexually transmitted infection based on the presence of urethral discharge or genital ulcers rather than on laboratory tests, was used. The data were from the 2001 Botswana AIDS Impact Survey where a nationally representative, randomly selected sample of men and women aged 1064 years who had ever had sexual intercourse. The (...) logistic regression technique was executed to examine the association between male circumcision and self-reported urethral discharge or genital ulcers, while controlling for all other independent variables in the analysis. The main finding of this study was that among men who are circumcised, the odds for self-reported urethral discharge or genital ulcers are significantly lower than for those men who are not circumcised in both urban and rural Botswana. The analysis also showed that the odds in favour of self-reported urethral discharge or genital ulcers, for men who drink alcohol, are twice as large as those for men who do not drink alcohol, controlling for all other independent variables in the analysis. Religion and ethnicity also came through as factors exerting a protective influence against self-reported symptoms of sexually transmitted infections. The conclusion is that while male circumcision appears to be significantly associated with the risk for self-reported urethral discharge or genital ulcers, it is man’s behaviour, irrespective of ethnicity or religious dictates, that continues to play a vital role in protection against self-reported symptoms of sexually transmitted infections in Botswana. (shrink)

Population-based research is enhanced by biological measures, but biological sampling raises complex ethical issues. The third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3) will estimate the population prevalence of five sexually transmitted infections (STIs) (Chlamydia trachomatis, Neisseria gonorrhoeae, human papillomavirus (HPV), HIV and Mycoplasma genitalium) in a probability sample aged 16–44 years. The present work describes the development of an ethical approach to urine testing for STIs, including the process of reaching consensus on whether to return (...) results. The following issues were considered: (1) testing for some STIs that are treatable and for which appropriate settings to obtain free testing and advice are widely available (Natsal-3 provides all respondents with STI and healthcare access information), (2) limits on test accuracy and timeliness imposed by survey conditions and sample type, (3) testing for some STIs with unknown clinical and public health implications, (4) how a uniform approach is easier to explain and understand, (5) practical difficulties in returning results and cost efficiency, such as enabling wider STI testing by not returning results. The agreed approach, to perform voluntary anonymous testing with specific consent for five STIs without returning results, was approved by stakeholders and a research ethics committee. Overall, this was acceptable to respondents in developmental piloting; 61% (68 of 111) of respondents agreed to provide a sample. The experiences reported here may inform the ethical decision making of researchers, research ethics committees and funders considering population-based biological sampling. (shrink)

Objective: To determine under what conditions lay people and health professionals find it acceptable for a physician to breach confidentiality to protect the wife of a patient with a sexually transmitted disease .Methods: In a study in France, breaching confidentiality in 48 scenarios were accepted by 144 lay people, 10 psychologists and 7 physicians. The scenarios were all possible combinations of five factors: severity of the disease ; time taken to discuss this with ; intent to inform the (...) spouse about the disease ; intent to adopt protective behaviours ; and decision to consult an expert in STDs , 2×2×3×2×2. The importance and interactions of each factor were determined, at the group level, by performing analyses of variance and constructing graphs.Results: The concept of breaching confidentiality to protect a wife from her husband’s STD was favoured much more by lay people and psychologists than by physicians . The patient’s stated intentions to protect his wife and to inform her of the disease had the greatest impact on acceptability. A cluster analysis showed groups of lay participants who found breaching confidentiality “always acceptable” , “depending on the many circumstances” , requiring “consultation with an expert” and “never acceptable ”.Conclusions: Most people in France are influenced by situational factors when deciding if a physician should breach confidentiality to protect the spouse of a patient infected with STD. (shrink)

Background: In prevalence studies of sexually transmitted infections (STIs), investigators often provide syndromic management for symptomatic participants, but may not provide specific treatment for asymptomatic individuals with positive laboratory test results due to the delays between sample collection and availability of results as well as logistical constraints in recontacting study participants. Methods: To characterize the extent of this issue, 80 prevalence studies from the World Health Organization’s Report on global sexually transmitted infection surveillance, 2018, were reviewed. (...) Studies were classified as to whether clinically relevant positive results were returned or if this was not specified. Results: More than half (56%) of the cited studies did not specify if participants were notified of clinically relevant positive STI test results. The percentages were similar for low- and middle-income country populations (57%) and high-income country populations (53%). Conclusions: The absence of documentation of the provision of test results raises the possibility that in some instances, results may not have been communicated, with potential negative effects for participants, their sexual partners, and newborns. From an ethical perspective, clinically relevant results should be returned to study participants and treating clinicians in a timely fashion to ensure appropriate management of identified infections. Study authors should document if they returned test results to study participants and report on numbers lost to follow-up. (shrink)

Human papillomavirus (HPV) is one of the most common sexually transmitted infections. It is a leading cause of cervical cancer in women but the virus is increasingly being linked to several other cancers in men and women alike. Since the introduction of safe and effective but also expensive vaccines, many developed countries have implemented selective vaccination programs for girls. Some however argue that these programs should be expanded to include boys, since (1) HPV constitutes non-negligible health risks for (...) boys as well and (2) protected boys will indirectly also protect girls. In this paper we approach this discussion from an ethical perspective. First, on which moral grounds can one justify not reimbursing vaccination for the male sex? We develop an ethical framework to evaluate selective vaccination programs and conclude that, in the case of HPV, efficiency needs to be balanced against non-stigmatization, non-discrimination and justice. Second, if vaccination programs were to be expanded to boys as well, do the latter then also have a moral duty to become immunized? Two arguments in favor of such a moral duty are well known in vaccination ethics: the duty not to harm others and to contribute to the public good of public health. However, we argue that these are not particularly convincing in the context of HPV. In contrast, we believe a third, more powerful but also more controversial argument is possible. In our view, the sexual mode of transmission of HPV constitutes an additional reason to believe that boys in fact may have a moral obligation to accept vaccination. (shrink)

Sexually transmitted infections (STIs) are socially constructed as more ‘dirty’ than other gynaecological conditions. This article analyses women’s accounts of interactions with clinicians, subsequent to a diagnosis of genital herpes simplex virus or human papilloma virus. Women conceptualised consultations as a ‘moral event,’ different from other consultations. This moral component is highlighted drawing on Foucault’s notion of ‘the confessional.’ Additionally, Douglas’ anthropological construction of ‘dirt’ is used to consider why these consultations are ‘confessional’ experiences. Email interviews were conducted (...) with 26 women diagnosed with a viral STI and 12 sexual health clinicians. Data were analysed thematically using a feminist, poststructuralist approach. Findings indicated that discourses of morality shape sexual health consultations. Five themes were identified in relation to the moral ‘work’ in clinical consultations about a viral STI diagnosis: the particular ‘dirtiness’ of viral STIs, clinicians as moral agents, the ‘non‐judgmental’ clinician, women juggling truth‐telling and risk and clinicians prescribing moral work. Clinicians support and educate women more effectively if they recognise subjective, moral aspects of sexual health consultations rather than assuming that effective clinical teaching is rational, scientific and non‐judgmental. (shrink)

Introducción: El embarazo, aborto, las infecciones de transmisión sexual incluido el Virus de Inmuno Deficiencia Humana, se han convertido en problemas sanitarios de mayor vulnerabilidad en jóvenes. Objetivo: Describir las conductas de riesgo y prevalencia de problemas sexuales y reproductivos de estudiantes universitarios. Método: Investigación descriptiva, el universo estuvo constituido por alumnos de dos grupos de segundo semestre; el grupo de estudio conformado por la totalidad de estudiantes de la Facultad de Salud Pública ; y el control seleccionado mediante una (...) muestra aleatoria de estudiantes del resto de las facultades, se realizó esta selección con el propósito de valorar la homogeneidad de las variables entre los grupos. Resultados: Existe homogeneidad en la mayoría de conductas de riesgo y problemas sexuales en los grupos, en consecuencia estas variables no están influenciadas por la pertenencia a la Facultad de Salud Pública. Se evidencian conductas de riesgo como: inicio temprano de relaciones sexuales, múltiples parejas, infidelidad, relaciones sexuales ligadas al consumo de sustancias, dificultades con el uso de métodos anticonceptivos o de protección; se encontró prevalencia de problemas como: experiencia de embarazos, la mayoría no planeados, abortos inducidos y presencia de infecciones de transmisión sexual. Conclusiones: Existe vulnerabilidad en la salud sexual y reproductiva de los jóvenes universitarios independientemente de la formación que reciben, por tanto, emerge la necesidad de buscar alternativas integrales de promoción, prevención y educación sexual integral. Introduction: Pregnancy, abortion, sexually transmitted infections including Human Immunodeficiency Virus, have become a health problem of more vulnerable in young people. Objective: To describe risk behaviors and prevalence of sexual and reproductive problems of university. Method: Descriptive study, the universe consisted of students from two groups of second semester; the study group is conformed by students of the Public Health Faculty ; and control selected by a random sample of students from other faculties, in order to assess the homogeneity of the variables between groups. Results: Homogeneity exists in most risk behaviors and sexual problems in groups, therefore these variables are not influenced by membership in the Public Health Faculty. Risk behaviors as evidence: early initiation of sexual activity, multiple partners, infidelity, sexual relationship linked to substance consumption, which prevails alcohol, together with the non-use or inappropriate use of contraception or protection; experience of pregnancy, most unplanned, induced abortions and the presence of sexually transmitted infections: prevalence of problems as found. Conclusions: There is vulnerability in sexual and reproductive health of young students regardless of their training, thus emerges the need to find alternatives comprehensive promotion, prevention and comprehensive sex education. (shrink)

Human immunodeficiency virus and other sexually transmitted infections significantly burden youth 13–24 years of age in the United States. Directly engaging youth in sexual health research is a public health priority and urgently needed to develop targeted, youth-friendly, and culturally relevant HIV/sti prevention interventions. Controversies arise, however, regarding informed assent and consent, parental permission or consent, and the definition of “child”/“minor” as it relates to medical, legal, and ethical issues. In this article, we describe challenges in the human (...) subjects review processes that were undertaken before beginning an HIV/sti prevention research project with sexually active youth in an urban setting. These findings provide important contextual information to facilitate youth sexual health research and care, and Institutional Review Board approval processes with fewer delays. (shrink)

Some of the causes of the 'sexual revolution' during the past few decades are widely known: The development of relatively safe and reliable contraceptives, especially the birth-control pill; the 'morning after' pill; antibiotics to relieve or cure sexually transmitted diseases such as gonorrhea, herpes, and syphilis; the increased social acceptance of pre-marital sex, homosexuality, and other behaviors that formerly were considered deviant; and the legalization of abortion as the ultimate 'contraceptive'. But little attention has been paid to two (...) rather cerebral factors relevant to these developments – namely, ethical theories, and theories of overpopulation. In this paper I will argue that these two less well-known and more subtle factors have been at least as powerful as the more obvious factors mentioned above, in bringing about sea-changes in sexual mores. More specifically, I will argue that some implicit approaches to ethical theory are more conducive than others to bringing about the present status quo in sexual mores, and that the widespread belief in world overpopulation has not only changed the moral climate regarding sexuality, but has helped to redefine what is moral and what is immoral. (shrink)

Interventions to decrease acquisition and transmission of sexually transmitted diseases among African American women using text messages versus small-group delivery modalities pose distinct research risks and benefits. Determining the relative risk–benefit ratio of studies using these different modalities has relied on the expertise of investigators and their institutional review boards. In this study, African American women participated in focus groups and surveys to elicit and compare risks and benefits inherent in these two intervention delivery modalities, focusing on issues (...) such as convenience, privacy, and stigma of participation. Some risk/benefit variables were implicated in willingness to participate the two intervention modalities. (shrink)

Historical progress has largely been described in terms of the power to order social and ecological realities according to the interests of a few. Their concepts, images, and metaphors have transmitted knowledge (both explicit and tacit) that has come to be regarded as received wisdom. This kind of power, which has shaped (as well as described) history, has belonged primarily to men; whereas women's nature and, accordingly, their power have been defined primarily in terms of sexuality. Men's control of (...) women's sexuality is therefore the source of the disqualification of women as free agents‐that is, as significant participants in, say, scientific and religious meaning‐giving processes. Thus morality requires reevaluation of our assumptions about human nature. Most importantly, it demands that female sexuality be considered within the context of rationality and spirituality. (shrink)

Using the threat of a severe AIDS epidemic in a collection of rural villages in South Africa, we illustrate how men and women reconsider gendered sexualities through conversations and interactions in everyday life. We draw from data collected by local ethnographers and focus on the processes through which men and women collectively respond to the threat posed by AIDS to relationships, families, and communities. Whereas previous research has shown that individuals often reaffirm hegemonic norms about gender and sexuality in response (...) to disruptions to heteronormative gender relations, we find that the threat of AIDS provokes reconsideration of gendered sexualities at the community level. That is, our data demonstrate how men and women—through the interactions and exchanges that make up their daily lives—debate, challenge, make sense of, and attempt to come to terms with social norms circumscribing gendered sexual practices in a context where the threat of a fatal disease transmitted through sex looms large. We argue that ethnographic data are particularly useful for capturing communal responses to events that threaten heteronormative gender relations and reflect on how our findings inform theories of gender relations and processes. (shrink)

Most mathematical models used to examine the role of different stages of human immunodeficiency virus infection unrealistically assume that HIV is transmitted through one-off contacts or that transmission rates are the same between males and females. We sought to examine whether inferences from previous models are robust to the relaxation of those unrealistic assumptions. We developed a model of HIV transmissions through sexual partnerships assuming that sexual partnerships have variable duration, sexual partnerships are concurrent, and the male-to-female transmission rate (...) is higher than the female-to-male transmission rate, with a focus on the third assumption. Assuming a higher rate for male-to-female than female-to-male transmissions decreases the overall transmission of HIV but increases the equilibrium fraction of transmissions during primary HIV infection in long-term partnerships, compared to the case where transmission rates are assumed to be symmetric between males an females. Previous modeling studies that assume symmetric transmission rates between males and females may have overestimated the overall spread of HIV, but underestimated the relative contribution of PHI. To make robust inferences on the role of different stages of HIV infection in the sexual spread of HIV, models should take into account that transmission rates may be asymmetric by sex. (shrink)

Why the DNA‐containing organelles, chloroplasts, and mitochondria, are inherited maternally is a long standing and unsolved question. However, recent years have seen a paradigm shift, in that the absoluteness of uniparental inheritance is increasingly questioned. Here, we review the field and propose a unifying model for organelle inheritance. We argue that the predominance of the maternal mode is a result of higher mutational load in the paternal gamete. Uniparental inheritance evolved from relaxed organelle inheritance patterns because it avoids the spread (...) of selfish cytoplasmic elements. However, on evolutionary timescales, uniparentally inherited organelles are susceptible to mutational meltdown (Muller's ratchet). To prevent this, fall‐back to relaxed inheritance patterns occurs, allowing low levels of sexual organelle recombination. Since sexual organelle recombination is insufficient to mitigate the effects of selfish cytoplasmic elements, various mechanisms for uniparental inheritance then evolve again independently. Organelle inheritance must therefore be seen as an evolutionary unstable trait, with a strong general bias to the uniparental, maternal, mode. (shrink)

This article makes a conceptual contribution to the broader literature on unfree labour by challenging the separate treatment of sexual and industrial labour exploitation both by researchers and in law and policy. This article argues that the prevailing focus of the supply chain literature on industrial labour has inadvertently posited sexual labour as the ‘other’ of industrial labour thus obfuscating how the legal blurring of boundaries between industrial and service labour is engendering new modalities of the erosion of workers’ rights (...) that are increasingly resembling those typical of sex work. This article advances the debate on unfree labour both conceptually and empirically. Conceptually, it highlights the relevance of social reproduction in understanding forms of labour unfreedom. Empirically, it demonstrates the similarities in forms of control and exploitation between sex work and industrial work by illustrating how debt and housing operate in both settings. (shrink)

Syphilis is a bacterial sexually transmitted disease (STD), whose main route of infection is through sexual contact. In order to diagnose syphilis, Treponema pallidum must be detected in the material sampled from a lesion and a blood test must be performed in order to detect serological response to syphilis. Since 1946, a statutory obligation to report all cases of syphilis has been in force in Poland, which is why data concerning the incidence is available. The aim of this (...) paper is to analyse trends in syphilis incidence in the years 1950–2017 using Joinpoint Regression and to present the impact of prophylaxis and education of society on syphilis prevention. The Joinpoint Regression method indicated the splitting time points of the trend corresponding to real changes in incidence, which corroborates the purpose of using the method in question in epidemiological studies. (shrink)

The sexually transmitted disease known as “The French Pox,” a forerunner of modern syphilis, represented a significant departure from early modern European knowledge of disease. Particularly distinctive was the gendered nature of the disease; females were labeled responsible for the formation of disease and thus associated with the moral corruption of the pox. This article examines the roots of this societal sexism in the Christian Pauline theory, using the binary between male and female to appreciate the development of (...) the pox and the social differentiation that occurred as a result of its contagion. (shrink)

This paper explores the ethical considerations surrounding human papillomavirus (HPV) vaccination for adolescents in three special circumstances: a) the preadolescent/adolescent vaccination target population; b) the sexually transmitted nature of the virus; and c) the delay in boys’ vaccination recommendations as compared to initial girls’ recommendations. Examining the gendered components of the HPV vaccine, medical consent, and assent for minors; the changing relationship between medical providers and patients; and the tension between individual and public health, I conclude that, in (...) most cases, parents are ethically required to choose vaccination for their children. (shrink)

There currently is sufficient scientific evidence directly linking acquisition, exposure and prevalence of the human papillomavirus to cervical cancer. The article addresses HPV in women by taking NaProTechnology into account, which makes it posible to combine scientific evidence with ethical approaches. It looks at both the biological aspect of sexuality and the ability to become a person within one’s sexual nucleus. There is an analysis of sex education programs based on preventive health and on the anthropology of sexuality, and supported (...) by family institutions, that have demonstrated better acceptance in dealing with the risk of sexually transmitted diseases, including HPV infection. (shrink)

© 2014 Taylor Francis. The Centers for Disease Control and Prevention recommends routine human immunodeficiency virus testing of every client presenting for services in venues where HIV prevalence is high. Because older adults have particularly poor prognosis if they receive their diagnosis late in the course of HIV disease, any screening provided to younger adults in these venues should also be provided to older adults. We examined aging-related disparities in recent and ever HIV testing in a probability sample of at-risk (...) adults seeking services in needle exchange sites, sexually transmitted disease clinics, and Latino community clinics that provide HIV testing. Using multiple logistic regression with generalized estimating equations, we estimated associations between age category and each HIV testing outcome. Even after controlling for covariates such as recent injection drug use, older adults had 40% lower odds than younger adults did of having tested in the past 12 months or ever. Aging-related disparities in HIV testing exist among clients of these high HIV prevalence venues and may contribute to known aging-related disparities in late diagnosis of HIV infection and poor long-term prognosis. (shrink)

This study investigated Belgian and Dutch parental opinions on confidentiality and consent regarding medical decisions about adolescents. Through an online survey, we presented six cases (three on confidentiality, and three on consent) to 1,382 Belgian and Dutch parents. We studied patterns in parental confidentiality and consent preferences across and between cases through binomial logistic regressions and latent class analysis. Participants often grant the right to consent for a treatment to the adolescent, but the majority diverges from the adolescent’s preferences regarding (...) confidentiality. More educated participants would rather not be informed about cases regarding a sexually transmitted disease or depression than lower educated participants. Further analysis shows that participants’ preferences correspond to authoritative (47%), permissive (30%) and authoritarian (17%) parenting styles. Belgian and Dutch parents are willing to grant some degree of autonomy, but they want to be informed about specific health issues. Parental views on confidentiality and granting consent appear to mirror existing parenting styles. (shrink)

Cohabiting has been associated with a number of problems including sexually transmitted diseases and HIV and AIDS, abortions, sexual abuse and violence, low academic performance, increased cost of medical care and unwanted pregnancies. However, there is little documented information on the extent and the factors influencing cohabitation among the youth and especially among tertiary education students. This study therefore sought to fill this gap by investigating factors that lead to the prevalence and practice of cohabitation by tertiary education (...) students. The research adopted the interpretivist philosophy. The qualitative research methodology was employed in order to understand in greater detail the behaviors, attitudes, opinions, and beliefs of the respondents on cohabitation among tertiary education students. The study used the survey research design. Primary research was conducted using questionnaire surveys that were administered to tertiary education students who participated at the Tertiary Education Sports Association of Zimbabwe in July 2016. There were 100 questionnaires distributed and 78 questionnaires were returned making 78% response rate. The respondents were randomly sampled to participate in the study. The study reflects that cohabitation among the Tertiary education students is quite common. The study noted that it is mostly caused by lack of accommodation, problems with roommates, lack of privacy and the need to be close and intimate with one's lover. In results cohabitation exposes students to premarital sex and other consequences such as unwanted pregnancies, abortion, complications and sexually transmitted infections. The study recommends that tertiary education students should be enlightened during orientations about the dangers of cohabitation. Parents should be encouraged to visit their children and find where and whom they live with while in school. (shrink)

Teenagers enjoy better physical and mental health when they avoid early sexual debut and reserve the sexual act for marriage. Teens who initiate sexual relations outside of marriage risk contracting sexually transmitted diseases, and those who also use hormonal contraception to avoid pregnancy often suffer unwanted physical and emotional side effects. Teens who have multiple partners may have later attachment or bonding difficulties. The consequences of an unintended pregnancy after a casual sexual relationship are often abortion or single (...) motherhood and an increased likelihood of poverty. Teenagers who save sexual relations for marriage experience freedom from these negative consequences and are more likely, in marriage, to experience the beauty of self-giving love. (shrink)

Health professionals, by agreeing to provide care, accept a fiduciary role that entails an obligation to preserve trust. We trust health professionals to be competent, to promote patient interests, and to properly utilize their discretionary power. While some health professionals argue that such activities as secretly screening for drugs or sexually transmitted diseases are necessary to fulfill their fiduciary obligations, these may actually constitute a breach of trust. In this paper, I argue that, in the specific case of (...) Munchausen’s Syndrome by Proxy, covert surveillance is ethically justifiable and does not constitute a breach of trust and an abuse of the fiduciary relationship. (shrink)

The article is dedicated to the issues of physical, infectious and mental health of Ukrainian students in the 1920-th years, and analyzes the factors that directly make worse this condition. Separately we explore issues of power to prevent sexually transmitted epidemics, epidemics of typhoid, tuberculosis and other diseases. We also study such factors that have caused students' diseases as housing insecurity, lack of funds for the existence and complete lack of moral prohibitions- because of a radical change in (...) the value of personality after the revolution and the civil war. (shrink)

ABSTRACTThis article examines the way in which some biomedical ethicists have constructed sexually transmitted AIDS as a significant threat to women's health. We demonstrate that the familiar claim that‘women are the fastest growing group'— whether of HIV‐infected or of AIDS patients — is misleading because it obscures the distinction between proportional rate of growth and absolute increase. Feminist ethicists have suggested that misogyny of a male dominated health care system has led to underreporting of women AIDS cases in (...) order to support these feminists’claim of AIDS being a real threat to women's health. Given the apparent rarity of tertiary transmissions of AIDS, the assertion that most or even many women are at significant risk for AIDS seem wrong. Particularly disturbing in this campaign is the fact that the theme of‘risky sex’has been extended all the way to lesbians, even though their risk to acquire AIDS sexually is non‐existent to minuscule. We argue that actual harm is done to women by this exaggeration of their risk of contracting AIDS sexually. The scare has led to misappropriations of scarce health care funds. AIDS disproportionately affects women who inject drugs, and who suffer other diseases, poverty and malnutrition. It would have been better to concentrate health care efforts in this area instead of‘educating’women not at risk for AIDS how to prevent the acquisition of this disease. Unjustifiable AIDS anxiety has been created in women and has resulted in millions of unnecessary HIV‐tests, and many broken relationships. This anxiety has inevitably reduced the pleasure of having sex for many women. We reject the kind of‘victim ideology’that lies at the heart of this strategy which has, unfortunately, been supported by a number of influential feminist ethicists. (shrink)

Over the past two decades, the epidemic of HIV/AIDS has challenged the public health community to fundamentally rethink the framework for preventing infectious diseases. While much progress has been made on the biomedical front in treatments for HIV infection, prevention still relies on behaviour change. This book documents and explains the remarkable breakthroughs in behavioural research design that have emerged to confront this new challenge: the study of partnership networks.Traditionally, public health research focused on the "knowledge, attitudes, and practices " (...) of individuals, an approach designed for understanding health-related behaviour like seat-belt wearing and cigarette smoking. For HIV and other sexually transmitted infections, however, there are at least two people involved in transmission. This may not seem like a big difference, but in fact it changes everything. First, it means that your risk depends on your partners -- and on their partners, and their partners: it depends on your position in the network of partnerships. Consider, for example, the rise of infections among monogamous women. Second, it means that individuals are not free to simply change their behaviour -- condom use, or abstinence, needs to be negotiated with a partner. both the epidemiology of risk and constraints to behaviour are therefore a function of the partnership network. And our ability to design effective prevention strategies depends on our ability to measure and summarize that network. Using the traditional research designs, you would not see this network at all -- you would only see the unconnected nodes. They key to solving this problem lies in Network Analysis, before now a relatively obscure subfield in Sociology.For empirical studies of networks to become feasible, however, many problems had to be solved. This book documents the rapid progress that has been made. It brings together eight pioneering studies that have sought to map the networks that spread infection around the world. Each chapter reviews the questions that drove the study, the changes in methodology that were needed to implement the network survey, the mistakes and successes encountered, and the central findings that the network design made possible. An introduction provides an overview of network survey design, a glossary provides a summary of network terminology, and example questionnaires from each study provide a template for further research. This is a unique and valuable resource for the international public health research community. (shrink)

Academics and professionals working with young women face a series of paradoxes. Over the last 20 years, the lives of young women in the UK and Europe have been transformed. They have gained considerable freedom and independence, but at the very same time, new, less tangible forms of constraint and subordination now play a defining role in the formation of their everyday subjectivities and identities. Young women have come to exemplify the pervasive sensibility of self-responsibility and self-organisation. This new ‘gender (...) regime’ demands both conceptualisation and practical response, drawing on educational research, social and cultural theory, and contemporary feminist thought. Within the overarching theme of pedagogical responses to these trends, through work in schools and within young women’s online and face-to-face communities, this book interrogates the field of sexuality and its visualisation across new and old media in the context of often predictable and endemic ‘moral panics’ about teenage pregnancy rates, sexually transmitted diseases, and internet pornography. In exploring how girls and young women respond to increasing expectations of them as the vanguard of economic, social, and cultural change, contributors to this volume interrogate the ways in which social and educational aspiration interact with young women’s developing and embodied identities. This book was originally published as a special issue of _Pedagogy, Culture and Society. _. (shrink)

The implementation of pre-exposure prophylaxis (PrEP) as a new tool for prevention against HIV raised particular ethical concerns regarding the individuals’ and the collective's best interests in France. It was questioned whether the beneficence of taking or prescribing PrEP regarding its high efficacy to protect people from HIV is always more important than the maleficence represented by the risks involved, such as healthy people taking a pill with side effects, the growth of sexually transmitted infections or the potential (...) generalization of risk-taking sexual behaviour. The main objective of this study was to explore patients’ and health professionals’ ethical questioning on PrEP. Sixty-nine qualitative interviews were conducted with 45 users and 24 healthcare professionals. Overall, this study shows that those primarily concerned by PrEP tend to dismiss ethical questions regarding PrEP itself in the name of its efficacy and the empowerment it allows, but they would rather stress the impact PrEP can have on individuals’ sexual behaviour and how it can affect their autonomy if it is prescribed blindly without taking into consideration the specific living context and life history of each PrEP user. (shrink)

Human Papilloma Virus (HPV) infection causes death of 270,000 people die from every year. Sexually transmitted HPV was found one of the major causes of cervical cancer. World Health Organization (WHO). Cervical cancer (CC) is one of the top five cancers that affect women around the world. In June 2006, the Food and Drug Administration (FDA) approved a new vaccine for women, Gardasil, produced by the pharmaceutical company Merck that protects against infection by certain strains of HPV, including (...) the two strains that cause most cases of cervical cancer. Vaccinations are counted as one of public health’s important development but there is an ethical dilemma between balancing personal autonomy and protection of the entire at risk population. The vaccine caused very few side effects like local reactions whereas signs or symptoms of greater importance were very. Moreover it was considered that the vaccine is has an efficacy of practically 100% in prevention of precancerous lesion caused by the viral genotypes included in the vaccine. Bioethicists were not convinced about compulsory vaccination laws as the values of patient autonomy and informed consent to be preeminent to them. Not surprisingly, some have expressed wariness about or opposition to mandating HPV vaccination. A critical question is whether achieving a higher level of coverage justifies the infringement on parental autonomy that compulsory vaccination inevitably entails. Recommendation of the universal vaccination of girls and young women may evolve ethical challenges which might make it difficult for smooth implementation of the vaccination campaigns. Review of the ethical issues in HPV vaccination will constitute the main part of our paper. (shrink)

In the USA, there are missed opportunities to diagnose hepatitis C virus (HCV) in pregnancy because screening is currently risk-stratified and thus primarily limited to individuals who disclose history of injection drug use or sexually transmitted infection risks. Over the past decade, the opioid epidemic has dramatically increased incidence of HCV and a feasible, well-tolerated cure was introduced. Considering these developments, recent evidence suggests universal HCV screening in pregnancy would be cost-effective and several professional organisations have called for (...) updated national policy. Historically, universal screening has been financially disincentivised on the healthcare system level, particularly since new diagnoses may generate an obligation to provide expensive treatments to a population largely reliant on public health resources. Here, we provide ethical arguments supporting universal HCV screening in pregnancy grounded in obligations to respect for persons, beneficence and justice. First, universal prenatal HCV screening respects pregnant women as persons by promoting their long-term health outside of pregnancy. Additionally, universal screening would optimise health outcomes within current treatment guidelines and may support research on treatment during pregnancy. Finally, universal screening would avoid potential harms of risk-stratifying pregnant women by highly stigmatised substance use and sexual behaviours. (shrink)

The passing on of information to GPs by genito-urinary doctors is to be encouraged but is not always possible and ultimately the patient's wishes and confidentiality must be respected if sexually transmitted diseases and HIV infection are to be controlled. Infected health-care workers should seek counselling and medical support and clear guidelines from professional organisations which are in existence. However, they will only do so if strict confidentiality is maintained and assurance about future employment can be given.

This issue of the Kennedy Institute of Ethics Journal contains a couple of papers that may be difficult to read for some: one concerning the sexual violation of young Black boys and one on the Guatemalans who were intentionally infected with sexually transmitted diseases and sexually abused in the hands of the United States government and other US-based institutions. I’m honored and proud to be publishing these papers in the journal; both dive headfirst into formidably painful topics (...) of enormous social and ethical importance. However, readers should understand before reading these papers that they contain descriptions of sexual violation within relationships of gross power inequality... (shrink)

Neisseria gonorrhoeae, the bacterium that causes the sexually transmitted disease gonorrhea, demonstrates extensive antigenic heterogeneity in its surface components. The organism has the capacity to switch on and off the synthesis of different versions of components such as pili, outer membrane proteins, and lipopolysaccharide. Recent studies have shown that the gonococcus uses novel and complex mechanisms, of types not described previously, to store different versions of genetic information for surface proteins, and to regulate expression of those genes.

The ability of adolescents to access safe and effective new products for HIV prevention and treatment is optimised by adolescent licensure at the same time these products are approved and marketed for adults. Many adolescent product development programmes for HIV prevention or treatment products may proceed simultaneously with adult phase III development programmes. Appropriately implemented, this strategy is not expected to delay licensure as information regarding product efficacy can often be extrapolated from adults to adolescents, and pharmacokinetic properties of drugs (...) in adolescents are expected to be similar to those in adults. Finally, adolescents enrolled in therapeutic HIV prevention and treatment research can be considered adults, based on US Food and Drug Administration regulations and the appropriate application of state law. The FDA permits local jurisdictions to apply state and local HIV/sexually transmitted infection minor treatment laws so that adolescents who are HIV-positive or at risk of contracting HIV may be enrolled in therapeutic or prevention trials without obtaining parental permission. (shrink)

The Islamic government of Iran recently passed and announced a new law titled “Rejuvenation of the Population and Protection of the Family.” This legislation is a noteworthy example of biopolitics‐influenced biolaw. In terms of abortion, contraception, prenatal screening, and population control, this law clearly contrasts with women's fundamental rights and freedoms and has significant health‐related consequences for different sectors of the population. A historical review of the population policies of the Islamic Republic of Iran shows the occurrence of multiple abrupt (...) and radical changes in such policies over the past four decades. This new law, promoted by religious biopolitics, is the most recent example, and places stringent limits on abortion. According to it, all decisions concerning abortion must be made in courts rather than in health clinics. Such courts are typically presided over by male religious scholars. This law also limits prenatal screening to the degree that will increase the rate of genetic defects, especially in the population's lower socioeconomic strata. By strictly limiting access to contraception, this law will increase the rate of unwanted pregnancies and sexually transmitted diseases. This paper argues that such an influence of biopolitics on biolaw contrasts with the principles of bioethics. Still, Iran's current institution of bioethics cannot address it effectively. Therefore, a new model of interaction between bioethics, biopolitics, and biolaw is needed to prevent the detrimental consequences of such pieces of legislation. Such a paradigm shift is demanded by the current “Woman, Life, Freedom” movement of the Iranian people. (shrink)

The term “exceptionalism” was introduced into health care in 1991 when Bayer described “HIV exceptionalism” as the policy of treating the human immunodeficiency virus different from other infectious diseases, particularly other sexually transmitted diseases. It was reflected in the following practices: pre- and post-HIV test counseling, the development of specific separate consent forms for HIV testing, and stringent requirements for confidentiality of HIV test results. The justification for these practices was the belief that testing was essential for prevention (...) and that patients might not seek HIV testing if confidentiality were not guaranteed. Confidentiality was believed to be particularly important given the degree of discrimination and stigmatization associated with the illness. Anonymous testing was a further step in ensuring strict confidentiality, even though such a practice prevented public officials from contacting partners and others who were at risk. (shrink)

Criminal law is one of the regulatory tools being used in the United States to influence risk behavior by people who have HIV/AIDS. Several different types of laws have been or could be used in this way These include:HIV-specific exposure and transmission laws — i.e., laws that explicitly mention and exclusively apply to conduct by people with HIV;public health statutes prohibiting conduct that would expose others to communicable diseases and/or sexually transmitted diseases ; andgeneral criminal laws governing attempted (...) murder and assault. (shrink)