At the end of the 1990s, Brazil was faced with a potentially explosive HIV/AIDS epidemic. Through an innovative and multifaceted campaign, and despite initial resistance from multinational pharmaceutical companies, the government of Brazil was able to negotiate price reductions for HIV medications and develop local production capacity, thereby averting a public health disaster. Using interview data and document analysis, the authors show that the exercise of corporate social responsibility can be viewed in practice as a dynamic negotiation and an (...) interaction between multiple actors. Action undertaken in terms of voluntary CSR alone may be insufficient. This finding highlights the importance of a strong role for national governments and international organizations to pressure companies to perform better. (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 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)

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)

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)

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)

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)

The bitter, public contest for priority over the discovery of the virus that causes AIDS was officially closed in 1987 with equal credit being awarded to two parties from opposite sides of the Atlantic. One was led by Robert C. Gallo of the Laboratory of Tumor Cell Biology at the National Cancer Institute in the United States and the other was led by Luc Montagnier of the viral-oncology unit at the Pasteur Institute in France. Using citation counts from articles (...) published by the scientific community, a process of alloca tion of credit is examined and compared with this official settlement. A novel pattern emerges. It is found that the scientific community began to redistribute priority when the dispute became highly publicized and took little notice of the official settlement. This, along with the fact that Gallo has now officially been charged with misconduct by an investigative committee, may mean that Montagnier's team may eventually receive sole creditfor the discovery of the AIDS virus. The importance of examining priority disputes from many different angles and the potential for citation analysis in such cases are highlighted. (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)

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)

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...

Research that is initiated, designed or funded by sponsor agencies based in countries with relatively high social and economic development, and conducted in countries that are relatively less developed, gives rise to many important ethical challenges. Although clinical trials of HIV vaccines began ten years ago in the US and Europe, an increasing number of trials are now being conducted or planned in other countries, including several that are considered “developing” countries. Safeguarding the rights and welfare of individuals participating as (...) research subjects in developing countries is a priority. In September, 1997, the Joint United Nations Programme on HIV/AIDS embarked on a process of international consultation; its purpose was further to define the important ethical issues and to formulate guidance that might facilitate the ethical design and conduct of HIV vaccine trials in international contexts. This paper summarises the major outcomes of the UNAIDS consultative process. (shrink)

This article analyzes narratives about living with HIV/ AIDS amid stigma, using the notion of “fragile stories” to further detail the linguistic practices through which people narrate experiences in danger of not being told. The article is based on fieldwork in 2008 in Durban, South Africa with a Zulu gospel choir in which all group members are living with HIV/AIDS. Close analysis of recorded narratives demonstrates how institutional story frameworks and the normative performance of gender helped storytellers to (...) breach boundaries drawn by stigma. The article consolidates research on narrative tellability and fragile stories, verbal art, and stigma. The article has implications for research amid stigma, advocating linguistic analysis of narrative to emphasize the relationship between stories told and life events involving stigmatization. (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)

I defend a certain claim about rationing in the context of HIV/AIDS, namely, the 'priority thesis' that the state of a developing country with a high rate of HIV should provide highly active anti-retroviral treatment (HAART) to those who would die without it, even if doing so would require not treating most other life-threatening diseases. More specifically, I defend the priority thesis in a negative way, by refuting two influential and important arguments against it inspired by the Kantian principle (...) of respect for persons. The 'equality argument' more or less maintains that prioritizing treatment for HIV/AIDS would objectionably treat those who suffer from it as more important than those who do not. The 'responsibility argument' says, roughly, that to ration life-saving treatment by prioritizing those with HIV would wrongly fail to hold people responsible for their actions, since most people infected with HIV could have avoided the foreseeable harm of infection. While it appears that a Kantian must think that one of these two arguments is sound, I maintain that, in fact, respect for persons grounds neither the equality nor responsibility argument against prioritizing HAART and hence at least permits doing so. If this negative defence of the priority thesis succeeds, then conceptual space is opened up for the possibility that respect for persons requires prioritizing HAART, which argument I sketch in the conclusion as something to articulate and defend in future work. (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 study aims to describe and compare nurses' willingness to provide care for patients with HIV/AIDS and factors associated with this in three countries. An international cross-sectional survey was conducted among nurses working in medical, surgical and gynaecology units in Finland (n =427), Estonia (n =221) and Lithuania ( n =185) in early 2006. The response rates were 75% (n = 322) in Finland, 54% (n =119) in Estonia and 86% (n = 160) in Lithuania. A modified version of (...) a scale developed in 1994 by Dubbert et al. was applied. Our findings showed a general willingness of the nurse participants to provide care for patients with HIV/AIDS. However, this willingness varied both among and within countries and was also related to specific nursing interventions. The results underline the importance of providing education on ethical issues related to HIV/AIDS care in Europe and tailoring the content of this education to meet nurses' national educational needs. (shrink)

Ong, Caroline There was once a strong belief amongst global HIV/AIDS organisations that the key to the prevention of the sexual transmission of HIV was condom use. Other measures such as abstinence and being loyal to one partner were seen as beneficial, but secondary. Thirty years later, the evidence is mounting that behavioural change is much more effective in halting the spread of HIV than condoms.

The HIV/AIDS epidemic is increasingly a diseaseof the disadvantaged, a destroyer of nations,and a threat to global security and well-being.But this need not be so: the world has thescientific knowledge, technologicalinnovations, and financial resources tosignificantly reduce the spread and sufferingcaused by the disease. This paper argues thatthe wealthy nations of the world, led by theUnited States, have a moral obligation to offermuch greater assistance to developing countrieswhere the epidemic is most severe. UsingZimbabwe as a case study, this essay examinesthe (...) immediate and underlying factors behind theepidemic in order to make realistic andaffordable policy recommendations that includenew investments in global health care, debtrelief, and long-term economic development. Bydemonstrating our ability to dramaticallyaffect the future course and consequences ofthis unprecedented epidemic, the paperconcludes that greater action is not only inthe interest of public health, but is also amoral imperative. By investing the necessaryresources to improve public health and toreduce global poverty, we promote and extendthe fundamental rights and values that weprofess to hold dear. (shrink)

While it is well-established that poverty and disease are intimately connected, the nature of this connection and the role of poverty in disease causation remains contested in scientific and social studies of disease. Using the case of HIV/AIDS in South Africa and drawing on a theoretically grounded analysis, this paper reconceptualises disease and poverty as ontologically entangled. In the context of the South African HIV epidemic, this rethinking of the poverty-disease dynamic enables an account of how social forces such (...) as poverty become embodied in the very substance of disease to produce ontologies of HIV/AIDS unique to South Africa. (shrink)

With the increasing number of people living with HIV/AIDS and the escalating costs of health care, there is an increasing demand for informal caregiving in the community. Currently, much emphasis is placed on individuals who are living with HIV/AIDS (in terms of the provision of social, psychological and economic support), but very little attention has been paid to the well-being and quality of life of informal caregivers. Lack of support and care for caregivers may have a negative impact (...) on the quality of care and effective services for individuals living with HIV/AIDS. This paper is based on findings from a qualitative study that explored major sources of stress associated with caregiving among informal caregivers in a village in the southern part of Botswana. The paper suggests that informal caregivers are an integral part of the continuum of care. As a result, they need to be nurtured and supported for the betterment of those both infected and affected by HIV/AIDS. The paper concludes by discussing the implications for further research, policy and programme development. (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)

--Do patients have the right to know their physician's HIV status?-Can a dentist refuse treatment to an HIV-positive patient?-How do educators determine whether to allow an HIV-positive child to attend school, and if they do, should the parents of other children be informed?-Should a counselor break confidentiality by disclosing to a wife that her husband is infected with HIV?This collection of original essays carefully examines the difficult moral choices the AIDS pandemic has presented for many professionals-physicians, nurses, dentists, teachers (...) and school administrators, business managers, psychotherapists, lawyers, clergy, journalists, and politicians. In the workplace, problems posed by HIV and AIDS have led to a reexamination of traditional codes of ethics. Providing systematic and reasoned discussions, the authors explore the moral, legal, and ethical issues involved in the reconsideration of policies, standards of conduct, and the practicality of balancing personal and professional ethics. Author note: Elliot D. Cohen is Professor of Philosophy at Indian River Community College and Editor-in-Chief of the International Journal of Applied Philosophy.Michael Davis is Senior Research Associate at the Center for the Study of Ethics in Professions, Illinois Institute of Technology. (shrink)

BackgroundCommunity engagement in research is valuable for instrumental and intrinsic reasons. Despite existing guidance on how to ensure meaningful CE, much of what it takes to achieve this goal differs across settings. Considering the emerging trend towards mandating CE in many research studies, this study aimed at documenting how CE is conceptualized and implemented, and then providing context-specific guidance on how researchers and research regulators in Uganda could think about and manage CE in research.MethodsWe conducted qualitative interviews and focus group (...) discussions involving forty-one respondents who were experienced in HIV/aids biomedical research involving CE. Thirty-eight of these were directly or indirectly associated with Uganda’s leading research institution in the field of HIV/aids. They included Principal Investigators, Community Liaisons Officers, Research Ethics Committee members and Community Advisory Board Members. Three respondents were from Uganda National Council for Science and Technology. Data were collected between August 2019 and August 2020, using audio-taped focus group discussions and key informant interviews, transcribed and analyzed manually to generate themes and subthemes.ResultsThree major themes emerged: goals or value of CE; the means of CE, and, the evaluation of CE. Goals or value of CE generated four subthemes representing the overarching goals of CE: Promote communities’ agency; Generate and sustain trust; Protect and promote communities’ rights and interests; and, Help studies optimize participation in the form of enrolment and retention of participants. What usually comes under the nomenclatures of methods, strategies, and approaches of CE, such as town-hall meetings, sports events, drama, and the like, should simply be understood as the means of CE, and it is not desirable to hold pre-conceived and fixed ideas about the best means to conduct CE in research since a lot depend on the context. Finally, the study found that despite CE’s critical importance, which suggests the need to track and evaluate it, CE is currently intermittently evaluated, and for inadequate motivations.ConclusionsExisting guidance on how to conduct robust CE in research is no substitute for creativity, flexibility, and reflexivity on the part of both researchers and research regulators. (shrink)

In 1999, Médecins Sans Frontières set out to explore and demonstrate the feasibility of preventing and treating HIV/AIDS in a so-called resource-poor, economically and socially disadvantaged setting. The first MSF mission to incorporate antiretroviral treatment into its HIV-AIDS-oriented medical program was undertaken in Bangkok. The second project was launched in Khayelitsha where MSF has been providing ARV treatment for persons with HIV/AIDS since May 2001. Khayelitsha is an enclave of some 500,000 inhabitants, most of whom live in (...) corrugated-iron shacks, without running water or electricity. Unemployment is extremely high; crime and violence are rampant. The general prevalence of HIV/AIDS is 26%, measured among pregnant women. The tuberculosis incidence rate is one of the world's highest for open-space sites. Unsurprisingly, TB/HIV coinfection is very high too: 63% of those with TB are also infected with HIV. (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.

Background Universities in Cameroon are playing an active part in HIV/AIDS research and much of this research is carried out by students, usually for the purpose of a dissertation/thesis. Student theses/dissertations present research findings in a much more comprehensive manner and have been described as the stepping-stone of a budding scientist’s potential in becoming an independent researcher. It is therefore important to verify how students handle issues of research ethics. Method Theses/dissertations on HIV/AIDS that described research studies involving (...) the use of human research participants were screened to verify if research ethics approval and informed consent were obtained and documented. The contents of the consent forms were also qualitatively analyzed. Results Of 174 theses/dissertations on HIV, ethics approval was documented in 17 and informed consent in 77. Research ethics approval was first mentioned at all in 2002 and highly reported in the year 2007. Evidence of ethics approval was found for the first time in 2005 and informed consent first observed and evidenced in 1997. Ethics approval was mostly reported by students studying for an MD and was not reported in any Bachelors’ degree dissertation. Informed consent was also highly reported in MD theses followed by undergraduate theses. Voluntary participation and potential benefits of the study were some of the common aspects dealt with in most of the consent forms. The right to discontinue participation in the study and management of residual samples were scarcely ever mentioned. Conclusions Overall, and given the current state of the art of research ethics around the world, student-scientists in Cameroon would seem to be merely kidding with research ethics. It is thus essential that training in health research ethics be incorporated in the curriculum of universities in Cameroon in order that the next generation of scientists may be better equipped with thorough knowledge and practice of HRE. This, we believe, would be one way of fighting the occurrence of research scandals, which have not yet abated significantly, especially those arising from negligence or inexcusable ignorance. (shrink)

BackgroundThe issue of stigma is very important in the battle against HIV/aids in Africa since it may affect patient attendance at healthcare centres for obtaining antiretroviral medications and regular medical check-ups. Stigmatization creates an unnecessary culture of secrecy and silence based on ignorance and fear of victimization. This study was designed to determine if there is external stigmatization of people living with HIV and AIDS by health care workers at a tertiary hospital in KwaZulu-Natal province, South Africa. The (...) study investigated the impact of knowledge of HIV/aids by HCWs on treatment of patients, as well as the comfort level and attitude of HCWs when rendering care to PLWHA.MethodsA descriptive cross sectional study was designed to collect data using an anonymous self-administered structured questionnaire from 334 HCWs. The study was conducted in clinical departments of a large multidisciplinary 922-bed tertiary care teaching hospital in Durban, KZN.ResultsOverall HCWs had an above average knowledge about HIV/aids although some gaps in knowledge were identified. Tests of statistical significance showed that there was association between level of education and knowledge of HIV/aids ; occupation and knowledge of HIV/aids ; and gender and knowledge of HIV/aids. Test for comfort level was only significant for gender, with males showing more comfort and empathy when dealing with PLWHA. The study also revealed that patients were sometimes tested for HIV without informed consent before surgery, due to fear of being infected, and there was some gossiping about patients' HIV status by HCWs, thereby compromising patient confidentiality. The majority of HCWs showed a willingness to report incidents of stigmatization and discrimination to higher authorities, for better monitoring and control.ConclusionsAlthough knowledge, attitude and comfort level of HCWs taking care of PLWHA was above average, enforcement of existing antidiscrimination laws and continuing education in medical ethics and healthcare law, would greatly improve the performance of HCWs taking care of PLWHAs. More psychological support and counselling should be provided to HCWs, to further reduce the impact of stigmatization and discrimination against PLWHA. (shrink)

The aim of this article is to engage critically with feminist HIV/aids research from an ‘intersectional’ perspective. Focusing in particular on the work of Tamsin Wilton and Janet Holland et al., the article examines how ‘race’, ethnicity and class are theorized and conceptualized in this literature. Through a scrutiny of their empirical analyses, the article points to the pitfalls of a descriptive approach to ‘differences’ and problematizes Wilton's and Holland et al.'s theoretical focus on gender and sexuality. The benefit (...) of including a critical perspective on ‘race’ and ethnicity and other axes of domination is illustrated further using some empirical examples from the Swedish HIV/aids policy context. The article concludes by arguing that an intersectional perspective poses a challenge to feminist HIV/aids research that needs to be addressed in order to produce an effective sexual health policy. (shrink)

Se realizó una investigación cualitativa, durante noviembre de 2013 a noviembre de 2015 con el objetivo de mostrar un protocolo de salud como tecnología social para la promoción y prevención de las manifestaciones oftalmológicas en pacientes con VIH/sida. Se utilizaron métodos teóricos y empíricos los cuales permitieron conocer antecedentes del problema a investigar, realizar acciones y caracterizar el fenómeno en estudio. El protocolo constituye una tecnología social, debido a que está compuesto por normas y procedimientos para la conducción de un (...) proceso social no relacionado con la esfera productiva. El diseño de esta tecnología social propicia un adecuado diagnóstico, tratamiento y seguimiento de las enfermedades oculares en pacientes con VIH/sida, sustentado en la teoría del conocimiento. A qualitative investigation was carried out during November 2013 to November 2015 with the objective of developing a protocol as social technology for the promotion and prevention of ophthalmologic manifestations in patients with HIV/AIDS. Theoretical and empirical methods that allowed knowing the antecedents of the problem under investigation, to carry out actions and to characterize the studied phenomenon, were used. The protocol constitutes a social technology, because it is composed by norms and procedures for the conduction of a social process that is not related with the productive area. The design of this social technology favors an adequate diagnosis, treatment and follow-up of eye conditions in patients with HIV/ AIDS, based on the theory of knowledge. (shrink)

This paper traces the development of policies dealing with HIV/AIDS in Botswana from their beginning in the late 1980s to the current programme to provide population-wide anti-retroviral therapy (ARV). Using a variety of source material, including long-term ethnographic research, it seeks to account for the failure of Western-inspired approaches in dealing with the pandemic. It does this by looking at the cultural and institutional features that have created resistance to the message and inhibited effective implementation. The negative response to (...) the first educational campaign stressing condom use is described and contextualized in terms of Tswana ideas of morality and illness. Nor, as was initially expected, did the introduction of free ARV therapy operate to break the silence and stigma that had developed around the disease. Take-up was very slow, and did not operate to encourage widespread testing. In 2003, key policymakers in Botswana began to argue for a break with the AIDS position, with its emphasis on voluntarism, confidentiality and the human rights of patients. This resulted in routine testing being introduced in 2004. This links to a major argument running through the paper which is that the failure of policy cannot be attributed solely to the nature of local populations. Western cultural assumptions about also require critical examination. (shrink)

Since its recognition in the early 1980s, the global HIV/AIDS pandemic has continued to grow relentlessly. Early efforts in HIV prevention sought to influence behavior by providing information about the dangers of AIDS along with recommendations for safe behavior. This approach helped to alert people about AIDS, but was insufficient to promote or sustain behavioral change.The second approach attempted to promote individual behavioral change by designing AIDS programs that would deliver a mix of information, materials, and (...) services. This program-based approach emerged within communities, was gradually adopted by some countries, and was subsequently articulated by the World Health Organization as the first Global AIDS Strategy. The emphasis during this period was to ensure that each community and country developed its own comprehensive program by adapting a global model to local and national circumstances. (shrink)

During August–September 2013, this research was conducted in two sites of World Vision India’s GRACE Project that specialize in providing care and support to children/adolescents impacted by HIV/aids in Chennai.1 This qualitative report presents the findings alongside a literature review that focuses on building resiliency upon the “innate capacities” of children/adolescents impacted by HIV/aids towards psychosocial, vocational, and spiritual flourishing. In order to better understand the ways in which programs can respond to the true needs of this demographic, (...) the interviews and focus groups were framed with a participatory grassroots approach to discover unique challenges, future dreams, and existing capabilities.2 This study addresses the nature of resiliency in transformational development by exploring its engagement with the interlocking dimensions of well-being in four sections: 1) framing immediate needs and integrated programming, 2) social support and the role of kinship in transformational development, 3) enhancing vocational resiliency through participatory development, and 4) identity reformation and redeemed relationships within the Kingdom of God. (shrink)

A two strain HIV/AIDS model with treatment which allows AIDS patients with sensitive HIV-strain to undergo amelioration is presented as a system of non-linear ordinary differential equations. The disease-free equilibrium is shown to be globally asymptotically stable when the associated epidemic threshold known as the basic reproduction number for the model is less than unity. The centre manifold theory is used to show that the sensitive HIV-strain only and resistant HIV-strain only endemic equilibria are locally asymptotically stable when (...) the associated reproduction numbers are greater than unity. Qualitative analysis of the model including positivity, boundedness and persistence of solutions are presented. The model is numerically analysed to assess the effects of treatment with amelioration on the dynamics of a two strain HIV/AIDS model. Numerical simulations of the model show that the two strains co-exist whenever the reproduction numbers exceed unity. Further, treatment with amelioration may result in an increase in the total number of infective individuals (asymptomatic) but results in a decrease in the number of AIDS patients. Further, analysis of the reproduction numbers show that antiretroviral resistance increases with increase in antiretroviral use. (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)

The use of foster children as subjects in the pediatric HIV/AIDS clinical trials has been the subject of media controversy, raising a range of ethical and social dimensions. Several unsettled issues and debates in research ethics underlie the controversy and the lack of consensus among professional researchers on these issues was neither adequately appreciated nor presented in media reports. These issues include (1) the tension between protecting subjects from research risk while allowing them access to the possible benefits of (...) research; (2) the blurring of the potentially conflicting roles of investigator and physician and the boundaries between research and therapy; (3) the adequacy of Institutional Review Board oversight; and (4) trust and the relationships among physicians, investigators and industry. The media controversy about the pediatric HIV/AIDS clinical trials can be seen as a means of “manufacturing mistrust” in health care, research and social services that have not always met the needs and expectations of the public. In an era of emerging infections, it is critical to the public’s health that people understand the role of rigorous and ethical research in the development of safe and effective care. Investigators, journalists and the public need to become knowledgeable about major ethical issues in the conduct of research in order to engage in dialogue about balancing research risks and benefits and to be able to distinguish fact from distortion in an era of multiple and rapid transmission of information. (shrink)

Given current constraints on universal treatment campaigns, recent advances in public health prevention initiatives have revitalized efforts to stem the tide of HIV transmission. Yet, despite a growing imperative for prevention—supported by the promise of behavioral, structural and biomedical approaches to lower the incidence of HIV—human rights frameworks remain limited in addressing collective prevention policy through global health governance. Assessing the evolution of rights-based approaches to global HIV/AIDS policy, this review finds that human rights have shifted from collective public (...) health to individual treatment access. While the advent of the HIV/AIDS pandemic gave meaning to rights in framing global health policy, the application of rights in treatment access litigation came at the expense of public health prevention efforts. Where the human rights framework remains limited to individual rights enforced against a state duty bearer, such rights have faced constrained application in framing population-level policy to realize the public good of HIV prevention. Concluding that human rights frameworks must be developed to reflect the complementarity of individual treatment and collective prevention, this article conceptualizes collective rights to public health, structuring collective combination prevention to alleviate limitations on individual rights frameworks and frame rights-based global HIV/AIDS policy to assure research expansion, prevention access and health system integration. (shrink)

A nonlinear differential equation model is proposed to study the dynamics of HIV/AIDS and its effects on workforce productivity. The disease-free equilibrium point of the model is shown to be locally asymptotically stable when the associated basic reproduction number $$\mathcal{{R}}_{0}$$ is less than unity. The model is also shown to exhibit multiple endemic states for some parameter values when $$\mathcal{{R}}_{0} 1$$. Global asymptotic stability of the disease-free equilibrium is guaranteed only when the fractions of the Susceptible subclass populations are (...) within some bounds. Optimal control analysis of the model revealed that the most cost effective strategy that should be adopted in the fight against HIV/AIDS spread within the workforce is one that seeks to prevent infections and the treatment of infected individuals. (shrink)

Although clarity about HIV transmission biology and effective therapy should mean that an AIDS diagnosis is more socially acceptable today, for some groups the cultural stigma of HIV infection has changed little in the last 30 years. This paper will examine why representations of HIV-positive gay men suggest they pose a special civic risk and how these conceptualizations have harnessed cultural anxieties about racial and sexual minorities to shape public policy and behavior since the advent of Highly Active Antiretroviral (...) Therapy (HAART) in 1996. (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)

South African writer Phaswane Mpe (1970—2004) is often canonized and memorialized as a brave truth-teller who broke the silence on HIV/AIDS in the context of government silence and denial. And yet Mpe’s writings—including poetry, short stories, a novel, and scholarly criticism—contemplate illness as a problem for truth and representation in works that linger in silence and ambiguity. This article analyses the tension between silence and speech in Mpe’s creative writing in response to HIV/AIDS. Using Mpe’s works as an (...) illustrative example, I trouble the desire to read illness narratives as forms of truth-telling and silence-breaking. The desire for the transparency of speech in a global archive of illness narratives also informs a colonial politics of representation that instrumentalizes literature as ethnographic evidence. Mpe’s writing on HIV/AIDS refuses a demand for authenticity by holding the embodied experience of disease at a slight remove from the reader in order to register the forms of spiritual and epistemological crisis that epidemic and social loss produce. My contention is that the political stakes of this writing lie not in Mpe’s ability to render a public health crisis with verisimilitude, but in the capacity for writing to provide solace and sublimity faced with death. Through an analysis of Mpe’s fiction and poetry, this article proposes a methodology for reading the politics of illness narratives across globalized space which attends to the world-building potential of creative expression as a radical practice that resists incorporative models of aesthetic intelligibility. (shrink)

The current approach for dealing with the global AIDS pandemic focuses on technology, particularly pharmaceuticals. However, most of the world’s PLWHA (people living with HIV/AIDS) have little or no access to these expensive treatments. Additionally, such technologies have not proven themselves adequate in addressing AIDS in global terms. When the health of communities is prioritised, rather than the interests of pharmaceutical companies and biomedicine, alternative strategies and policies can be considered. These strategies include seriously investigating traditional medicines (...) in other cultures, rather than adopting an uncritical assumption that the biomedical approach is preferable. The limited research available suggests that some alternative treatments could indeed turn out to be useful in treating HIV/AIDS. However, without Western support for rigorous evaluation and development of local alternative therapies, the potential of these treatments for HIV/AIDS will continue to be dismissed. Additionally, the rights of communities to self-determination, and PLWHA to the best possible primary health care, whether in rich or poorer nations, will also be diminished. (shrink)