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Lancet. 2007 Dec 1; 370(9602):1808-1809.Important questions about implementation of the new guidance by WHO and UNAIDS on provider-initiated HIV testing and counselling were raised by Daniel Tarantola and Sofia Gruskin. Their comments and those by other critics centre on individuals' rights to confidentiality, to refuse testing, and to not disclose their status if they fear negative consequences. We are concerned that a singular focus on the individual's rights of refusal overlooks the rights of the individual's sexual partners to protect themselves from HIV. Human rights and public health will be best served by an ethical framework which recognises that both persons in a sexual relationship or exchange have equal rights and responsibilities for their mutual pleasure and protection. Further, these individual rights are meaningless unless each partner respects the rights of the other. Protection of the human rights of both partners needs more commitment from health systems, and from societies, than simply ensuring informed consent and confidentiality. (excerpt)
Exploring disparities between global HIV / AIDS funding and recent tsunami relief efforts: an ethical analysis.
Developing World Bioethics. 2007; 7(1):1-7.The objective was to contrast relief efforts for the 26 December 2004 tsunami with current global HIV/AIDS relief efforts and analyse possible reasons for the disparity. Methods: Literature review and ethical analysis. Just over 273,000 people died in the tsunami, resulting in relief efforts of more than US$10 bn, which is sufficient to achieve the United Nation's long-term recovery plan for South East Asia. In contrast, 14 times more people died from HIV/AIDS in 2004, with UNAIDS predicting a US$8 bn funding gap for HIV/AIDS in developing nations between now and 2007. This disparity raises two important ethical questions. First, what is it that motivates a more empathic response to the victims of the tsunami than to those affected by HIV/AIDS? Second, is there a morally relevant difference between the two tragedies that justifies the difference in the international response? The principle of justice requires that two cases similarly situated be treated similarly. For the difference in the international response to the tsunami and HIV/AIDS to be justified, the tragedies have to be shown to be dissimilar in some relevant respect. Are the tragedies of the tsunami disaster and the HIV/AIDS pandemic sufficiently different, in relevant respects, to justify the difference in scope of the response by the international community? We detected no morally relevant distinction between the tsunami and the HIV/AIDS pandemic that justifies the disparity. Therefore, we must conclude that the international response to HIV/ AIDS violates the fundamental principles of justice and fairness. (author's)
A report of a theological workshop focusing on HIV- and AIDS-related stigma, 8th-11th December 2003, Windhoek, Namibia. Supported by UNAIDS.
Geneva, Switzerland, UNAIDS, 2005 Feb. 62 p. (UNAIDS/05.01E)Stigma is difficult to define. Generally, though, it implies the branding or labelling of a person or a group of persons as being unworthy of inclusion in human community, resulting in discrimination and ostracization. The branding or labelling is usually related to some perceived physical, psychological or moral condition believed to render the individual unworthy of full inclusion in the community. We may stigmatize those we regard as impure, unclean or dangerous, those who are different from ourselves or live in different ways, or those who are simply strangers. In the process we construct damaging stereotypes and perpetuate injustice and discrimination. Stigma often involves a conscious or unconscious exercise of power over the vulnerable and marginalized. The purpose of this document is to identify those aspects of Christian theology that endorse or foster stigmatizing attitudes and behaviour towards people living with HIV and AIDS and those around them, and to suggest what resources exist within Christian theology that might enable churches to develop more positive and loving approaches. It is not a theological statement, but rather a framework for theological thinking, and an opportunity, for church leaders, to pursue a deeper Christian reflection on the current crisis. (excerpt)
Geneva, Switzerland, UNAIDS, 2000 Jul. 47 p. (UNAIDS Best Practice Collection. Key Material; UNAIDS/00.28E)Surveillance is the radar of public health. Nevertheless, its precise contours and justifications remain a matter of contention. Although the World Health Organization (WHO) Epidemiological Surveillance Unit in the Division of Communicable Diseases has defined disease surveillance quite broadly, most public health authorities, such as the United States Centers for Disease Prevention and Control (CDC) and the World Health Assembly, typically identify three key elements of surveillance. Surveillance involves the ongoing, systematic collection of health data, the evaluation and interpretation of these data for the purpose of shaping public health practice and outcomes, and the prompt dissemination of the results to those responsible for disease prevention and control. Surveillance, then, encompasses more than just disease reporting. "The critical challenge in public health surveillance today," conclude two prominent figures who have helped to define surveillance in the United States, "remains the ensurance of its usefulness." Two issues emerge from this understanding of surveillance. The first entails a question of efficacy. The second involves matters of privacy. Although conceptually distinct, the two are nevertheless intimately related. While the necessities of surveillance may justifiably limit some elements of privacy, such limitations are only justifiable to the extent that they in fact benefit the public's health. (excerpt)
New England Journal of Medicine. 2006 Jun 8; 354(23):2414-2417.On June 5, 1981, when the Centers for Disease Control reported five cases of Pneumocystis carinii pneumonia in young homosexual men in Los Angeles, few suspected it heralded a pandemic of AIDS. In 1983, a retrovirus (later named the human immunodeficiency virus, or HIV) was isolated from a patient with AIDS. In the 25 years since the first report, more than 65 million persons have been infected with HIV, and more than 25 million have died of AIDS. Worldwide, more than 40 percent of new infections among adults are in young people 15 to 24 years of age. Ninety-five percent of these infections and deaths have occurred in developing countries. Sub-Saharan Africa is home to almost 64 percent of the estimated 38.6 million persons living with HIV infection. In this region, women represent 60 percent of those infected and 77 percent of newly infected persons 15 to 24 years of age. AIDS is now the leading cause of premature death among people 15 to 59 years of age. In the hardest-hit countries, the foundations of society, governance, and national security are eroding, stretching safety nets to the breaking point, with social and economic repercussions that will span generations. (excerpt)
Population 2005. 2002 Sep-Oct; 4(3):8.The HIV/AIDS epidemic shows no sign of leveling off in the hardest hit countries and as much as $10 billion is needed annually to fight it effectively, according to UNAIDS Executive Director Peter Piot. Addressing the 14th international AIDS conference in Barcelona in July, Mr. Piot said that unless the global community provided more assistance to countries with high rates of HIV/AIDS, like debt relief, there could be catastrophic results. “The epidemic hit the world 20 years ago but we failed to contain the increase in HIV cases. The answers point towards politics, power and priorities. $10 billion is needed annually to combat the menace,” he said. Mr. Piot told his audience they must mobilize political support, scale up AIDS prevention and treatment, eliminate stigma, develop a vaccine and arrange funds to fight the disease. (excerpt)
Geneva, Switzerland, UNAIDS, 2004. Prepared for the 4th Meeting of the UNAIDS Global Reference Group on HIV / AIDS and Human Rights, August 23-25, 2004. 7 p.This paper explores issues and approaches relevant to the assessment of the application of a rights based approach to the planning and implementation of HIV/AIDS strategies. It builds on the premise that the Reference Group may wish to recommend to UNAIDS a set of practical steps towards integrating human rights in HIV/AIDS policies and programs and monitoring the compliance of HIV/AIDS policies and programs with international human rights principles and guidelines, in particular those that have been explicitly promoted by UNAIDS in its publications and other work. Some suggested key issues are highlighted and, HIV testing strategies will be used as an example to the extent necessary to clarify concepts. (excerpt)
Issue paper: Review and assessment of HIV / AIDS strategies that explicitly include attention to rights. Impact mitigation.
Geneva, Switzerland, UNAIDS, 2004. Prepared for the 4th Meeting of the UNAIDS Global Reference Group on HIV / AIDS and Human Rights, August 23-25, 2004. 4 p.This issue paper examines human rights based approaches explicitly defined as such by organizations addressing impact mitigation policy and programmatic efforts. Given the diversity of definitions of rights based approaches, consideration is given to how rights are conceptualized, and the explicit attention to rights in these policy and program efforts. Commonalities and differences should be considered between the various approaches to determine the evidence that exists of the value of paying attention to rights in these strategies, as well as how rights based approaches to impact mitigation are articulated. While impact mitigation covers a broad range of areas, given the devastating consequences of the epidemic on the lives of children, most of the examples below will focus on children orphaned by AIDS as an example to illustrate how rights based approaches are applied at policy and programmatic levels. (excerpt)
The role of civil society in protecting public health over commercial interests: lessons from Thailand.
Lancet. 2004 Feb 14; 363(9408):560-563.In October, 2002, two Thai people with HIV-1 won an important legal case to increase access to medicines. In its judgment in the didanosine patent case against Bristol-Myers Squibb, the Thai Central Intellectual Property and International Trade Court ruled that, because pharmaceutical patents can lead to high prices and limit access to medicines, patients are injured by them and can challenge their legality. This ruling had great international implications for health and human rights, confirming that patients—whose health and lives can depend on being able to afford a medicine—can be considered as damaged parties and therefore have legal standing to sue. The complexities of pharmaceutical intellectual property law are most poorly understood by those most affected by their consequences—the patients who need the drugs. The Thai court case was the outcome of a learning process and years of networking between different civil society actors who joined forces to protect and promote the right of access to treatment. Our Viewpoint, based on key interviews and published reviews, summarises the efforts of civil society in Thailand to achieve a fair balance between international trade and public health. These efforts have focused on didanosine, an essential antiretroviral drug that in Thailand has become symbolic of how multinational companies and governments of industrialised countries protect their own interests at the expense of access to essential medicines for the poor. (author's)