Ethical Problems in HIV/AIDS

Question 1

Is it ethically justifiable to increase the number of patients diagnosed with HIV when not all of them will have access to treatment?

Answer 1

The ethical considerations surrounding increasing the number of patients diagnosed with HIV when not all have access to treatment are complex. Some argue that early diagnosis allows for timely intervention and prevention of transmission, while others contend that without adequate access to treatment, diagnosis may lead to unnecessary psychological distress. However, many advocate for increased efforts to expand access to treatment alongside diagnosis to ensure equitable healthcare provision.

Question 2

What are examples of structural HIV prevention programs?

Answer 2

Structural HIV prevention programs include initiatives such as decriminalizing sex work, improving education for girls, addressing drug use, and protecting the rights of HIV-positive individuals. These programs aim to address the underlying social, economic, and political factors that contribute to HIV transmission and stigma.

Question 3

How are condoms classified in the context of HIV prevention?

Answer 3

Condoms are classified as a biomedical intervention rather than a purely behavioral one, alongside interventions such as male circumcision and antiretroviral therapy (ARVs). This classification recognizes the role of condoms in directly reducing the risk of HIV transmission.

Question 4

What are examples of behavioral interventions in HIV prevention?

Answer 4

Behavioral interventions in HIV prevention include comprehensive sex education, counseling services, and stigma reduction initiatives. These interventions aim to promote safer sexual practices, increase knowledge about HIV transmission and prevention, and address social attitudes and beliefs that contribute to stigma and discrimination.

Question 5

Ethical problems around HIV testing: Informed consent

Answer 5

 Public health approach (utilitarian but limits people’s autonomy) vs. human rights approach (people will be more likely to access treatment and care)

Question 6

 Approaches include: (4)

Answer 6

Question 7

 In SA, human rights approach was adopted due to high levels of _____ (combination of the above methods)

Answer 7

stigma

Question 8

 National Health Act outlines voluntary informed consent which considers: (5)

Answer 8

Question 9

What is required for informed consent (IC) for an HIV test according to guidelines?

Answer 9

Informed consent for an HIV test requires pre-test counseling, which includes information about HIV infection, transmission modes, the nature of the test, required consent, and the social, psychological, and legal implications. Individuals must be given time to consider this information before consenting to the test.

Question 10

What is involved in post-test counseling for HIV testing?

Answer 10

Post-test counseling is required regardless of test outcomes and involves explaining the test results and diagnosis, providing information on antiretroviral therapy (ART) and its benefits, guidance on obtaining ART or making referrals, education on preventing HIV transmission and achieving viral suppression, providing condoms and lubricants with guidance on their use, and encouraging and offering HIV testing to sexual partners, children, and other family members.

Question 11

What ethical guidelines are provided by the Health Professions Council of South Africa (HPCSA) regarding HIV testing?

Answer 11

The HPCSA outlines Ethical Guidelines for Good Practice with regard to HIV (2016), which provide standards and protocols for healthcare professionals conducting HIV testing and counseling.

Question 12

What national policy governs HIV testing services in South Africa?

Answer 12

The Department of Health (DOH) instituted the National HIV Testing Services Policy in 2016, which outlines the framework and guidelines for HIV testing and counseling services across the country.

Question 13

Who can consent to HIV testing? (3)

Answer 13

 Children aged 12 years and older

 Children under 12 years who have sufficient maturity to understand the benefits, risks and social implications
of HIV test

 Proxy consent for children under 12 years who are not sufficiently mature

Question 14

 Children may only be tested for HIV in two circumstances: (2)

Answer 14

i. if in their best interests and lawful consent has been given, or

ii. if the test is needed to establish the child’s HIV status where a healthcare worker or another person may have contracted HIV from the child’s body fluids.

Question 15

 Must be accompanied by pre- and post–test counselling by an appropriately _______ person.

Answer 15

trained

Question 16

 If parents of the child are not married, or no longer in a relationship: (2)

Answer 16

Question 17

When HIV testing without consent can take place: (3)

Answer 17

 As part of unlinked anonymous testing for epidemiological purposes authorised by the government

 When screening donated blood for diseases

 Where a needle-stick injury or other risk-bearing incident has occurred to the health practitioner

Question 18

 Test an existing ______ specimen from the source patient, preferably with the consent.
 If consent is withheld still test the specimen after informing the patient that the test is being performed anyway and that ______ will be protected.
 If there is no existing blood specimen and consent is refused, take ______ as if the patient is positive.
 If patient is unable to give consent for a significant length of time, try to get _____ _______.

Answer 18

blood
privacy
prophylaxis
proxy consent

Question 19

True or False, It is not acceptable for HCPs to refuse care to HIV+ patients

Answer 19

True

Question 20

 Decisions must respect in 4 ethical principles (________________________________________) but they must be taken as prima facie obligations and weighed up when in conflict with each other

Answer 20

(autonomy, non-maleficence, beneficence and justice)

Question 21

When it is permissible for health professionals to disclose a patient’s HIV status to others: (4)

Answer 21

Question 22

What legal precedent governs the disclosure of a patient’s HIV status to others?

Answer 22

Jansen van Vuuren & Another NNO v Kruger 1993 case established that disclosure can only be permissible if it serves the public’s benefit and is done in good faith.

Question 23

What is encouraged regarding disclosure of HIV status to sexual partners?

Answer 23

Health professionals are encouraged to counsel patients on the importance of disclosing their HIV status to sexual partners and provide support in doing so.

Question 24

 If disclosure is to be made against the patient’s wishes, the doctor must: (4)

Answer 24

Question 25

Are there laws in South Africa criminalizing non-disclosure of HIV status and HIV transmission?

Answer 25

Despite arguments for criminalization, no such laws have been enacted in South Africa. Courts decide on a case-by-case basis.

Question 26

What was the outcome of the case Phiri v State (2013)?

Answer 26

In the case, Phiri, an HIV counselor, was accused of attempted murder for transmitting the infection to a sexual partner by not using a condom despite the partner’s requests. Phiri was found guilty.

Question 27

What was Phiri’s argument during the appeal to the High Court?

Answer 27

Phiri argued that there was no proof of the transmission of HIV and that he should have been charged with intent to cause bodily harm instead of attempted murder.

Question 28

How did the High Court respond to Phiri’s appeal?

Answer 28

The High Court rejected Phiri’s version of events and his argument regarding the charges. It upheld the initial verdict of guilt.

Question 29

• SA common law recognises 4 requirements for criminal liability: (4)

Answer 29

 Anact
 Which is unlawful
 Which causes a crime
 Committed with intent (culpa)

Question 30

 Sexual partners sue for monetary compensation if 5 elements of Delict are proven (Venter v Nel 1997 – not regarded as a useful precedent): (5)

Answer 30

i. Conduct
ii. Wrongfulness
iii. Fault
iv. Causation – is the partner indeed the one responsible for transmission?
v. Damage

Question 31

Basic criteria or standards that can be employed in making resource allocation decisions

 What proportion of the national budget should be spent on healthcare, and further on specific diseases?

Principles that come to the fore in limited resource allocation decisions: (3)

Answer 31

 Deontology (Kant)
 Utilitarianism
 Rawls

Question 32

What principle does deontology, as proposed by Kant, emphasize in limited resource allocation decisions?

Answer 32

Deontology emphasizes that each person has equal worth and inherent value. Nobody should be sacrificed based on apparent relative “value” or talent. It advocates for acting according to the maxim that you would wish all other rational people to follow, as if it were a universal law.

Question 33

What principle does utilitarianism prioritize in limited resource allocation decisions?

Answer 33

Utilitarianism prioritizes the greatest good for the greatest number. It considers the social worth of people based on factors such as age, health status, occupation, and education.

Question 34

According to Rawls, what are the principles that should guide limited resource allocation decisions?

Answer 34

Rawls emphasizes fair procedures, rejecting social worth considerations seen in utilitarianism. He advocates for ensuring that special benefits are open to all and proposes the use of special and just procedures, such as random selection. Decisions should not be made by individual healthcare professionals but rather by a representative committee.