HIV/AIDS

Through a rhetorical analysis of fragments of language used by United States public health experts, victims, and advocates during the early periods of polio, HIV and COVID-19, this project shows how constitutive rhetoric within infectious disease discourse articulates the subject position of potential victim for different publics. The author finds that the analyzed discourse simultaneously calls forth a negative identity that asks people to not become something and also asks for actions to prevent disease spread – and, in doing so, (...) the awakening of potential victim reveals hegemonic assumptions about whose bodies are valued and whose are not. (shrink)

Public funders of health research have been widely criticized on the grounds that their allocations of funding for disease-specific research do not reflect the relative burdens imposed by different diseases. For example, the US National Institutes of Health spends a much greater fraction of its budget on HIV/AIDS research and a much smaller fraction on migraine research than their relative contribution to the US burden of disease would suggest. Implicit in this criticism is a normative claim: Insofar as the scientific (...) opportunities are equal, each patient merits research into their condition proportional to the burden of disease for which that condition is responsible. This claim—the proportional view—is widely accepted but has never been fully specified or defended. In this paper, I explain what is required to specify the view, attempt to do so in the most charitable way, and then critically evaluate its normative underpinnings. I conclude that a severity-weighted proportional view is defensible. I close by drawing out five key lessons of my analysis for health research priority-setting. (shrink)

Gay men have been severely affected by the AIDS crisis, and gay subjectivity, sexual ethics, and politics continue to be deeply influenced by HIV to this day. PrEP (Pre-Exposure Prophylaxis) is a new, drug-based HIV prevention technique, that allows disentangling gay sex from its widespread, 40 yearlong association with illness and death. This article explores PrEP's fundamental impact on gay subjectivity, sexual ethics, and politics. It traces the genealogy of gay politics regarding homophobia and HIV stigma, suggesting a new biopolitical (...) and body political framework that accounts for the agency of activists as well as pharmapower, and proposing that PrEP is an example of democratic biopolitics. Highlighting the entanglement of medical technology, sexual ethics, and politics, the article shows how conservative and homonormative gay politics developed as a reaction to HIV stigma and how, by overcoming this stigma, PrEP enables a new era of intersectional queer politics and solidarities. It thereby develops a Foucauldian account of sexual liberation beyond the repression hypothesis that accounts for the ambivalence of sexual subjectification and the political potential of sexuality. (shrink)

Le politologue, philosophe et sociologue Karsten Schubert examine le lien entre sexualité et politique gay et se demande quel type de politique a été favorisé ou au contraire entravé suivant la situation liée à la pandémie de VIH. Il présente deux thèses à cet égard.

In 2018-2019, at the Keck School of Medicine of the University of Southern California, we developed and piloted a narrative-based health systems science intervention for patients living with HIV and medical students in which medical students co-wrote patients’ life narratives for inclusion in the electronic health record. The pilot study aimed to assess the acceptability of the “life narrative protocol” from multiple stakeholder positions and characterize participants’ experiences of the clinical and pedagogical implications of the LNP. Students were recruited from (...) KSOM. Patients and staff were recruited from the Maternal, Child, and Adolescent/Adult Center for Infectious Disease and Virology at Los Angeles County+USC Medical Center. Ten patients, seventeen students, and ten MCA staff participated in the pilot study. Qualitative methods were used to gather data from students’, patients’, and staff’s perspectives. Three themes emerged from the thematic analysis: patients’ life narratives conveyed their unique life experiences and voices; the protocol could result in wide-ranging effects on HIV care; the LNP enabled students to contribute value to patients’ healthcare. Across groups, participants considered the LNP an acceptable intervention. The LNP, its limitations, and implications for HIV care, narrative medicine, and health information technology are presented. (shrink)

Despite several research on HIV/aids, it is still incumbent to investigate more effective control measures to mitigate its infection level. Therefore, we introduce an HIV/aids-resistant model with behavior change and study its basic properties. In order to determine the most sensitive parameters that are responsible for disease transmission with respect to the basic reproduction number and those responsible for disease prevalence with respect to the endemic equilibrium, the sensitivity analysis was established and it was confirmed that the influx rate of (...) people into the infected population and total abstinence from all risk practices and endemic areas are some of the most sensitive parameters for disease spread and disease eradication, respectively. Furthermore, by considering controls u1\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$u_1$$\end{document} denoting the government’s intervention in promoting and encouraging behavior change, u2\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$u_2$$\end{document} representing intake of balanced nutritional supplementation, and u3\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$u_3$$\end{document} connoting antiretroviral therapy (ART), an optimal control problem was developed and analyzed. Before the establishment of the necessary conditions of the optimal control using Pontryagin’s Maximum Principle, we proved the existence of the optimal control triplet (u1(t),u2(t),u3(t)∈Φ,\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$(u_1(t),u_2(t),u_3(t)\in \Phi,$$\end{document} where Φ\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\Phi$$\end{document} is the control set at time t,) which has been neglected by many researchers in recent years. Using the Runge–Kutta scheme, the optimal control problem was solved to understand the best combination of control strategies. Using the demographic and epidemiological data for South Africa on HIV/aids, a numerical simulation was carried out and results are presented on 3D surface plots. The obtained results suggested that the combination of all the considered control measures is the best method to ensure disease eradication. (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)

BackgroundCritical public health measures implemented to mitigate the spread of the novel coronavirus disease (COVID-19) pandemic have disrupted health research worldwide, including HIV prevention research. While general guidance has been issued for the responsible conduct of research in these challenging circumstances, the contours of the dueling COVID-19 and HIV/aids pandemics raise some critical ethical issues for HIV prevention research. In this paper, we use the recently updated HIV Prevention Trials Network (HPTN) Ethics Guidance Document (EGD) to situate and analyze key (...) ethical challenges related to the conduct of HIV prevention research during the COVID-19 pandemic as well as identify potential areas for refinement of the guidance document based on this unprecedented state of affairs.Main bodyNecessary actions taken for HIV prevention research studies due to the COVID-19 pandemic involve an array of ethical issues including those related to: (1) risk mitigation; (2) behavior change; (3) compounding vulnerability; (4) community engagement; (5) trial reopening; and 6) shifting research priorities.ConclusionsIn the context of the dueling HIV and COVID-19 global pandemics, research teams and sponsors must be nimble in responding to the rapidly changing environment by being sensitive to the associated ethical issues. The HTPN EGD provides a rich set of tools to help identify, analyze and address many of these issues. At the same time, future refinements of the HPTN EGD and other research ethics guidance could be strengthened by providing explicit advice regarding the ethical issues associated with disrupted research and the reopening of studies. In addition, additional consideration should be given to appropriately balancing domains of risk (e.g., physical versus social), addressing the vulnerability of research staff and community partners, and responding to un-anticipatable ancillary care needs of participants and communities. Appropriately addressing these issues will necessitate conceptual work, which would benefit from the careful documentation of the actual ethical issues encountered in research, the strategies implemented to overcome them, and their success in doing so. Throughout all of these efforts, it is critical to remember that the HIV pandemic not be forgotten in the rush to deal with the COVID-19 pandemic. (shrink)

In this paper, I utilise the tools of analytic philosophy to amalgamate mono-causal and multi-causal theories of disease. My aim is to better integrate viral and socio-economic explanations of AIDS in particular, and to consider how the perceived divide between mono-causal and multi-causal theories played a role in the tragedy of AIDS denialism in South Africa in the early 2000s. Currently, there is conceptual ambiguity surrounding the relationship between mono-causal and multi-causal theories in biomedicine and epidemiology. Mono-causal theories focus on (...) single, typically microbial, sources of illness and are most concerned with infectious diseases. By contrast, multi-causal theories allow for multiple factors to underpin a disease’s aetiology, including socio-economic and behavioural factors, and they usually focus on chronic non-communicable diseases. However, if these theories are taken to be strictly distinct, this prevents the inclusion of both microbial and socio-economic factors in a single explanation of any particular disease. This strict distinction became a problem when trying to explain the disproportionate prevalence of AIDS in southern Africa and ultimately contributed to the tragedy of AIDS denialism in South Africa. In tandem with viewing how the perceived divide between multi-causal and mono-causal theories underpinned AIDS denialism, I examine Thabo Mbeki’s specific role, while acknowledging that AIDS is being deprioritised on a broader international level. Overall, I will demonstrate that any long-term plan to eliminate AIDS will require viral and socio-economic factors to be considered simultaneously and that such a theoretical approach requires a clearer understanding of the underlying concepts of disease aetiology. (shrink)

The author reviews various conceptions of autonomy to show that humans are actually not autonomous, strictly speaking. He argues for a need to rethink the personal autonomy approaches to HIV testing in sub-Saharan Africa (SSA) countries. HIV/AIDS has remained a leading cause of disease burden in SSA. It is important to bring this disease burden under control, especially given the availability of current effective antiretroviral regimens in low- and middle-income countries. In most SSA countries the ethic or value of personal (...) autonomy or self-determination is promoted as primary in HIV testing decision-making. SSA policymakers have an ontological and moral duty to adopt HIV testing policies that reflect human and medical realities, relationships, local contexts, and respect human rights for both individuals and others who are affected by HIV in society. Without rethinking the value of autonomy in HIV testing decision-making, the article cautions that attainment of the Sustainable Development Goal (SDG) 3 and the UNAIDS fast-track strategy that explicitly call to end the epidemic by 2030 will not be feasible for SSA. (shrink)

In this article I read textual metaphors of ‘untouchability’ in ‘post-AIDS’ representation as an erasure of structures that condition HIV stigmatization in India. Throughout, my discussion is contextualised by the political economy of HIV and AIDS, which has been productive of particular modern sexual subjects. In the film My Brother…Nikhil, the stigmatization of Nikhil, a gay Indian man living with HIV, is constituted through visual and verbal caste metaphors, which draw on existing subject positions that are elided as ‘traditional’, residual, (...) and receding. This stigma is resolved textually through parental acceptance of the gay protagonist and his partner, projecting stigma as traditional and modernity as the resolution. Such metaphors of ‘untouchability’ prevent the representation of queer Dalit subjects in contexts of HIV and AIDS. Yet if addressing shame and social stigma are key to HIV treatment and prevention programmes, caste cannot be set aside simply as a metaphor. Expanding to include textual representations of queer Dalit subjectivity, the article reads a novel, The Boyfriend, and a poem, “Gandu Bagicha,” to show ways in which caste stigma and homophobia intersect in contexts of seroconversion risk. (shrink)

Introduction: Universal health coverage (UHC) was introduced in Iran in 2014. The aim of this study was to evaluate the usage rate of health services by human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients after UHC implementation. Material and methods: In 2018, in a cross-sectional study, we evaluated the outpatients’ needs (within its previous month) and inpatients’ needs (within its previous 6 months) of HIV/AIDS patients in Isfahan province (the center of Iran). Concurrently, we estimated the essential health care services (...) that HIV/AIDS patients have to receive regularly, including vaccination for hepatitis B, measurement of CD4, tuberculosis (TB) assessments and TB treatment, anti-retroviral therapy, examination of viral load, treatment approach, and drug side effects counseling. Two checklists were used for assessing the utilization of health services and essential health cares for HIV/AIDS patients, validated by the Ministry of Health and Medical Education of Iran. Data were analyzed by χ2 test, Pearson’s correlation coefficient, and Spearman’s correlation test. Results: Two hundred and thirteen HIV/AIDS patients completed the questionnaires. The mean age of participants was 41.14 ± 9.23. The outpatient service utilization rate was 31.94% in the previous month and the rate of hospitalization was 126 per 1,000 HIV/AIDS patients in the previous 6 months. The majority of HIV/AIDS patients received essential health services more often than the national standard goals estimation. Conclusions: After UHC implementation, the utilization rate of outpatients and inpatients services in HIV/AIDS patients was more than similar indices in the general population. In addition, HIV/AIDS patients received essential health services adequately. (shrink)

Die Einführung der HIV-Prophylaxe PrEP ist ein Beispiel für demokratische Biopolitik und macht Hoffnung auf eine Beendigung von Sexnegativität und Stigmatisierung, findet Dr. Karsten Schubert.

PrEP (Präexpositionsprophylaxe) ist ein relativ neues Mittel zur Prävention von HIV-Infektionen. HIV-negative Menschen nehmen antivirale Medikamente ein, die verhindern, dass der Kontakt mit dem Virus zu einer Infektion führt. Im Gegensatz zum Kondomgebrauch basiert dieses Präventionsverfahren auf Medikamenten und nicht auf einer Verhaltensänderung. Aus der Perspektive der Biopolitik fügt sie sich in einen größeren Trend in Richtung Medikalisierung, des Anstiegs der Macht der Pharmaindustrie und der Reglementierung des Risikos ein. Sexuelles Verhalten ist das Ergebnis der Subjektivierung, des Prozesses, durch den (...) soziale Normen Subjekte und ihre Wünsche bilden. Die Medikalisierung von schwulem Sex durch PrEP verändert die sexuelle Subjektivierung und geht daher mit einer Veränderung der Praktiken von schwulem Sex einher. Nach einer kurzen Erläuterung der medizinischen Besonderheiten und der Geschichte von PrEP (1) vereint dieser Artikel eine Rekonstruktion zeitgenössischer theoretischer Ansätze zur Biopolitik im Zusammenhang mit PrEP (2) mit einer Darstellung aktueller politischer Debatten um PrEP (3). Die Untersuchung zeigt, dass sich Gouvernementalitätsstudien und die Italienische Theorie auf repressive Machtverhältnisse konzentrieren und daher die Komplexität der Debatte nicht berücksichtigen können, die sich aus der Subjektivität und Handlungsfähigkeit verschiedener beteiligter Akteure, insbesondere schwuler PrEP-Aktivisten, ergibt. Dennoch werden Interpretationen von PrEP als repressiver Macht auch von einigen Akteuren in der politischen Debatte um PrEP genutzt, meist ohne ausdrücklichen Bezug zur biopolitischen Theorie. Nikolas Roses und Paul Rabinows differenziertes Konzept der Biopolitik bietet einige Ansätze wie diejenigen der biopolitischen Bürgerschaft und der somatischen Ethik, um die Debatte um PrEP und die damit verbundenen komplexen Verhandlungen über Sexualität zu beschreiben. Ausgehend von diesen Ideen entwickle ich ein neues Konzept der ‚demokratischen Biopolitik‘ von PrEP, die eine weitere Demokratisierung der Sexualität im biopolitischen Zeitalter ermöglicht. (shrink)

This article uses the African communal concept of ubuntu to reflect on the ministry of Mashoko Christian Hospital, Zimbabwe, to people living with the human immunodeficiency virus and AIDS during the early days since the discovery of the disease. The main question this article seeks to answer is: from a perspective of the African philosophy of ubuntu, how did the ministry of MCH to PLWHA challenge the fear and judgemental attitudes towards the disease within the Churches of Christ in Zimbabwe? (...) This leads to another question: what should the churches learn from MCH’s response to HIV and AIDS? This article only focusses on trends in conduct and not on a detailed history of engaging HIV and AIDS. The significance of this article is to demonstrate the important role played by faith-based organisations in complementing the compassion and care often lacking in the official churches’ response to HIV and AIDS. (shrink)

The ethics of safe sex in the gay community has, for many years, been focused on debates surrounding the responsibility regarding the use of condoms to prevent HIV transmission, once the only tool available. With the development of Truvada as a pre-exposure prophylaxis for HIV, for the first time in the history of the HIV/AIDS epidemic there is the potential to significantly reduce the risk of HIV transmission during sex without the use of condoms. The introduction of PrEP necessitates a (...) renewed discussion about the politics and ethics of safe sex for men who have sex with men. We present the arguments of authors who hold radically opposite positions with regard to the ethics of condom use by gay men, but who currently both criticize the use of PrEP. We offer a critique of their arguments and advance the position that the use of PrEP, even without condoms, can be acceptable and part of a safe sex ethics framework for MSM. (shrink)

Analyzing two harm reduction comics campaigns—one early in the AIDS crisis and one more recent, I explore tensions between queer safer sexual erotics and national discourses of sexual norms/deviation raised by Cindy Patton and William Haver at the height of AIDS discourse theory in 1996, approximately halfway between the comics. Using these theorists’ reflections on the history of AIDS activism/representation as a hinge, I explore the manifestation/transformation a decade later of the ethical, educational, and erotic issues they raise. Both foreground (...) the ways that HIV, safer sex, and/or eroticism pose difficulties for systems of linguistic and visual representation. Combining text and image, comics—a common harm reduction medium—epitomize this representational issue. While the GMHC addresses an immediate need for information about safer sex, Alex attempts to tackle the unrepresentability/unthinkability of safer and/or seropositive sex. Safer Sex Comix, while largely prioritizing directness above formal experimentation, employ strategies of transgressing the borders of the comics panel to emphasize a plethora of lower-risk sexual acts. The most visually inventive moments in Alex represent Alex’s feelings of unintelligbility post-diagnosis, but the comic restricts its representation of sex only to anal intercourse, and it proves unable to visualize alternative formulations of the erotic, turning to more normative narratives and images as earlier, visually explicit unsafe sexual encounters are replaced with more a/illusive representations post-conversion, literalizing the unrepresentability of seropositive erotic life. (shrink)

HIV stigma and fears surrounding the disease pose a challenge for public health interventions, particularly those that target pregnant women. In order to reduce stigma and improve the lives of vulnerable populations, researchers have recognized a need to integrate different types of support at various levels. To better inform HIV interventions, the current study draws on social-ecological and evolutionary theories of reproduction to predict stigma and fear of contracting HIV among pregnant women in South India. The aims of this study (...) were twofold: compare the social-ecological model to a modified maternal-fetal protection model and test a combined model that included strong predictors from each model. The study took place in 2008–2011 in Mysore District, Karnataka, India. Using data from a cross-sectional survey and biological indicators of health, we statistically modeled social-ecological variables representing individual, interpersonal, and community/institutional levels. Participants were 645 pregnant women. The social-ecological and combined models were the best-fitting models for HIV-related stigma, and the combined model was the best fit for HIV-related fear. Our findings suggest that combining reproductive life history factors along with individual, interpersonal, and community/institutional factors are significant indicators of HIV-related stigma and fear. Results of this study support a multifaceted approach to intervention development for HIV-related stigma and fear. The combined model in this study can be used as a predictive model for future research focused on HIV stigma and fear, with the intent that dual consideration of social-ecological and evolutionary theories will improve public health communication efforts. (shrink)

Despite abundant evidence associating CD38 overexpression and CD4 T cell depletion in HIV infection, no causal relation has been investigated. To address this issue, a series of mechanisms are proposed, supported by evidence from different fields, by which CD38 overexpression can facilitate CD4 T cell depletion in HIV infection. According to this model, increased catalytic activity of CD38 may reduce CD4 T cells’ cytoplasmic nicotin‐amide adenine dinucleotide (NAD), leading to a chronic Warburg effect. This will reduce mitochondrial function. Simultaneously, CD38's (...) catalytic products ADPR and cADPR may be transported to the cytoplasm, where they can activate calcium channels and increase cytoplasmic Ca2+ concentrations, further altering mitochondrial integrity. These mechanisms will decrease the viability and regenerative capacity of CD4 T cells. These hypotheses can be tested experimentally, and might reveal novel therapeutic targets. (shrink)

PrEP (Pre-Exposure Prophylaxis) is a relatively new drug-based HIV prevention technique and an important means to lower the HIV risk of gay men who are especially vulnerable to HIV. From the perspective of biopolitics, PrEP inscribes itself in a larger trend of medicalization and the rise of pharmapower. This article reconstructs and evaluates contemporary literature on biopolitical theory as it applies to PrEP, by bringing it in a dialogue with a mapping of the political debate on PrEP. As PrEP changes (...) sexual norms and subjectification, for example condom use and its meaning for gay subjectivity, it is highly contested. The article shows that the debate on PrEP can be best described with the concepts ‘sexual-somatic ethics’ and ‘democratic biopolitics’, which I develop based on the biopolitical approach of Nikolas Rose and Paul Rabinow. In contrast, interpretations of PrEP which are following governmentality studies or Italian Theory amount to either farfetched or trivial positions on PrEP, when seen in light of the political debate. Furthermore, the article is a contribution to the scholarship on gay subjectivity, highlighting how homophobia and homonormativity haunts gay sex even in liberal environments, and how PrEP can serve as an entry point for the destigmatization of gay sexuality and transformation of gay subjectivity. ‘Biopolitical democratization’ entails making explicit how medical technology and health care relates to sexual subjectification and ethics, to strengthen the voice of (potential) PrEP users in health politics, and to renegotiate the profit and power of Big Pharma. (shrink)

Client-provider relationships have significant effects on how individuals comprehend their life situation during chronic disease and illness. Yet, little is known about how frontline health care providers (HCPs) influence client’s identity formation through meaning-making with clients such as HIV-positive women living in poverty. This requires ethical consideration of the meanings made between clients and providers about client’s health and well-being, both individually and in the larger society. Health care providers (N = 15) and married women living with HIV (N = (...) 33) in north-central India engaged in separate intensive interviews providing narrative data which were analysed using a conceptual framework crossing Lipsky’s street-level bureaucracy theory (Lipsky 2010) with meaning-making processes. HCPs and women construct meanings of women’s role as caregivers that impact women’s sense of identity, health, and well-being. Findings indicate that despite being well-intentioned, HCPs inadvertently reinforce rigid gender norms and convey that women’s worth is tied to their familial caregiving role. HCPs’ discretionary advocacy may also reinforce societal images of women as incapable and needy, thereby harming them more generally. Attention to the gender-sensitive training of HIV health care providers may assure that discretion is ethically interrogated to promote gender equity and enhance women’s access to social welfare services. (shrink)

This article works across multiple disciplinary boundaries, especially queer theory, to examine critically the controversial, and often socially controlling, role of biomedical knowledge and interventions in the realm of human sexuality. It will attempt to situate scientific/medical discourses on sexuality historically, socially, and culturally in order to expose the ways in which “proper” sexual health in medical research and clinical practice has been conflated with prevailing social norms at particular historical junctures in the 20th and 21st centuries. How might the (...) relationship between clinical and cultural spheres be better engaged in biomedical knowledge and clinical practice in understanding sexual health, given the impact of homophobic and transphobic assumptions in the diagnostic histories of homosexuality and Gender Identity Disorder in Childhood, a new diagnostic category introduced into the DSM following the removal of homosexuality from the DSM-III? The article will argue further that biomedical knowledge is always already mediated through culture by analyzing normative racial, gender, class, and sexual ideologies that regulated early understandings of the epidemiology of the HIV/AIDS pandemic in the West and in the postcolonial world while informing global health policy on HIV/AIDS. The article concludes by examining the implications of medical education for both LGBTQI patients and medical professionals, for understanding gender and sexual rights as human rights, and for thinking about new kinds of interventions, contestations, and struggles to resist continued homophobic and transphobic assumptions in biomedical practice today and their ongoing effects in the everyday world. (shrink)

In 1987, Harry Reasoner of 60 Minutes questioned Dr. Selma Dritz about her search in the early 1980s for the origins of the deadly outbreak of AIDS in the United States. “It was the whodunit of the century, and I was born nosy,” she tells him. The title of the 60 Minutes piece was “Patient Zero” who Mr. Reasoner explains “was a man – a central victim and victimizer” in the spread of AIDS. Dr. Dritz, who had been the head (...) of infectious diseases in the San Francisco branch of the Centers for Disease Control and Prevention (CDC), recalled warning Patient Zero of the danger he posed to others. In her retelling, Mr. Dugas callously rebuffed her concerns, showed little remorse for infecting others, and concluded their interaction with “screw you.” Also interviewed was Randy Shilts whose book, And the Band Played On, identified Patient Zero as Gaëtan Dugas, a Canadian flight attendant. Mr. Shilts explained that Mr. Dugas constituted what epidemiologists today call a superspreader – someone with unlimited ability to infect others and “speed this disease into every corner of America.” The narrative of a villainous foreigner maliciously spreading a deadly epidemic culminated in an infamous New York Post headline condemning Mr. Dugas as “THE MAN WHO GAVE US AIDS.” The story unraveled upon closer inspection. In 1984, the CDC had indeed identified a “Patient O” who had sexual connections with other AIDS patients, but the “O” stood for “Outside” California. Nowhere in the study is “Patient O” identified as “Patient Zero” -- i.e., the person who introduced the virus in America. In 2007, an article in the Proceedings of the National Academy of Sciences concluded that HIV traveled from Africa to Haiti and then on to the US sometime in 1969, many years before Mr. Dugas became infected. On October 26th of this year, the story was conclusively debunked in a study published in Nature. The authors “recovered the HIV-1 genome from the individual known as ‘Patient O’ and found neither biological nor historical evidence that he was the primary case in the US….” The mainstream media rediscovered the story with the New York Times writing that “the alleged ‘Patient Zero’ of the American AIDS epidemic – a French Canadian flight attendant named Gaëtan Dugas, who died of AIDS in 1984 – was exonerated last week.” Dr. Dritz’s description of the epidemic’s origins as a “whodunit,” as well as Mr. Reasoner’s characterization of Mr. Dugas as a “victimizer,” embody culpable language, reflecting the difficulties of balancing the need to identify “index cases” as they are known in epidemiology with the ethical considerations of patient privacy and justice. As discussed by Ronald Bayer and Amy Fairchild in The Genesis of Public Health Ethics, the AIDS epidemic triggered a rethinking of ethics in public health. Hard fought battles for privacy and civil liberties had been won by the gay community, and the traditional epidemiological methods of mandatory case reporting by name, contact investigation and quarantine were perceived as threats to those gains. Consequently, public health measures emphasized education to change cultural behavior, the protection of individual privacy, and a rejection of coercive measures in favor of voluntary testing and counselling of those infected and at risk. Richard McKay, a co-author of the Nature study, has questioned whether the notion of a “patient zero” is itself a fallacy that overshadows structural factors that contribute to the spread of disease such as cultural inequalities and barriers to health care and education. Containing an epidemic is far more complex than hunting down the person who may have spread the disease initially. David Heymann, an infectious disease epidemiologist at the London School of Hygiene and Tropical Medicine, confirms that locating a patient zero is only useful if they are still alive and infecting others: “And more often than not, especially in large disease outbreaks, they’re not.” The modern healthcare response to epidemics aims to respectfully and ethically limit exposure and, when necessary, alter societal behaviors that may spread disease, but the Gaëtan Dugas case demonstrates that the media and the public may focus unduly on blaming the behavior of individuals. The overwhelming media attention on Dr. Craig Spencer and nurse Kaci Hickox during the Ebola crisis are more recent examples. Many also believe that policymakers have over-reacted to the public’s fears of the individual, malicious AIDS infector: 32 states have criminalized the spread of HIV. The search and public identification of a “patient zero” risks stigmatizing and traumatizing individuals, and alienating those who may be infected from coming forward. The exoneration of Patient O is a reminder that the management of an epidemic must be met with a determination to protect the privacy, liberty and just treatment of individual patients. References 1) Dritz, Selma. “Patient Zero.” Interview with Harry Reasoner. 60 Minutes. CBS. November 15, 1987. 2) Rothman, Kenneth J., et al. Modern Epidemiology, 3rd Edition. (Philadelphia: Lippincott, Williams & Wilkins) 2008, 561. 3) Shilts, Randy. “Patient Zero.” Interview with Harry Reasoner. 60 Minutes. CBS. November 15, 1987. 4) McKay, Ricard A., “Patient Zero”:The Absence of a Patient’s View of the Early North American AIDS Epidemic,” Bull Hist Med. 2014 Spring : 161-194. doi: 10.1353/bhm.2014.0005 5) Auerbach, David M., et al., “Cluster of Cases of the Acquired Immune Deficiency Syndrome: Patients Linked by Sexual Contact.” The American Journal of Medicine 76, (March 1984) 487-92. 6) Thomas, M. et al. “Evolution The emergence of HIV/AIDS in the Americas and beyond“ Proc Natl Acad Sci 2007 Nov 20; 104(47): 18566–18570. Published online 2007 Oct 31. 7) Worobey, Michael, et al. “1970s and ‘Patient O’ HIV-1 Genomes Illuminate Early HIV/AIDS History in North America.” Nature 539, 98-101. 26 October 2016. 8) McNeil, Donald G., “H.I.V. Arrived in the U.S. Long Before ‘Patient Zero’”. New York Times, October 26, 2016. Mr. McNeil wrote a second article addressing the ethical issues. “The Ethics of Hunting Down ‘Patient Zero’” New York Times, October 29, 2016. 9) Bayer R1, Fairchild AL. “The Genesis of Public Health Ethics.” Bioethics. 2004 Nov;18(6):473-92.xi Ibid, 478 10) Bayer R1, Fairchild AL. “The Genesis of Public Health Ethics.” Bioethics. 2004 Nov;18(6):473-92.xi Ibid, 478 11) CDC MMWR Ebola Transmission Linked to a Single Traditional Funeral Ceremony April 17, 2015/64 (14); 386-388) 12)Mohammadi, Dara. “Finding Patient Zero.” The Pharmaceutical Journal. 17 Jan 2015, Vol 294, No 7845, online DOI: 10/1211/PJ.2015.200067543. 13)"Prosecutions for HIV Exposure in the United States, 2008–2013". The Center for HIV Law & Policy, Positive Justice Project. Retrieved. (shrink)

The aim of the study was to determine how the health of people living with Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome is affected by social and structural factors conducive to non-adherence to antiretroviral treatment. In a qualitative study conducted at Victoria Hospital in Alice, a town in the Eastern Cape, South Africa, 23 isiXhosa-speaking participants between the ages of 18 and 60 years were interviewed. Guided by the social-ecological framework of Bronfenbrenner, which is based on the notion that the (...) health-seeking behaviour of people living with HIV/aids is influenced by their social, institutional and physical environments, the analysis of the data identified the following themes conducive to non-adherence to antiretroviral treatment: food insecurity, financial constraints, poor service from health workers, unfair dismissal, fear of the consequences of disclosure, and rejection by church members. Based on these findings, and given that there is no single model of best practice that can appropriately address the various social and structural factors complicating the treatment of HIV/aids and hence the containing of the pandemic, the study suggests the need for not only supportive community initiatives, but a collaborative approach at both local and national level, and particularly in impoverished communities, by the appropriate departments of state to promote adherence to anti-retroviral treatment by making treatment and counselling facilities more accessible to PLWHA and educating communities about the implications and prevention of the disease. (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)

The place is San Francisco, the year 1981. The newly minted young doctor, all shiny confidence, sits at his desk. Suddenly, he stares down at a lab result, startled. This opening scene can mean only one thing in a medical memoir: the mysterious disease not yet known as AIDS has come to town. As the generation who first encountered AIDS ages into its memoir-writing years, we will be seeing more of these first chapters, and despite their inevitable redundancies, each may (...) well bring something unique to the table. Every illness subsumes many worlds, but the AIDS epidemic in particular has contained multitudes, each smaller epidemic whirling at a different speed and spinning out a different set of urgencies. In Lethal Decisions: The Unnecessary Deaths of Women and Children from HIV/AIDS, Arthur Ammann offers a comprehensive if problematic account from the world of pediatric AIDS. (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)

Background. Trauma is the fourth burden of disease in South Africa. The risk group is the same as that for HIV/AIDS. The Centers for Disease Control and the World Health Organization promulgated the opt-out testing system 10 years ago and several high- and lower-middleincome countries have adopted this approach.Objective. To review the feasibility of implementing the opt-out system in SA emergency departments.Methods. We examined the clinical, economic, practical and patient/provider perceptions concerning the scientific and ethical aspects of the opt-out concept.Results. (...) Patients were generally positive about the opt-out system and the overall test rate and disease identification rates were better than with other systems. Although initial costs may increase, the long-term cost benefit and prevention of transmission, due to linking to care,make this option attractive.Conclusion. The opt-out option for patients presenting to emergency departments with an acute life-threatening illness or trauma, and for those in critically ill states in an intensive care unit, is justifiable based on international and regional practices. This also has the potential to advance early highly active antiretroviral therapy and reduce treatment costs and the disease-adjusted life years for HIV management and trauma critical care. SA should adopt an opt-out testing system instead of the current tedious opt-in system. (shrink)

Background: HIV/AIDS is a pandemic disease and its scourge has had a devastating impact on health, nutrition, food security and overall socioeconomic development in affected countries. Moreover, intervention programmes, which simply employ antiretroviral drugs, have been found to lack effectiveness particularly when the patient is under-nourished. Aim and Purpose: This presented pilot intervention provides evidence that suggests use of local resources as therapeutic nutrition. This can act as a fundamental part of the comprehensive package of care at the country level. (...) Methodology: Local ingredients, which were known for their availability, accessibility, micro and macro-nutrient strengths were selected and optimised into a nutritional functional meal (Amtewa). Daily consumption was ascertained to assess its effects on nutritional status and biomedical indices of the study participants (n = 100) who were/were not taking Highly Active Anti-retroviral Therapy (HAART). Findings: Mean CD4 count for ART-Test group at baseline and sixth months increased by 40.8 cells/mm3 while the ART-Control group decreased 18.12 cells/mm3. This positive outcome qualified Amtewa meal to the next phase of intervention (400 participants) to ascertain its effectiveness on health status of HIV infected subjects and appraise its position within the National Health Services framework as innovative approach to attenuate the progression of HIV to AIDS in Nigeria. Conclusion: Amtewa-based approach in HIV management is innovative, culturally relevant, reliable and requiring low technology in order to assure compliance, sustainability and cost effectiveness. Although the achieved results take the form of specific technology, it suggests that a prolong consumption of the intervention meal (Amtewa)eww140926dxn will be suitable to sustain the gained improvements in MUAC and CD4 cell counts thereby slowing the progression of the disease. (shrink)

Tyler Perry has done it yet again. As writer, executive producer, and director of the OWN Channel’s modern soap opera, The Haves and the Have Nots, Perry tactfully addresses the ethical challenge of forced duplicity in black male identity through the prism of risky sexual-behavior practices among African American homosexual men. For a number of years, many gay black men have been under societal pressure to conform and marry women. These practices eventually harm the entire family structure because many of (...) these men live secret, closeted lives as homosexuals. In some cases, these men contract HIV/AIDS due to unsafe and risky sexual practices with other gay men, only to infect their wives or female partners. Within the black community, this practice is known as “living on the down low.” Although this ethical issue is seldom discussed in the African American community, especially within the traditional black church, unsafe and risky sexual practices by married homosexual men still unfortunately affect the entire black family, especially black women, who make up one of the leading groups of HIV/AIDS victims. In the season two episode, Tyler Perry highlights how “living on the down low” ultimately harms the medical good of society. The character, Jeffrey, wants to live free from judgment for his decision to tell his parents that he is gay. His father, David, is very supportive of his lifestyle choice. Jeffrey’s mother, Veronica, on the other hand, is very judgmental and rejects his decision, only to forcibly blackmail him into living as a closeted homosexual young man. As a result, Jeffrey goes through a crisis of black male identity because he tries to appease his mother by living as a heterosexual. In order to make Jeffrey comply with her demands, his mother selects Melissa, a beautiful African American young lady for him to date. Although Melissa is highly attractive, Jeffrey initially resists her sexual advances after their first dinner date-only to have sexual intercourse with her later that evening. Although he does not desire her sexually, Jeffrey’s risky behavior of having unprotected sex with Melissa contributes to the potentiality of acquiring HIV/AIDS. Although the discussion of black male sexuality is a taboo subject within many black communities, it does not mean that the topic should not be discussed and confronted head on. As long as this troubling trajectory persists, a growing number of African American women with HIV/AIDS will continue to negatively impact their children’s upbringing. In the end analysis, children lose their primary caregivers because of this untimely disease. Continuing educational health care initiatives through the black church is an effective means to help decrease the rate of African American women infected by HIV/AIDS because, in many cases, the makeup of this institution is mostly composed of black women. Although some black churches have initiated HIV/AIDS programs in recent years since the escalated rise of HIV/AIDS cases, many black churches are resistant to facilitating public discussions or program initiatives on this significant public health problem. A much more concerted effort by the black clergy must play a significant role in promoting health care awareness surrounding HIV/AIDS prevention and educational awareness. Because many facets of African American culture surround the black church, they are ethically bound and morally responsible for becoming change agents in the black community. The black church’s deliberate influence in HIV/AIDS awareness and prevention can make the most positive impact in health care advocacy. A false male identity based on stereotypical ideals of masculinity often poisons and deteriorates qualities of manhood that are otherwise valued. More salient values such as care, discipline, empathy, and responsibility are often replaced by a more abstract value system based on promiscuity, trickery, and thuggish mannerisms. Oftentimes, contemporary society and the mass media feed into these false notions of black male identity through nonsensical and stereotypical portrayals of black men in popular music and television. These portrayals only promote externalized black male toughness based on mentally enslaved beliefs of low self-worth and value. Tyler Perry’s ingenious tackling of black male identity crafted in Jeffrey’s storyline further shows that black men are complex and multilayered, full of contradictions like any other race of men. All in all, Perry’s usage of HIV/AIDS awareness through a dramatic medium serves a multilayered purpose bringing to light the health care dangers of “living on the down low” while being cognizant of the fact that this practice ultimately harms black men, the black community, and those who they love the most. (shrink)

In this paper, I examine activist group ACT UP's campaign to change the US Centers for Disease Control surveillance case definition of HIV and AIDS. This campaign's effects included a profound shift in how AIDS is understood, and thus in some real way in what it is. I argue that classification should be understood as a political formation with material effects, attending to the words of activists, most of them women, who contested the way AIDS was defined in a moment (...) when no one else thought that definition needed to be changed. I argue that philosopher Sue Campbell's work on the importance of understanding memory and feeling as relational helps understand the histories of death and loss, resistance and fierce joy, crystallized in activist responses to HIV and AIDS. (shrink)

We develop and use mathematical models that describe changes in the South African population over the last decades, brought on by HIV and AIDS. We do not model all the phases in HIV progression but rather, we show that a relatively simple model is sufficient to represent the data and allows us to investigate important aspects of HIV infection: firstly, we are able to investigate the effect of awareness on the prevalence of HIV and secondly, it enables us to make (...) a comparison between South Africa and Botswana. A comparison is made between two models: a model that does not reflect awareness of the devastating impact of HIV and AIDS, and a model with an added psychological awareness factor. Both models are fitted to data that reflects the incidence of HIV and AIDS within South Africa. This allows us to examine the impact of psychological awareness. We show that inclusion of the effect of awareness is absolutely necessary to arrive at a model description that satisfactorily fits the available HIV and AIDS data for South Africa. We also show that a relatively simple modelling of awareness (as opposed to more complex mathematical techniques that have been used in past studies) is sufficient to accurately describe the observed patterns in the data. Even though awareness alone is not sufficient to eradicate any disease and other control strategies should be explored and implemented concurrently with educational campaigns, we are able to conclude (through thorough model analyses procedures) that the current level of awareness in South Africa is far below the level that is effectively required to eradicate HIV from the South African population. The awareness model is also fitted to HIV-related data for Botswana and we compare the results with the South African case. Though the effect of awareness is currently estimated at a much higher level in Botswana, other factors such as poorer health care and cultural differences may play a role in limiting the ability of awareness to combat HIV in Botswana. (shrink)

he human immunodeficiency virus (HIV) has disproportionately affected the gay community and victims of hemophilia, a rare bleeding disorder. For more than a decade in the 1960s, the Food and Drug Administration (FDA) turned the other cheek on drug regulation and allowed pharmaceutical industries to control manufacturing processes. This approach led to violations of safety standards, as pharmaceutical companies became increasingly concerned with enormous profits and less about oversight. When AIDS emerged in the 1980s, over 10,000 people with hemophilia were (...) infected with HIV and hepatitis after receiving FDA-approved medical treatment. This hemophilia treatment contained factor of active ingredients made from large pools of plasma of up to 60,000 donations, but only one HIV-infected donation was all it took to contaminate the entire supply. Bad Blood: A Cautionary Tale is a documentary highlighting the tragic historical facts of HIV detection in the U.S. blood supply and the aftermath of societal demands to correct the situation. The film portrays survivors and their family members showing that effects of deregulation are still felt by innocent members of our society. Furthermore, it exposes evidence that pharmaceutical companies and government regulators were aware of the viral contamination and were slow to respond to emergency warnings from the Center for Disease Control. The cautionary tale presents two bioethical issues: government’s awareness of contaminated blood donations and the pharmaceutical industry’s concern for prioritizing profit over safety. When the government chose to deregulate the pharmaceutical companies, it handed out thousands of death certificates. The film reveals the early years of blood processing as unsanitary, by depicting improper screening during donations from the homeless and sick. To make matters worse, the government and medical professionals were already aware hepatitis contaminated the factor. However, they continuously ignored it, believing the viral infections were mostly harmless and the societal benefit greatly outweighed the minimal risk. Once these wrongdoings came to light, many companies responded by shipping the contaminated products out of the country, to continue making profits. Although, we hope that with today’s standards government regulators do not repeat such oversight mistakes, many pharmaceutical companies are private enterprises. And thus, it is up to us, to push pharmaceutical manufacturers to listen to consumers and implement extensive safety measures when screening plasma products. Although, there haven’t been any known cases of transmitted HIV or hepatitis for at least 20 years, fear of recurrence is well founded. The four personal stories at the center of the film are what really capture the viewer. Each character’s struggle is depicted as a heartfelt journey described through interviews, narration, photographs, media coverage, and animations. You can feel the pain behind the idea of being infected with a deadly ailment by the very people you seek for help. (shrink)

Brazil has occupied a central role in the access to medicines movement, especially with respect to drugs used to treat those with the human immunodeficiency virus that causes the acquired immune deficiency syndrome. Contrary to previous literature centered on the role of the domestic pharmaceutical industry, politicians seeking electoral gains, and civil society activists, I argue that the state, especially the National AIDS Program, led the struggle in contesting a corporate-driven international intellectual property regime. After reviewing the origins of Brazil’s (...) treatment policies and patent reforms, I trace the actions and relationships between the state, civil society, transnational corporations, and local industry in three instances when Brazilian officials used compulsory licenses to reduce the price of medicines. Coalition-building and “naming and shaming” tactics contributed to Brazil’s success, while changing pharmaceutical capabilities limited more aggressive actions. (shrink)

Can Congress require AIDS service organizations to pledge fidelity to the government's view opposing prostitution as a condition of receiving funding? This term, the Supreme Court will decide whether the First Amendment permits such censorship in USAID v. Alliance for Open Society International (AOSI). The 2008 legislation reauthorizing the President's Emergency Plan for AIDS Relief (PEPFAR) requires host countries to support “activities promoting abstinence, delay of sexual début, monogamy, and fidelity.” PEPFAR's “conscience clause” allows organizations with a moral or religious (...) objection to opt out of providing services to patients with a sexual orientation of which they disapprove. In addition, the law requires grantees to adopt “a policy explicitly opposing prostitution” and to refrain from any speech or activities the government deems “inconsistent” with that policy. The antiprostitution pledge extends not only to what a recipient says or does with PEPFAR funds, but even to what it says or does with its own private funds. The government, however, has not enforced the pledge against U.S.‐based nongovernmental organizations partly because of a preliminary injunction granted by the lower courts. That injunction is now at risk if the Supreme Court upholds the loyalty oath. (shrink)

This book’s lead title seemed to make it a natural for review in the Journal of Scientific Exploration; but it is the subtitle that properly describes the contents: It deals almost exclusively with South African controversies, about HIV/AIDS in particular and medical matters more generally. Still, there are points of general interest. When a belief does not correspond to reality, the believers can go far astray in their actions and their recounting and explicating of events. So it is with this (...) book, which is based on the mistaken notion that a retrovirus designated HIV causes fatal illness—AIDS—by destroying the immune system. Readers should also beware of the frequently used but entirely misleading terms “AIDS denialist” and “AIDS denialism”: No one denies the existence of AIDS. What is denied is that AIDS is a new syndrome and that HIV is its cause. “Cognitive dissonance” refers to the fact of human psychology that makes it essentially impossible for true believers to recognize—to see, to take in—evidence that falsifies their belief. The classic description was by Festinger, Riecken, and Schachter (1956). Cognitive dissonance is rampant among those who have accepted HIV/AIDS theory, and this book illustrates it. (shrink)

Life Goes On (1989–1993) was the first television series in U.S. history not only to introduce a recurring teenaged HIV-positive character but also to feature an actor with Down syndrome in a leading role. Drawing new connections among disability studies, queer theory, and bioethics, I argue that Life responded to American disability rights activism and the AIDS epidemic of the early 1990s by depicting sex education as disability activism. By portraying fulfilling sexual relationships for its disabled protagonists, Life challenged heteronormative (...) and ableist underpinnings of marriage, sexuality, reproduction, and sex education and imagined transgressive queer/disabled alliances that often surpassed those of activists of its cultural moment. By representing homophobia, AIDS-phobia, and ableism as intertwined oppressions, the series conjured an expansive vision of sexual justice and pleasure, one that included and united teenagers, intellectually disabled people, and seropositive people—populations whose sexualities have generally been regarded as pathological or nonexistent. (shrink)

Statutes criminalizing behavior that risks transmission of HIV/AIDS exemplify use of the criminal law against individuals who are victims of infectious disease. These statutes, despite their frequency, are misguided in terms of the goals of the criminal law and the public health aim of reducing overall burdens of disease, for at least three important reasons. First, they identify individual offenders for punishment, a paradigm that is misplaced in the most typical contexts of transmission of infectious disease and even for HIV/AIDS, (...) despite claims of AIDS exceptionalism. Second, although there are examples of individuals who transmit infectious disease in a manner that fits the criminal law paradigm of identification of individual offenders for deterrence or retribution, these examples are limited and can be accommodated by existing criminal laws not devoted specifically to infectious disease. Third, and most importantly, the current criminal laws regarding HIV/AIDS, like many other criminal laws applied to infectious disease transmission, have been misguided in focusing on punishment of the diseased individual as a wrongful transmitter. Instead of individual offenders, activities that enhance the scale of disease transmission—behaviors that might be characterized as ‘transmission facilitation’—are a more appropriate target for the criminal law. Examples are trafficking in human beings (including sex trafficking, organ trafficking, and labor trafficking), suppression of information about the emergence of infection in circumstances in which there is a legally established obligation to disclose, and intentional or reckless activities to discourage disease treatment or prevention. Difficulties remain with justifications for criminalizing even these behaviors, however, most importantly the need for trust in reducing overall burdens of disease, problems in identifying individual responsible offenders, and potential misalignment between static criminal law and the changing nature of infectious disease. (shrink)

The way Cambodian patients and health professionals judge the priority of HIV-infected patients in relation to the allocation of antiretroviral drugs was examined. Participants were either HIV-infected patients attending the HIV/AIDS Care and Support Centre for People Living with HIV/AIDS in Phnom Penh (29 females and 21 males) or members of the staff (9 physicians, 6 pharmacists and 15 health counsellors and health educators). They were presented with stories of a few lines depicting a patient's situation and were instructed to (...) judge the extent to which the patient should be given priority for HIV drugs. The stories were composed according to a four within-subject factor design: (a) the patient's family responsibilities, (b) the severity of infection, (c) the time elapsed since the first consultation, and (d) the financial difficulties of the family. Most patients expressed the view that the drugs should be used for the patients who are most important from a familial point of view, namely, when the family contains small children and/or is already in a precarious financial condition. (shrink)

ABSTRACTThe way Cambodian patients and health professionals judge the priority of HIV‐infected patients in relation to the allocation of antiretroviral drugs was examined. Participants were either HIV‐infected patients attending the HIV/AIDS Care and Support Centre for People Living with HIV/AIDS in Phnom Penh or members of the staff . They were presented with stories of a few lines depicting a patient's situation and were instructed to judge the extent to which the patient should be given priority for HIV drugs. The (...) stories were composed according to a four within‐subject factor design: the patient's family responsibilities, the severity of infection, the time elapsed since the first consultation, and the financial difficulties of the family. Most patients expressed the view that the drugs should be used for the patients who are most important from a familial point of view, namely, when the family contains small children and/or is already in a precarious financial condition. (shrink)

Particular bodies within the Australian nation can be seen to threaten to disrupt and destabilise dominant notions of cultural citizenship. Understood through intricate intersections of ethnicity, gender and sexuality, ‘Australianness’–and its correlation to the geographical nation–is constantly monitored. Crucial here is the manner in which boundaries of whiteness, and ‘true Australianess’, are reconstituted, fuelling avoidance of the ambiguities of national belonging and ensuring the enduring pathologisation of the ‘un’Australian. In particular, discursive associations between HIV/AIDS and the ‘foreign’ as perceived contaminates (...) to the nation operate to reinforce these understandings. Here, the threat of disease both informs, and is fuelled by, connotations to ‘the foreign’, often conflating the two in very literal ways. Discourses of pathology correlate here with visceral connotations of pollution and darkness. As such, HIV/AIDS has become a crucial site whereby cultural fears of the ‘non-normal’ coalesce; a meeting point for all manner of perceived threats to the ‘white heteronormativity’ of a healthy Australia. The relationship between Australian citizens–rendered knowable and safe through normalising hegemonies–and the nation becomes one of identification through these signifying practices of fetishised affiliation. The body is implicated in all aspects of these complicated matrices of identity markings, revealing the fluid and often contradictory manner in which the nation’s cultural borders are articulated, assumed and performed, on, and through, the body. Indeed, as the taxonomies of national identity are reiterated and reaffirmed through discourses of the everyday, the boundaries rendering distinct those deemed truly ‘Australian’, by virtue of cultural appropriateness, become increasingly important in the desire to maintain the ‘essential’ nature of national belonging. (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)

As new HIV prevention tools are developed, researchers face a number of ethical and logistic questions about how and when to include novel HIV prevention strategies and tools in the standard prevention package of ongoing and future HIV prevention trials. Current Joint United Nations Programme on HIV/AIDS /World Health Organization guidance recommends that participants in prevention trials receive ‘access to all state of the art HIV risk reduction methods’, and that decisions about adding new tools to the prevention package be (...) made in consultation with ‘all relevant stakeholders’. The guidance, however, leaves open questions of both process and implementation. In March 2009, the Global Campaign for Microbicides, UNAIDS and the Centers for Disease Control and Prevention convened a consultation to develop practical answers to these questions. Fifty-nine diverse participants, including researchers, ethicists, advocates and policymakers, worked to develop consensus criteria on when to include new HIV prevention tools in future trials. Participants developed a set of questions to guide decision-making, including: whether the method has been recommended by international bodies or adopted at a national level; the size of the effect and weight of the evidence; relevance to the trial population; whether the tool has been approved or introduced in the trial country; whether adding the tool might lead to trial futility; outstanding safety issues and status of the trial. Further work is needed to develop, implement and evaluate approaches to facilitate meaningful stakeholder participation in this deliberative process. (shrink)

IN THE UNITED STATES, 25 PERCENT OF PEOPLE LIVING WITH HIV/AIDS HAVE spent time in the correctional system. HIV is known to spread among incarcerated individuals through high-risk behaviors including unprotected sex, injection drug use, tattooing, and body piercing. When released from prison, persons living with HIV can spread the disease in the wider community. This essay explores the complex problem of HIV infection among US prisoners from a common good approach rooted in Catholic social teachings by examining available data (...) on US prison populations, describing recent trends in the prosecution of drug-related crimes, and proposing concrete policy recommendations for HIV prevention interventions in US prisons. (shrink)

HIV/AIDS’e ilişkin damgalama ve ayrımcılık çağımızın en önemli sorunlarından birisidir. Bu makalede, sosyal bir sorun olarak HIV/AIDS’e ilişkin damgalama ve ayrımcılık incelenmektedir. HIV/AIDS sadece tıbbi bir hastalık değil, aynı zamanda ekonomik, kültürel, psikolojik ve sosyal boyutları da olan bir sorundur. HIV/AIDS’li bireylere karşı bireysel ve sosyal reaksiyonların çoğu, bu kişilere karşı korku, cehalet, sosyal yargı ve kontrol sonucu oluşan damgalamadan kaynaklanır. Sonuç olarak, bu çalışmada daha önce yapılmış çalışmalara dayalı olarak, HIV/AIDS’le ilgili damgalama ve ayrımcılığın sosyal neden ve sonuçları gözden (...) geçirilecektir.HIV/AIDS related stigma and discrimination are one of the vital problems of our century. This article focused on HIV/AIDS related stigma and discrimination as a social problem. HIV/AIDS is not merely a medical disease but also a problem, which possesses economical, cultural, psychological and social dimensions. Much of societal and individual reaction to people with HIV/AIDS may arise from stigma caused from fear, ignorance, social judgement and control. As a result in this paper, reasons and consequences of stigma associated with HIV/AIDS are reviewed by referring to preceding studies. (shrink)

Abstract -/- “The Obvious Invisibility of the Relationship Between Technology and Social Values” -/- We all too often assume that technology is the product of objective scientific research. And, we assume that technology’s moral value lies in only the moral character of its user. Yet, in order to objectify technology in a manner that removes it from a moral realm, we rely on the assumption that technology is value neutral, i.e., it is independent of all contexts other than the context (...) in which it is used morally or immorally by someone. However, there is a power to technology. At the very least, technology should be seen as reflecting the values that it rises from: a developmental context. Consequently, we can make the invisible moral realm visible as we investigate the relationship between culture and technology. Pragmatically, we can trace how cultural values inform what counts as a scientific question. When we look at the 1980s epidemiological model for AIDS we see how the presuppositions within a culture frame the type of question asked, i.e. What population do we see AIDS occurring in? This question initially leads scientific research away from actual individual behaviors until a different question is asked that leads the question towards behavioral epidemiological models rather than population models. Secondly, we can make visible the circumstance that depicts that what constitutes a scientific problem has a direct relationship to the types of technologies that are developed. We can more clearly see this circular relationship between culture and technology by looking at clinical research and practice regarding heart disease. Men who were dying of diagnosed heart disease were showing symptoms of problems in large arteries of the heart. Women were also dying of heart disease, but since their large arteries were not overwhelmingly compromised they were not being properly diagnosed until recently. Different technologies and protocol were needed to “see” different symptoms in the smaller vessels of women. Thirdly, I show how the types of technology developed, in turn, can create new values or enhance preexisting values within a culture. DNA research can be used to investigate long, unanswered questions about qualitative dimensions of life in quantitative manners. Yet, long held unanswered questions about a biological basis of race or intelligence are themselves rarely challenged as uninteresting or misguided even when they are tied to prejudicial qualitative assumptions if the chance of a “scientific” answer is possible. When existing technologies or modifications of existing technologies can be used they seem to direct human reactions and behaviors in predictable ways. The technologies themselves may be said to direct culture in ethically valenced manners. (shrink)

Particular bodies within the Australian nation can be seen to threaten to disrupt and destabilise dominant notions of cultural citizenship. Understood through intricate intersections of ethnicity, gender and sexuality, ‘Australianness’–and its correlation to the geographical nation–is constantly monitored. Crucial here is the manner in which boundaries of whiteness, and ‘true Australianess’, are reconstituted, fuelling avoidance of the ambiguities of national belonging and ensuring the enduring pathologisation of the ‘un’Australian. In particular, discursive associations between HIV/AIDS and the ‘foreign’ as perceived contaminates (...) to the nation operate to reinforce these understandings. Here, the threat of disease both informs, and is fuelled by, connotations to ‘the foreign’, often conflating the two in very literal ways. Discourses of pathology correlate here with visceral connotations of pollution and darkness. As such, HIV/AIDS has become a crucial site whereby cultural fears of the ‘non-normal’ coalesce; a meeting point for all manner of perceived threats to the ‘white heteronormativity’ of a healthy Australia. The relationship between Australian citizens–rendered knowable and safe through normalising hegemonies–and the nation becomes one of identification through these signifying practices of fetishised affiliation. The body is implicated in all aspects of these complicated matrices of identity markings, revealing the fluid and often contradictory manner in which the nation’s cultural borders are articulated, assumed and performed, on, and through, the body. Indeed, as the taxonomies of national identity are reiterated and reaffirmed through discourses of the everyday, the boundaries rendering distinct those deemed truly ‘Australian’, by virtue of cultural appropriateness, become increasingly important in the desire to maintain the ‘essential’ nature of national belonging. (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)

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)