This article examines bioethics in Tanzania, particularly in relation to the HIV/AIDS epidemic for the following reasons: First, not only is HIV/AIDS the most alarming health problem in most parts of Africa, but the complexity of issues involved in medical and research ethics clearly illustrates the various levels of problems that bioethics—more precisely, both professional medical ethics and research ethics—faces in a poor, developing country. The article defends uniformity in the general, international bioethical guidelines but calls for (...) wider discussion in their applicability in different economic and social conditions by claiming that in the present debates the issues of distributive justice, culture, and individual professional judgment have been tangled together in a manner that tends to justify double standards in practice. To avoid this confusion there is a need to find a more coherent approach to bioethics that brings together the normative requirements set by international guidelines, national policy planning, social ethics, and professional medical ethics. a. (shrink)

The aim of this study is to undertake an in-depth conceptual and ethical analysis of African philosophy of sex and the HIV/AIDS epidemic in Africa by taking the Oromo of Ethiopia as an example. The continent with just 10% of the world’s population is home to over 70% of the world’s HIV/AIDS infection. HIV/AIDS is a social, economic, demographic and moral problem as well as a health care issue. Some scholars hypothesise that the unique nature of (...) African sexuality, sexual promiscuity, the prevalence of other ailments, and the unique nature of the viral subtypes (known as clades) are the major reasons for Africa’s AIDS prevalence. However, there is little substance to their hypotheses. As of today there is no sound explanation for the prevalence of HIV/AIDS in Africa. So far the HIVintervention has largely focused on behaviours, systems and structures which are visible without fully taking into account culture, values, norms and traditions which are invisible but have a strong influence on visible aspects of individual behaviours and societal structures. Thus, this issue requires further research into people’s philosophy of sex and indigenous moral values. This study and the contributions of many scholars have shown that Africans have a diverse spectrum of sexual behaviour ranging from the very restrictive to the permissive. Although some ethnic groups have developed a profound philosophy of ex that can curb the expansion of HIV/AIDS, there have been some sexual and religious norms and expectations in Africa that have contributed to the rapid spread of HIV/AIDS. Social, economical, and political forces have also shaped the HIV/AIDS epidemic. This paper thus suggests that global fight against HIV/AIDS should go beyond a narrow focus on the behavioural and biological, and consider broader structural and underlying factors such as poverty, homelessness, widespread sex work, rural to urban migration, instability, a high rate of unemployment, unequal gender relations, harmful traditional practice and global injustice that have facilitated the spread of HIV/AIDS. African governments should involve the local people and civil society organisations in the fight against HIV/AIDS by using a wide range of participatory methodologies and culturally sensitive advocacy strategies. This study thus suggests that a multi-faceted approach is needed to deal with the challenges of the 21st century and address the HIV/AIDS epidemic in our world. This study relies on literature review, interviews and personal observation. (shrink)

The aim of this study is to undertake an in-depth conceptual and ethical analysis of African philosophy of sex and the HIV/AIDS epidemic in Africa by taking the Oromo of Ethiopia as an example. The continent with just 10% of the world’s population is home to over 70% of the world’s HIV/AIDS infection. HIV/AIDS is a social, economic, demographic and moral problem as well as a health care issue. Some scholars hypothesise that the unique nature of (...) African sexuality, sexual promiscuity, the prevalence of other ailments, and the unique nature of the viral subtypes (known as clades) are the major reasons for Africa’s AIDS prevalence. However, there is little substance to their hypotheses. As of today there is no sound explanation for the prevalence of HIV/AIDS in Africa. So far the HIVintervention has largely focused on behaviours, systems and structures which are visible without fully taking into account culture, values, norms and traditions which are invisible but have a strong influence on visible aspects of individual behaviours and societal structures. Thus, this issue requires further research into people’s philosophy of sex and indigenous moral values. This study and the contributions of many scholars have shown that Africans have a diverse spectrum of sexual behaviour ranging from the very restrictive to the permissive. Although some ethnic groups have developed a profound philosophy of ex that can curb the expansion of HIV/AIDS, there have been some sexual and religious norms and expectations in Africa that have contributed to the rapid spread of HIV/AIDS. Social, economical, and political forces have also shaped the HIV/AIDS epidemic. This paper thus suggests that global fight against HIV/AIDS should go beyond a narrow focus on the behavioural and biological, and consider broader structural and underlying factors such as poverty, homelessness, widespread sex work, rural to urban migration, instability, a high rate of unemployment, unequal gender relations, harmful traditional practice and global injustice that have facilitated the spread of HIV/AIDS. African governments should involve the local people and civil society organisations in the fight against HIV/AIDS by using a wide range of participatory methodologies and culturally sensitive advocacy strategies. This study thus suggests that a multi-faceted approach is needed to deal with the challenges of the 21st century and address the HIV/AIDS epidemic in our world. This study relies on literature review, interviews and personal observation. (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)

Contemporary art can be a powerful pedagogical tool in the health humanities. Students in an undergraduate course in the health humanities explore the subjective experience of illness and develop their empathy by studying three artists in the context of the AIDS epidemic: Keith Haring, Felix Gonzalez-Torres, and Wolfgang Tillmans. Using assignments based in narrative pedagogy, students expand their empathic response to pain and suffering. The role of visual art in health humanities pedagogy is discussed.

Australia and Thailand have made great progress in partnering with NGOs to respond to HIV/AIDS through the protection of human rights. Unquestionably, the Australian experience is more advanced. However, it is important to note that Australia’s political institutions and traditions were able to empower and accept an NGO movement of this nature almost from the start of disease identification.Thailand did not have this advantage, having only moved toward political institutions that are open to public opinion and civil society’s input (...) within the last 15 years.In spite of their varied histories, both countries eventually traveled down similar paths. In Australia, HIV/AIDS NGOs moved rapidly forward from being standard-setting, fact-finding, and advocacy organizations to becoming capable of creating new HIV/AIDS umbrella organizations and influencing existing governmental organizations on HIV/AIDS human rights issues. Indeed, by the close of the 1980s, NGOs had established themselves firmly in all of these roles. The fact that Australia still struggles with addressing an emerging epidemic among indigenous people is more a sign that the movement has thus far been incomplete than that it is faltering or ineffective. Additionally, now that NGOs are actively working through AFAO on behalf of indigenous peoples, it is likely that there will finally be more movement on human rights and H1V/AIDS issues for this group. However, sex tourism and the illegal trafficking of women and children for purposes of prostitution continue to require ongoing proactive management by the partnership before they become a serious epidemic threat.Thailand’s situation is somewhat different from that of Australia. The HIV/AIDS NGO community has grown since the epidemic exploded in the 1990s, but the organizations themselves continue to have limited power, While they have been an important voice in human rights standard-setting, fact-finding and advocacy regarding HIV/AIDS, they remain unable to fully influence the governmental organizations that ultimately make and implement human rights policies in these areas. As the NGO experience in general is new to Thai politics, continuing human rights abuses are a sign of the miles left to travel on this road rather than an indicator that the road needs to be abandoned.Regardless of their differing experiences with creating HIV/AIDS partnerships, it is impossible to say that either effort has failed to use this mechanism successfully to at least begin seriously addressing HIV/AIDS human rights issues. What can be said is that each partnership can be placed at a differing point on a continuum of effectiveness that ultimately concludes with a fully integrated partnership capable of fundamentally influencing a country’s HIV/AIDS human rights policies on an ongoing basis. (shrink)

In this humane and graceful book, philosopher Timothy Murphy offers insight into our attempts--popular and academic, American and non-American, scientific and ...

The recent statistics on the prevalence of HIV and AIDS shows that the number of people living with the virus keep on increasing amidst government’s interventions to deal with the epidemic. Pentecostal churches have a potential to deal with the problem, given their theology of experience, but are hindered by some myths about the factors associated with the epidemic highlighted in this article, such as the demonisation of sex and HIV and AIDS, judgemental views, denominationalism and (...) condemnation of condoms. Many scholars interested in the study of HIV and AIDS have researched these myths. The unique contribution that this article makes is a proposal for a strategy of demythologisation of the factors associated with the epidemic among Pentecostals. The article uses a literary analysis to discuss effective ways of dealing with the epidemic in South Africa, such as to talk openly about sex, encourage safer sex, adopt a tolerant approach, embrace a holistic view and reconstruct a theology of HIV and AIDS. (shrink)

Studying national and local contexts is essential for understanding the ending of epidemics and related policy responses. This article examines HIV/AIDS in the 1980s and 1990s and swine flu in 2009-2010 in the UK as comparative “tracer epidemics” to understand the multiplicity of endings from the perspective of the contemporary history of policy. Such endings can include: the political ending, changes in definition away from epidemic, the medical end, different endings for different “risk groups,” local endings, and media (...) endings. This multiplicity of endings throws light on the nature of political and institutional structures and their change over time. (shrink)

The present situation of the HIV/aids epidemic is very grim in China. The probability of China becoming a country with a high prevalence of HIV/aids cannot be excluded because there have been factors which promote the wide spread of HIV if we fail to take timely action to prevent it at the opportune moment. However, China's HIV prevention policy is inadequate. Health professionals and programmers believed that they could take a conventional public health approach to cope with (...) the HIV epidemic. They simply ignored the fact that HIV infection is an epidemic so special that their approach is not effective to deter the epidemic. Many health professionals and programmers bypassed ethical issues that had emerged in the prevention of the HIV epidemic. Even some health educators, sexologists and officials believe that `AIDS is the punishment for promiscuity', and this belief has led to discrimination and stigmatization of AIDS patients, HIV positive people, their family members and high risk groups. Although homosexuality is not illegal, the police can always find any reason to detain homosexuals. A difficult ethical issue is about the laws prohibiting prostitution and drug use in China which force prostitutes and intravenous drug users underground, giving them no chance to access information, education and the services needed to protect them. The dilemma facing China is whether to stay with a restrictive policy for the reason of ideology cleansing or to turn to a more supportive policy. It is necessary to have some change in the ethical framework to evaluate the action in HIV prevention. Tolerance should be the first ethical principle. (shrink)

The present situation of the HIV/AIDS epidemic is very grim in China. The probability of China becoming a country with a high prevalence of HIV/AIDS cannot be excluded because there have been factors which promote the wide spread of HIV if we fail to take timely action to prevent it at the opportune moment. However, China's HIV prevention policy is inadequate. Health professionals and programmers believed that they could take a conventional public health approach to cope with (...) the HIV epidemic. They simply ignored the fact that HIV infection is an epidemic so special that their approach is not effective to deter the epidemic. Many health professionals and programmers bypassed ethical issues that had emerged in the prevention of the HIV epidemic. Even some health educators, sexologists and officials believe that `AIDS is the punishment for promiscuity', and this belief has led to discrimination and stigmatization of AIDS patients, HIV positive people, their family members and high risk groups. Although homosexuality is not illegal, the police can always find any reason to detain homosexuals. A difficult ethical issue is about the laws prohibiting prostitution and drug use in China which force prostitutes and intravenous drug users underground, giving them no chance to access information, education and the services needed to protect them. The dilemma facing China is whether to stay with a restrictive policy for the reason of ideology cleansing or to turn to a more supportive policy. It is necessary to have some change in the ethical framework to evaluate the action in HIV prevention. Tolerance should be the first ethical principle. (shrink)

This dossier article contains four short and varied contributions from activists and other service and healthcare providers who have been agitating and working on the frontlines of HIV/AIDS in Ireland since the early 1980s. The dossier contains: (1) a history, by Bill Foley, of the early collective efforts of a group of gay men to provoke government action and healthcare under the umbrella of Gay Health Action (GHA) (2) a speech delivered by Dr. Erin Nugent to government officials on (...) the re-branding of HIV Ireland in 2015; (3) a brief history, recounted by Noel Donnellan, of ACT UP Dublin since it was revitalized in 2016 by a small cohort of dedicated activists from a dormant group into a vibrant collective that has achieved great legislative change with regards to pre-exposure prophylaxis (PrEP); and (4) a polemic, written by Thomas Strong, on living with HIV as a queer man in Ireland that demonstrates the ways in which HIV stigma not only thrives in but molds and shapes twenty-first-century gay men’s communities, both in real life and online. (shrink)

The AIDS epidemic has elicited sometimes conflicting Jewish theological, ethical, and halackhic responses regarding morality, compulsory testing and treatment, and ritual circumcision. Compiled here are 12 major texts, 1986-1995, and the resolutions on AIDS of two US Jewish organizations. Some bibliographic references are in untranslated Hebrew. Annotation copyrighted by Book News, Inc., Portland, OR.

This article’s central aim is to debunk the overly simplified, paradigmatic, and essentialist description of certain types of Muslim sexuality, arguing that such essentialist characterization of Muslims ignores the nonunique social determinants (poverty, education, and sociostructural exclusions) of HIV/aids risk in an increasingly globalized world. To support this argument, we rely on a thematic and comparative analysis. A reoccurring theme in this project is that issues of public health, human rights, justice, and social empowerment are inextricably intertwined. Having established (...) a conceptual framework linking health and human rights, we use a comparative analysis of the cases of Iran, Indonesia, and Bangladesh in an attempt to single out similarities and differences among these cases. All these cases hold a majority Muslim population (at 98%, 86%, and 89%, respectively) and are also representative of the two primary strands of Islam: Shi’a and Sunni. Additionally, each of these states has signed the Declaration of Commitment on HIV/aids and reports the progress of their HIV/aids treatment and prevention efforts to United Nations Program on HIV/aids, the United Nations organization tasked with monitoring and combating the spread of HIV/aids. (shrink)

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

HIV-related state laws are being created transnationally though the use of omnibus model laws. In 2004, the US Agency for International Development funded the creation of one such guidance text known as the USAID/Action for West Africa Region Model Law, or N'Djamena Model Law, which led to the rapid spread of HIV/AIDS laws, including the criminalisation of HIV transmission, across much of West and Central Africa . In this article, I explicate how an epidemic of highly problematic legislation (...) spread across the region as a result of a text-mediated work process enabled through model laws. I theorise the textual genre of model laws arguing that these texts are best understood as ‘preoperative documents’ which, when activated, can lead to swift legislative reform in and beyond the field of HIV/AIDS governance. The legislative process being investigated was made visible through participant observation, archival research, textual analysis and informant interviews with national and international stakeholders . This involved ethnographic research in Canada, the USA, Switzerland, Austria, South Africa and Senegal . The untold policy processes and narratives explored in this article make evident how the work of contesting problematic HIV/AIDS model laws and newly drafted state laws involves both creating new texts and contesting the legitimacy and efficacy of others. (shrink)

The historiography of pandemics and inequality can be characterized by two distinct but often overlapping traditions. One centers structural and political analysis, the other a race-critical approach to the production of human difference. This bibliographic essay reviews historical scholarship in these traditions spanning the past hundred years, with a focus on Anglophone literature in the history of medicine in the United States over the past half century. Early writing on the history of epidemics celebrated the conquest of disease through the (...) application of laboratory research. Insights from social history and environmental history came to inform new analyses of epidemic inequalities, drawing questions of race, class, and empire into the frame during the 1960s and 1970s. The AIDS pandemic of the 1980s further oriented scholarship toward reckoning with stigma, identity, and human experiences of inequality while also troubling the relationship between medicine and the state. In more recent decades, the scholarship on race, social inequality, and pandemics has become deep and broad, remedying longstanding biases toward elite scientific actors and the metropolitan centers of Europe and the East Coast of the United States. In expanding their vision, historians also have engaged in more nuanced analyses of racialization as a social, environmental, and ideological process of embodying difference. Further, where earlier scholarship often relied on mortality data, there has been growing awareness of how numbers shape narratives and are shaped by them in turn. In its conclusion, the essay highlights emerging themes in race and inequality with particular attention to themes that have become prominent amid the global devastation wrought by the COVID-19 pandemic. (shrink)

Irrational responses to patient with AIDS, particularly in regards to the transmissibility of HIV are examined from an historical and psychosocial perspective. Although these responses are similar to those reported from past epidemics such as plague and leprosy, they are in direct conflict with our current level of understanding regarding the transmission of this virus. Their genesis may relate to the human penchant to react to illness metaphorically. In order to allay effectively public concern about the transmissibility of (...) class='Hi'>AIDS, it is essential to recognize the metaphor associated with venereal disease in general and AIDS in particular. (shrink)

Sub-Saharan Africa is the epicenter of the HIV/AIDS epidemic, and in this issue of the Journal, seven authors discuss the moral, social and medical implications of having 70% of those stricken living in this area. Anton A. van Niekerk considers complexities of plague in this region (poverty, denial, poor leadership, illiteracy, women's vulnerability, and disenchantment of intimacy) and the importance of finding responses that empower its people. Solomon Benatar reinforces these issues, but also discusses the role of global (...) politics in sub-Saharan Africa, especially discrimination, imperialism and its exploitation by first world countries. Given the public health crisis, Udo Schüklenk and Richard E. Ashcroft defend compulsory licensing of essential HIV/AIDS medications on consequentialist grounds. Keymanthri Moodley discusses the importance of conducting research and the need to understand a moderate form of communitarianism, also referred to as "ubuntu" or "communalism", to help some Africans understand research as an altruistic endeavour. Godfrey B. Tangwa also defends traditional African values of empathy and ubuntu, discussing how they should be enlisted to fight this pandemic. Loretta M. Kopelman criticizes the tendency among those outside Africa to dismiss the HIV/AIDS pandemic, attributing one source to the ubiquitous and misguided punishment theory of disease. The authors conclude that good solutions must be cooperative ventures among countries within and outside of sub-Saharan Africa with far more support from wealthy countries. (shrink)

AIDS provides society an opportunity to expand and rationliza control over a broad range of psychological phenomena. Social control today is panoptical, involving dispersed centers and agents of surveillance and discipline throughout the whole community . The control of persons perceived as "dangerous" is effected partly through public psycho-social discourse on AIDS. This reproduces earlier encounters with frightening diseases, most notably the nineteenth-century cholera epidemic, and reveals a morally-laden ideology behind modern efforts at public hygiene.

The AIDS crisis poses a special challenge for American health care, which depends heavily on private insurance to pay medical bills. Can we provide adequate health care to all who need it and still meet the financial requirements of the private health insurance industry? More insurance carriers are turning to antibody testing in order to eliminate poor risks from non‐group, direct‐pay pools. Some cost‐conscious employers have attempted to fire AIDS patients summarily or to exclude AIDS coverage from (...) group insurance policies. Various remedies are available for spreading the financial risks of the epidemic, such as covering persons with AIDS under Medicare or in state‐sponsored health insurance pools. Ethical questions about cost and access may also rekindle the debate about the need for national health insurance. (shrink)

This paper is not about the medical condition of AIDS. Nor is it about the history of the condition since it was first reported in Atlanta, Georgia in 1981. It looks rather, at the catalogue of legislative and other legal responses to the spread of AIDS. The paper analyses the AIDS condition in its historical context. The hysteria accompanying the outbreak of AIDS is contrasted with the similar hysteria associated with other previous epidemics experienced in Australia (...) over the past two centuries. The paper categorises the responses of lawmakers to the condition, according to the approach taken; from 'full blast', through 'moderate heat' to 'low key' or an attempt to avoid or minimise legal intervention. It is suggested that the appropriate response should depend upon such factors as the present magnitude of the condition, its likely future course, the availability of cures and protections against its spread and objectives being sought by intervention. Unless these factors are taken into account gross over-reaction can occur, causing social disruption and much personal injustice. (shrink)

Most major pharmaceutical companies have corporate social responsibility policies that pledge their commitment to improving the health and quality of life of people around the world. Yet these same companies also have difficulty in ensuring that developing countries have access to affordable medications. In the late 1990s, Brazil engaged in a heated battle with large US-backed multinational pharmaceutical companies. Brazil was facing a growing HIV epidemic and was determined to provide treatment to those in need. This required massive price (...) reductions on HIV medications. Although met with resistance, Brazil’s campaign eventually resulted in the negotiation of significant price reductions. Our study examines how Brazil was able to secure these price concessions. We conclude that corporate social responsibility initiatives must be viewed as a dynamic interaction between multiple actors. Our study highlights the importance of governmental action, in both the national and international forums, to negotiate pro-actively with companies to ensure that CSR commitments are met. (shrink)

Most major pharmaceutical companies have corporate social responsibility policies that pledge their commitment to improving the health and quality of life of people around the world. Yet these same companies also have difficulty in ensuring that developing countries have access to affordable medications. In the late 1990s, Brazil engaged in a heated battle with large US-backed multinational pharmaceutical companies. Brazil was facing a growing HIV epidemic and was determined to provide treatment to those in need. This required massive price (...) reductions on HIV medications. Although met with resistance, Brazil’s campaign eventually resulted in the negotiation of significant price reductions. Our study examines how Brazil was able to secure these price concessions. We conclude that corporate social responsibility initiatives must be viewed as a dynamic interaction between multiple actors. Our study highlights the importance of governmental action, in both the national and international forums, to negotiate pro-actively with companies to ensure that CSR commitments are met. (shrink)

This paper contrasts biomedical and epidemiological approaches to the diagnosis and treatment of disease, and uses Collingwoods principle of the relativity of causes to show how different approaches focus on different causal factors reflecting different interests. By distinguishing between the etiology of a disease and an epidemic, the paper argues that, from an epidemiological perspective, poverty is an important causal factor in the African AIDS epidemic and that emphasizing this should not be considered incompatible with recognizing the (...) causal necessity of HIV for the AIDS disease. (shrink)