Ethical perspectives on surveillance and preventive strategies for HIV/AIDS in South Africa

Koenane, Mojalefa Johannes (Stellenbosch : University of Stellenbosch, 2000-12)

Thesis

ENGLISH ABSTRACT: It is a well-known fact that the sub-Saharan Africa is a continent most affected by HIV/AIDS. The HIV/AIDS pandemic has in other words become our disease. For many of us, this fact may be difficult to fully accept. There are elements of prejudice in our reactions. Ignorance and intolerance can be found around the world. Therefore, by presenting the facts about HIV/AIDS, this assignment challenges the misconceptions and focuses on the profound dilemmas confronting society. I think the success in combating the HIV/AIDS pandemic could be found in President Thabo Mbeki's terminology "Partnership against HIV/AIDS". In his speech, the President appealed to both the private and public sectors and all South Africans to work together with greater determination than before to fight against HIV infection and AIDS. Arguably, this was the best speech President Thabo Mbeki ever made on HIV/AIDS on October 9, 1998. Back then, the government seems to have had a direction and led from the front in the battle against HIV/AIDS. The title of this thesis reads: "Ethical perspectives on surveillance and preventive strategies for HIV/AIDS in South Africa". Presently, the South African Government through the Ministry of Health is seriously considering making AIDS a notifiable medical condition. This is a serious and a controversial move that has serious ethical and legal implications that will be discussed. Should partners of HIV-infected individuals be informed? If the answer is on the affirmative, who should inform them? I am also looking at the ethical obligation of health care workers to treat HIV/AIDS patients despite the fear of being accidentally infected. Tough questions need to be asked. Should health workers be informed of the HIV status of every patients they treat? On the other hand, some patients have some fears too that HIV-infected health professionals may infect them. Again, the fundamental ethical concerns related to confidentiality, privacy, the right to treatment will also be discussed. The country is divided on this issue. Ethical principles are directly involved in such a decision, for instance, the principle of confidentiality, respect for autonomy and informed consent. How can the government go about implementing this without disregarding these fundamental ethical requirements?Another ethical issue that comes to mind regarding HIV/AIDS concerns AIDS vaccine trials, which are so far dominantly manufactured in 'developed countries' while subjects of these trials are from 'third world' or 'developing countries '. The ethical concerns here are: How will informed consent be protected, especially where subjects of the trials are not educated and do not understand the terms used? What are the cost-effects or benefits of such trials? What are the risks involved? Together with this, other issues include ethical debates concerning market prices of drugs, which are too expensive for poorer countries and affordable for richer countries. Finally, this work does not treat everything that needs to be dealt with insofar as HIV/AIDS is concerned. However, I hope that this thesis will contribute (in a small way) in making people appreciate the ethical dilemmas that are presented by HIV/AIDS.

AFRIKAANSE OPSOMMING: Dit is algemeen bekend dat Afrika suid van die Sahara die gebied is met die hoogste voorkoms van MIV/vIGS. Die MIV/VIGS-pandemie het dus ons siekte geword. Dit is vir baie van ons moeilik om hierdie feit te aanvaar, en ons reaksies is dikwels bevooroordeeld. Onkunde en onverdraagsaamheid oor MIV/vIGS word trouens wereldwyd aangetref. Hierdie verhandeling Ie klem op die feite van MIV/VIGS, en konfronteer sodoende hierdie wanopvattings terwyl daar gefokus word op die diepgaande dilemmas waarmee die samelewing gekonfronteer word. President Thabo Mbeki se woorde "Vennootskap teen MIV/VIGS" verwoord myns insiens die enigste oplossing vir die MIV/VIGS-pandemie. Die President doen in sy toespraak 'n beroep op al1e Suid-Afrikaners, in private en openbare sektore, om met groter determinasie saam te veg teen MIV-infeksie en VIGS; Hierdie toespraak, gelewer op 9 Oktober 1998, toe die regering klaarblyklik nog rigting gehad het en op die voorfront was in die styd teen MIV/VIGS, was moontlik President Thabo Mbeki se beste ooit oor die onderwerp MIV/VIGS. Die titel van hierdie verhandeling is "Etiese perspektiewe ten opsigte van waarnemende en voorkomende strategiee vir MIV/VIGS in Suid-Afrika". Die Suid-Afrikaanse regering, by monde van die Ministerie van Gesondheid, oorweeg dit tans sterk om VIGS 'n aanmeldbare mediese kondisie te verklaar. Die ernstige etiese en regsimplikasies van so 'n daadwerklike en kontroversiele stap sal in die verhandeling bespreek word. Behoort die rnetgesel1e van MIV-positiewe persone ingelig te word? Indien wei, wie moet hulle in kennis stel? Daar sal ook gekyk word na die etiese verpligting van gesondheidsorgwerkers om MIV/VIGS-pasiente te behandel ten spyte van hul1e vrees om per ongeluk besmet te word. Indringende vrae moet gevra word. Behoort gesondheidsorgwerkers ingelig te word oor die MIV-status van elke pasient wat hul1e behandel? Aan die ander kant vrees sornmige pasiente dat hul1e deur MIV-positiewe gesondheisorgwerkers besmet kan word. Die fundamentele etiese aangeleenthede rakende vertroulikheid, privaatheid en die reg tot mediese behandeling sal ook bespreek word. Suid-Afrika is verdeeld oor hierdie kwessies. Etiese waardes, soos die beginsel van vertroulikheid, respek vir outonomie en ingeligte goedkeuring is direk betrokke by besluite oor etiese kwessies. Die regering kan nie hierdie aangeleenthede implementeer sonder om die fundamentele etiese vereistes in ag te neem nie. VIGS-entstofproefnemings is'n verdere etiese kwessie wat ter sprake kom. Hierdie proefnemings word grotendeels deur "ontwikkelde" lande uitgevoer, tewyl die proefpersone van "derdewereldse" of "ontwikkelende" lande afkomstig is. Die etiese kwessies hierby betrokke is: hoe sal ingeligte goedkeuring beskerm word, veral wanneer proefpersone onopgevoed is en nie die tersaaklike terme verstaan nie? Wat is die kosteeffektiwiteit of voordele van hierdie proefnemings? Watter risiko's is betrokke? Die etiese debat oor die markprys van medisyne, wat heel bekostigbaar vir ryk lande, maar duur vir armer lande is, word ook aangeraak. Hierdie verhandeling dek nie alle relevante kwessies wat betref MIV/VIGS nie. Tog hoop ek dat dit 'n bydrae sal lewer tot mense se bewuswording van die etiese dilemmas wat MIV/VIGS inhou.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/16419
This item appears in the following collections: