Academic literature on the topic 'AIDS (Disease) Treatment Moral and ethical aspects'

This article focuses on the elderly patient with a progressive and irreversible dementia, most often of the Alzheimer type. However dementia, the decline in mental function from a previous state, can occur in all ages. For example, if Alzheimer's disease (AD) is the dementia of the elderly, increasingly AIDS is the dementia of many who are relatively young. I will not present the major ethical issues relating to dementia care following the progression of disease from the mild to the severe stages, for I have done this elsewhere. Among the issues included are: presymptomatic testing, both psychological and genetic; responsible diag- nostic disclosure and use of support groups; restrictions on driving and other activities; preemptive assisted suicide; advance directives for research and treatment; quality of life in relation to the use of life-extending technologies; and euthanasia.

In recent years, the interest in corporate social responsibility issues has shown an increase. Worldwide problems, especially those related to HIV/AIDS, caught public attention towards Corporate Social Responsibility (CSR) themes. In a country with more people living with HIV/AIDS than in any other nation (UNAIDS 2007), prevention and treatment is critical. HIV/AIDS is seen to be threatening the communities in which businesses are functioning and is further threatening the business itself. This article examines the moral and social responsibility of the corporate sector in its effort to deal with the issue of HIV/AIDS. Big business leaders have recognized the threat of HIV/AIDS to the workplace and have positioned responses towards the disease from an ethical, legal and cost-effective business perspective; however the response from small to medium businesses is relatively weak. This article conveys a descriptive critique, based on bibliographic research on Corporate Social Responsibility, HIV/AIDS and related concepts.

In recent years, the interest in corporate social responsibility issues has shown an increase. Worldwide problems, especially those related to HIV/AIDS, caught public attention towards Corporate Social Responsibility (CSR) themes. In a country with more people living with HIV/AIDS than in any other nation (UNAIDS 2007), prevention and treatment is critical. HIV/AIDS is seen to be threatening the communities in which businesses are functioning and is further threatening the business itself. This article examines the moral and social responsibility of the corporate sector in its effort to deal with the issue of HIV/AIDS. Big business leaders have recognized the threat of HIV/AIDS to the workplace and have positioned responses towards the disease from an ethical, legal and cost-effective business perspective; however the response from small to medium businesses is relatively weak. This article conveys a descriptive critique, based on bibliographic research on Corporate Social Responsibility, HIV/AIDS and related concepts.

Abstract Like medicine, ethics is a practical discipline, which they acquire the knowledge of the general principles and skills to solve problems. Long term care involves both clinical and ethical issues in medicine. Effective medical education of long-suffering patients has to be focusing on increasing their adherence to treatment. The occurrence of AIDS pandemic has changed the physician’s way of thinking in terms of ethics in general, and in medicine in particular. HIV/AIDS has focused attention on deficiencies in the field of therapy, long care issues, medical training and education of the patients, as well as in deontology. The treatment of HIV infected patients with all new drugs discovered is not yet completely curative and the association of opportunistic infections, as tuberculosis (TB), is representing a permanent challenge for therapist. Both ethical and medical training in general as regards AIDS and TB, should focus mainly on exposed people and learning through experience, to form skills that would make doctors to work with sensitivity in regard to sexuality, substance abuse, lack of treatment, relapses of disease and even death. In the same time, any ethical or cultural environment can enrich and support the real moral education of medical staff. Medical ethics and ethics relating specifically to TB and HIV/AIDS, often meet highly complex problems. Alternative possibilities and decisions to take of what is right or wrong may create a real ethical, clinical and therapeutic dilemma.

In the research ethics literature, there is strong disagreement about the ethical acceptability of placebo-controlled trials, particularly when a tested therapy aims to alleviate a condition for which standard treatment exists. Recently, this disagreement has given rise to debate over the moral appropriateness of the principle of clinical equipoise for medical research. Underlying these debates are two fundamentally different visions of the moral obligations that investigators owe their subjects.Some commentators and ethics documents claim that physicians, whether acting as care givers or researchers, have the same duty of beneficence towards their patients and subjects: namely, that they must provide optimal medical care. In discussing placebo surgery in research on refractory Parkinson's disease, Peter Clark succinctly states this view: “The researcher has an ethical responsibility to act in the best interest of subjects.”

Background: Nurses and physicians in nephrology settings provide care for patients with end-stage kidney disease receiving hemodialysis treatment along a complex illness trajectory. Aim: The aim was to explore physicians’ and nurses’ perspectives on the trajectories toward the end of life involving decisions regarding hemodialysis withdrawal for patients with end-stage kidney disease. Research design and participants: A qualitative research approach was used. Four mixed focus group interviews were conducted with renal physicians (5) and nurses (17) in Sweden. Qualitative content analysis was used to analyse data. Ethical considerations: Ethical approval was obtained (Dnr 2014/304-31). Findings and discussion: Findings illuminated multi-faceted, intertwined processes encompassing healthcare professionals, patients, and family members. The analysis resulted in four themes: Complexities of initiating end-of-life conversations, Genuine attentiveness to the patient’s decision-making process, The challenge awaiting the family members’ processes, and Negotiating different professional responsibilities. Findings showed complexities and challenges when striving to provide good, ethical care which are related to beneficence, nonmaleficence, and self-determination, and which can give rise to moral distress. Conclusion: There are ethical challenges and strains in the dialysis context that healthcare professionals may not always be prepared for. Supporting healthcare professionals in not allowing complexities to hinder the patient’s possibilities for shared decision-making seems important. An open and continual communication, including family meetings, from dialysis initiation could serve to make conversations involving decisions about hemodialysis withdrawal a more natural routine, as well as build up a relationship of trust necessary for the advance care planning about the end of life. Healthcare professionals should also receive support in ethical reasoning to meet these challenges and handle potential moral distress in the dialysis context.

The scientific importance of our recently acquired ability to test for heredity predisposition to breast and ovarian cancers is paralleled only by its social and ethical relevance. Dilemmas are common in all genetic testing, but they assume particular nuances in the setting of breast cancer. Due to its devastating nature and to its increasing incidence, breast cancer is a central issue in women’s health. Breast cancer patients and women in general are often deeply involved in understanding the disease process and the treatment options, as they are in discussing the psychological, social and moral ramifications. This paper is a reflection upon some qualitative aspects of the debate that surrounds genetic testing for breast and ovarian cancer, as they have emerged in my encounters with breast cancer patients prior to their decision to consider genetic testing. The five recurrent themes identified in those conversations may or may not be representative of other practice situations, but they illustrate some fundamental philosophical, ethical and moral questions which exist at the core of our human essence and of our moral agency, and which point to the unavoidable intertwinement of medicine, culture, normativity and philosophy, vis-à-vis the many questions raised by genetics. The Author has intentionally refrained from questionnaires, which could betray the complexity of our thinking process, and from the vignettes, as they could betray confidentiality. The paper concludes that the correct answers to the dilemmas posed by genetic testing for breast cancer predisposition can only arise from a blend of medical, social and philosophical analysis.

Overview Objective: The aim of this research is to present our experiences with the surgical treatment of gynecological patients among Jehovah’s Witnesses. Moreover, the medical, moral, and ethical problems in this regard have been highlighted. Methods: 75 Jehovah’s Witnesses patients were operated on for various benign and malignant gynecological diseases between 2007 and 2018. All of these patients were operated on according to the rules of blood-sparing surgery. Results: The operations were assessed according to the dia­gnosis, mode of surgery, estimated blood loss, and disease outcome. Excessive blood loss did not occur during any of these operations, and the estimated blood loss for the same procedure was 10 to 550 mL. Conclusion: Jehovah’s Witnesses gynecological patients is a group of high-risk patients because they refuse to undergo blood transfusion. Nevertheless, the principles of blood-sparing surgery should be applied to not only Jehovah’s Witnesses patients but also to all patients in general. Even if a blood transfusion is the last resort to solve issues pertaining to excessive blood loss during complicated operations, the said procedure always carries certain risks. Therefore, blood transfusion should be performed only on rare occasions. Jehovah’s Witnesses patients categorically refuse blood transfusion even if it is the only way to save one’s life. Even though the legislation of the Czech Republic deals with this problem, there are other moral and ethical aspects that need to be addressed in this regard. Keywords: bloodless surgery – Gynecologic surgery – Jehovah’s Witnesses – legislation – moral and ethical problems

The first case of HIV infection was reported in Nigeria in1986. Since then, the prevalence has risen from less than 0.1% in 1987 to 5.8% in 2002, and an estimated 3.6 million Nigerians now live with HIV/AIDS. More than 40 oral manifestations of HIV infection have been recorded and between 70% and 90% of persons with HIV infection will have at least one oral manifestation at sometime during the course of their disease. Oral health-care workers (OHCWS) are expected to play active roles in the prevention and control of HIV/AIDS. In this study, a one-day workshop was organized for 64 oral health workers in Ile-Ife, Nigeria, focusing on the epidemiology of HIV/AIDS, the oral manifestations, control and prevention of HIV in a dental environment, oral care of the infected patient and the ethical, legal and social aspects of HIV/AIDS. Participants' knowledge and practices of infection control were assessed with an infection control checklist administered pre- and post-workshop. Sixty (90.8%) respondents believed that HIV/AIDS was not yet a problem in Nigeria, and 58 (90.6%) believed that drugs have been developed which can cure HIV infection and AIDS. The men complied more with waste disposal regulations than women ( P=0.010). Twenty-nine of 58 (50.0%) did not discard gloves which were torn, cut or punctured. Seven (12.1%) did not change gloves between patients' treatment. Conscious efforts should be made to train OHCWS on all aspects of HIV/AIDS prevention and care. It must never be assumed that adequate information will be acquired through tangential sources.

Both sperm and embryo cryopreservation have become routine procedures in human assisted reproduction and oocyte cryopreservation is being introduced into clinical practice and is getting more and more widely used. Embryo cryopreservation has decreased the number of fresh embryo transfers and maximized the effectiveness of the IVF cycle. The data shows that women who had transfers of fresh and frozen embryos obtained 8% additional births by using their cryopreserved embryos. Oocyte cryopreservation offers more advantages compared to embryo freezing, such as fertility preservation in women at risk of losing fertility due to oncological treatment or chronic disease, egg donation, and postponing childbirth, and eliminates religious and/or other ethical, legal, and moral concerns of embryo freezing. In this review, the basic principles, methodology, and practical experiences as well as safety and other aspects concerning slow cooling and ultrarapid cooling (vitrification) of human embryos and oocytes are summarized.

Thesis (M.Phil.)--Stellenbosch University, 2000.
ENGLISH ABSTRACT: AIDS is the most important threat to world health. Recent years have seen a dramatic spread of HIVand AIDS in South Africa. Health education directed at modifying risk behaviour appears to be the only way in which the disease can be contained. Controlling AIDS is not only by controlling the virus, but also involves tackling social, economic and political issues and putting AIDS into the broader context of sexuality and gender roles. This requires a broader understanding of this aspect of HIV-AIDS ranging from population dynamics, through to research on individual behaviour and its socio-economic impact; so that we can dispel the myths and rumours that surround AIDS and answer searching questions that will be asked by the community. In South Africa, HIV-AIDS remains a stigmatized disease. There have been calls from courageous and influential people for those who are living with HIV-AIDS to be open about their status and to destigmatise the disease. Institutions too have been drawn into the controversy about whether to remain silent or speak out. Southern African Anglican bishops, as well as some politicians declared their intention to undergo testing for HIV status in order to sensitise the public to the seriousness of the epidemic. Were AIDS not regarded as intolerable, the entire issue of confidentiality would fall away. Calls to destigmatise the disease through openness cannot stand alone. Government must put effective treatment programmes in place. In the absence of treatment, AIDS may represent only frustration and hopelessness to those who test positive; and fear, danger and resultant animosity to those who are HIV negative. The text is in four chapters. Chapter 1 focuses on confidentiality as an important principle in the management of disease. In HIV -AIDS, confidentiality is a more sensitive issue as AIDS is particularly viewed as a social stigma, accompanied by discrimination and harassment. The chapter also addresses HIV infection, transmission, counseling and screemng. Chapter 2 deals with the principles of biomedical ethics namely, autonomy, to enable the patient to determine his/her course of treatment; informed consent, designed to protect the interests of patients from exploitation and harm, and encourage health professionals to act responsibly; beneficence and nonmaleficence, to protect the welfare of others; and justice, to ensure access to health care for all. It also highlights the aspects of and limitations to confidentiality. Chapter 3 discusses broadly the ethical dilemmas pertammg to professional-patient relationships, women and HIV-AIDS, religion, prisoners and employer-employee relationships. When the AIDS epidemic started, very few people suffered from the disease, and the disease was treated with great caution and confidentiality. Today, AIDS is a pandemic and emphasis should shift from the ethic of autonomy and confidentiality, to a social ethic, which emphasizes the responsibility of minimizing the risk of spread of infection. The chapter also examines the role of the Department of Health, the participation of health professional bodies and the legal aspects relating to confidentiality in HIV-AIDS. Chapter 4 attempts to construct an argument to destigmatise HIV-AIDS by arguing the responsibility of the government to make sufficient resources available for the treatment and control of the pandemic. Health professionals are challenged to engage their expertise and skills in the service of the sick with dignity and respect. The community is encouraged to support the drive towards controlling the spread of HIV infection and enable people living with AIDS to disclose their status without fear of harassment.
AFRIKAANSE OPSOMMING: Vigs is die gevaarlikste bedreiging van wéreldgesondheid. Die afgelope paar jaar het 'n dramatiese verspreiding van mv en VIGS in Suid-Afrika plaasgevind. Gesondheidsopvoeding wat gemik is op die verandering van risiko-gedrag is skynbaar die enigste metode wat die siekte kan beheer. Die kontrolering van VIGS is nie net die kontrolering van die virus nie, maar dit betref ook herbesinning oor sosiale, ekonomiese en politiese en geslagsrolle. Dit vereis 'n omvattender verstaan van hierdie aspek van HIV-VIGS, wat strek vanaf van bevolkingspatrone tot by die navorsing oor individuele gedrag en die sosio-ekonomiese impak van 19. So kan ons hopelik help om die mites rondom VIGS te besweer. In Suid-Afrika bly mV-VIGS 'n gestigmatiseerde siekte. Daar rus 'n veranbtwoordelikheid op invloedryke mense wat met mV-VIGS leef en wat as rolmodelle sou kon dien, om hul mv -status te openbaar en sodoeonde te help om die siekte te destigmatiseer. Instansies is ook by hierdie twispunt betrek om vas te stelof die mense moet praat of swyg. Suider-Afrikaanse Anglikaanse Biskoppe, asook somige politici het hulle intensies aangekondig om die mv -toets te ondergaan om sodoende die publiek te help opvoed oor die gevaar van hierdie epidemie. Oproepe om die siekte te destigmatiseer deur openbaarheid kan nie in isolasie funksioneer nie. Die staat moet effektiewe kuratiewe en voorkomingsprogramme hier rondom loods en kontinueer. In die afwesigheid van 'n geneesmiddel, sal VIGS slegs frustrasie, hopeloosheid, en vrees skep by diegene wat positief getoets is, sowel as vyandigheid onder diegene wat nie mv positief is nie. Die teks het vier hoofstukke. Hoofstuk 1 fokus op vertroulikheid as 'n belangrike beginsel in die bestuur van die siekte. In mV-VIGS is vertroulikheid 'n meer sensitiewe beginsel aangesien VIGS in die besonder as 'n sosiale skandvlek, aangevreet deur diskriminasie, gesien word. Die hoofstuk bespreek ook mv -infeksie, transmissie, raadgewing en toetsing. Hoofstuk 2 gaan oor die beginsels van die biomediese etiek, naamlik, outonomie, waaronder ingeligte toetstemming, ontwerp om die belange van die pasiente te beskerm teen eksploitasie en gevaar: om gesondheids professionele aan te moedig om hulle op 'n verantwoordelike manier te gedra. Ander beginsels is goedwilligheid en niekwaadwiligheid om die welsyn van ander te beskerm, asook geregtigheid, om toegang tot gesondheidshulp vir almal te verseker. Dit beklemtoon ook die aspekte verwant aan beperkinge tot vertroulikheid. Hoofstuk 3 bespreek breedweg die etiese dilemmas met betrekking tot die verhouding tussen pasiënye en professionele gesondheidswerkers, vrouens en mV-VIGS, godsdiens, gevangenes en werkgewer-werker verhoudings. Toe die VIGS-epidemie begin het, het min mense aan die siekte gely, en die siekte is met groot sorg en vertroulikheid behandel. Vandag is VIGS 'n pandemie en die klem moet geskuif word vanaf outonomie en vetrouilikheid na 'n sosiale etos wat verantwoordlikheid en die vermindering van die risiko van die verspreiding van die infeksie beklemtoon. Die hoofstuk kyk ook na die rolle van gesondheidsdepartmente, deelname van gesondheids professionele organisasies en die juridiese aspekte met betrekking tot vertroulikheid van HIV-VIGS. Hoofstuk 4 poog om 'n argument te ontwikkel wat daartoe sou kon bydra dat HIV-VIGS gedestigmatiseer sal word. Klem word gelê op die verabtwoordelikheid van die staat om soveel moontlike bronne beskikbaar te stel vir die behandeling van en beheer oor hierdie pandemie. Gesondheids professionele word uitgedaag om hulle deskundigheid en bekwaamheid in die diens van die siekes met waardigheid en respek te gebruik. Die gemeenskap word aangemoedig om die poging tot die beheer van die verspreiding van die HIV -infeksie te ondersteun en om die mense wat met VIGS leef in staat te stelom hul status sonder die dreigement van stigmatisering bekend te maak.

This thesis explores the relationship between law and society and various forms of causality: (1) legal change leading to social change; (2) social change leading to legal change; and (3) the interdependent interaction between social change and legal change. It is proposed that a multi-directional approach would be the most useful in examining the moral boundaries exemplified in the law identified with legal and social changes that have resulted in response to the AIDS epidemic.

Thesis (MPhil)--Stellenbosch University, 2003.
ENGLISH ABSTRACT: When South Africa's President, Thabo Mbeki, began doubting that HfV was the cause of AIDS in the late nineties, the debate he introduced in his country was not new; it had raged in the United States as far back as a decade ago. But, even prior to that, there had been numerous controversies pertaining to the discovery of the Ill-virus. This thesis argues that those contentions created such a heated atmosphere that the causal debates that were to follow, however incredible they were, were largely unavoidable. In its coverage of the epidemic, the media were immersed in its own politics. During the early eighties, the gay newspapers in the US felt a personal responsibility to find the cause of a disease that was rapidly killing many of its readers. But, in the process, the often promoted unscientific and dangerous approaches. By the time the AIDS dissident debate had unraveled in the US, the gay media was so suspicious of the anti-gay Reagan government that they frequently advanced dissident arguments. The mainstream and scientific media, on the other hand, were perceived as rigidly supporting government institutions, excluding critical voices. When the dissident debate reached South Africa ten years later, the South African media was completely unprepared. Most journalists had never heard of AIDS dissidents; some had not even heard of HfV or the anti-AIDS drug AZT, that the President had labeled toxic. Begin a new democracy, with a history of white oppression, the black and white media differed immensely on how to cover 'the President's debate'. Criticism of the newly elected ANC government's arguments were often branded racist and unpatriotic, with journalists suffering regular intimidation at the hands of state officials and governmentaligned editors. This thesis examines the development of the politics surrounding the science of AIDS, from the discovery of'HfV up until Thabo Mbeki's controversial contentions. To an equal extent, it looks at the news media's coverage of the process, focusing on the approaches to the debate of various media outlets and individual journalists. It also raises ethical issues, particularly in South Africa, that emerged during one of the most widely reported debates in the country's history. It in no way attempts to provide a quantitative analysis of media coverage and, in the case of the US media, draws heavily on analytical studies conducted at the time. NOTE: In the analysis of the South African media's coverage of the AIDS dissident debate in Part Three: B, issues pertaining to the country's public broadcaster, the South African Broadcasting Corporation (SABC), were not discussed The reason was that the author was the Corporation's Health Correspondent at the time, and therefore too closely involved in the institution in order to provide an objective perspective.
AFRIKAANSE OPSOMMING: Toe Suid-Afrika se president, Thabo Mbeki, in die laat jare negentig begin het om die oorsaak van VIGS in twyfel te trek, was die debat wat hy in sy land ingelei het, nie nuut nie; dit reeds 'n dekade tevore in die VSA gewoed. Maar, selfs voor daardie debat, was daar 'n hewige omstredenheid wat met die ontdekking van die MI-virus verband gehou het. Hierdie tesis argumenteer dat daardie omstredenheid so 'n driftige atmosfeer geskep het, dat die debat oor die oorsaak van VIGS wat sou volg, hoe ongeloofwaardig ook al, grootliks onvermydelik was. Met die dekking van die epidemie was die media in hul eie politiek gedompel. Tydens die vroeë jare tagtig het gay-koerante in die VSA 'n persoonlike verantwoordelikheid gevoel om die oorsaak te vind van 'n siekte wat baie van hulle lesers vinnig laat sterfhet. Maar, in die proses het hulle dikwels onwetenskaplike en gevaarlike benaderings bevorder. Teen die tyd dat die 'oorsaak-debat' in die VSA begin posvat het, was gay-koerante so agterdogtig oor die anti-gay Reagan-regering dat hulle dikwels 'afvallige' argumente aangemoedig het. Die hoofstroommedia en wetenskaplike joernale is aan die ander kant weer gesien as rigiede ondersteuners van regeringsorganisasies, wat kritiese stemme wou stilmaak. Toe die 'oorsaak-debat' Suid-Afrika tien jaar later bereik het, het dit die plaaslike media geheel en alonkant betrap. Die meeste joernaliste het toe nog nooit van 'VIGS-afvalliges' gehoor nie; party nie eens van MIV of die teenvigsmiddel AZT, wat die president as giftig geëtiketteer het nie. Daarby was die land 'n jong demokrasie met 'n geskiedenis van wit onderdrukking, wat meegebring het dat wit en swart media-instansies grotendeels verskil het oor hoe die 'president se debat' gedek moes word. Kritiek teen die nuut verkose ANC-regering se argumente is dikwels as rassisties of onpatrioties afgemaak, en regeringsamptenare of regeringsgesinde redakteurs het gereeld probeer om joernaliste te intimideer. Hierdie proefskrif ondersoek die ontwikkeling van die politiek rondom die wetenskap van VIGS, van die ontdekking van MIV tot en met Thabo Mbeki se omstrede argumente. Dit kyk ook na die nuusdekking van die proses, deur op die benaderings van verskeie media-instansies asook individuele joernalistse te fokus. Dit bespreek ook etiese kwessies wat tydens nuusdekking na vore gekom het, veral in Suid-Afrika, waar hierdie debat van die wydste nuusdekking óóit in die geskiedenis van die land geniet het. Dit poog geensins om 'n kwantitatiewe analise van mediadekking te verskaf nie, en waar die Amerikaanse media beskou word, word daar sterk gesteun op analitiese studies wat tydens die duur van die debat uitgevoer is. NOTA: In die analise van die Suid-Afrikaanse media se dekking van die 'oorsaak-debat' in Deel 3:B word kwessies wat met die nuusdekking van die land se openbare uitsaaier, die Suid-Afrikaanse Uitsaaikorporasie (SA UK), verband hou, nie bespreek nie. Die rede is dat die outeur die korporasie se gesondheidskorrespondent was, en was daarom te nou verbind aan die korporasie om 'n objektiewe perspektiefte verseker.

Thesis (MPhil)-- University of Stellenbosch, 2000
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.

Thesis (MA)--Stellenbosch University, 2005.
ENGLISH ABSTRACT: Religion plays a significant role in the structuring of people's identities and perceptions and also has the potential to playa fundamental role to determine how communities respond to HIV/AIDS. Faith-based organisations are respected in their communities and have existing resources, structures and systems in place. People who are diagnosed with HIV often turn to the church where they receive emotional and spiritual support. The primary objective of this study was to determine the knowledge of religious leaders about HIV/AIDS and their attitudes towards people living with it. A non-experimental quantitative research design was used in this study and the data was gathered through a structured questionnaire. The respondents were not exceptionally informed about the transmission of the HI-virus, but their knowledge around the risk of specific sexual behaviour was high and their attitudes towards PLHA generally positive.
AFRIKAANSE OPSOMMING: Geloof speel "n belangrike rol in die vorming van "n mens se identiteit en persepsies en het ook die potensiaal om gemeenskappe se reaksie rakende MIV/Vigs te bepaal. Geloofsorganisasies word in hul gemeenskappe gerespekteer en het bestaande hulpbronne en stelsels in plek. Mense wat MIV postitef gediagnoseer word, wend hul dikwels na hierdie organisasies waar hul emosionele en geestelike ondersteuning ontvang. Die doel van hierdie navorsing was om die kennis en houdings van geloofsleiers rondom MIV/Vigs en die mense wat daarmee leef te bepaal. "n Nie-eksperimenteel kwantitatiewe navorsingsontwerp is gebruik, en die data is deur middel van "n gestruktureerde vraelys ingesamel. Hoewel die respondente se kennis omtrent die oordrag van die MI-virus nie voldoende was nie, het hul die nodige kennis rondom die risiko van spesifieke seksuele gedrag gehad. Hul houdings rondom MIV/Vigs en mense wat daarmee leef was positief.

This research critically analysed Muslim approaches to five women with HIV/AIDS in Cape Town focussing particularly on the approach of 'Positive Muslims' - an awareness-raising and support group for Muslims living with HIV/AIDS. The central question of this thesis dealt with the impact of the norms, values and practices of Cape Muslims on the approach of Positive Muslims to women living with HIV/AIDS. It is suggested that while norms and values articulated in religious texts inform the ideological approach of the organisation's AIDS prevention model. This is due to the pragmatic approach adopted by Postive Muslims which recognises that the articulated norms and values do not always conform to the practices of Cape Muslims.

South Africa has the largest percentage of people living with HIV/AIDS in the world. However, the response against the further spread of HIV/AIDS in the country is being hindered by stigma and discrimination. In order to develop effective intervention programmes to control and reduce the further spread of the disease, it is first important to understand the nature of HIV/AIDS-related stigma and especially how people construct it. In the present study, the social construction of HIV/AIDS-related stigma among Muslims was investigated because high levels of stigma were found in this group. This was fuelled partly by the belief that HIV/AIDS was not a serious problem amongst Muslims. Two focus groups were conducted, one among Muslim women only and the second among Muslim men only. The main aim of the study was to examine the perceptions of HIV/AIDS-related stigma among Muslims. The transcripts were analyzed using thematic content analysis to determine the themes that emerged from the research material. The main findings of the study included that Muslims&rsquo
religious identity/positioning was the most salient discourse that informed how they understood, made meaning of, and responded to HIV/AIDS. They engaged in various forms of stigma such as &lsquo
othering&rsquo
, and mediating factors of stigma included religious positioning. Stigma also served as a social barrier to VCT and disclosure of HIV status. However, supportive attitudes and behaviours were also evident. The findings yielded useful insights into possible elements of intervention programmes, both to reduce HIV/AIDS-related stigma, and also to encourage behavioural change in order to control and reduce the spread of HIV/AIDS in this community.

The HIV and AIDS crisis can be presented as a socio-ecological issue, with an ever-increasing impact on both human beings and the environment. Teaching about socio-ecological issues and the consideration of individual capabilities has become crucial within HIV and AIDS education programmes. Issues of deforestation, land degradation and other environmental problems have worsened since the advent of HIV and AIDS, especially in developing countries. The My Future is My Choice (MFMC) programme has been identified as an important HIV and AIDS education initiative that caters for young people in Namibian secondary schools (Grades 8-12). One of the themes within the programme (Facing HIV and AIDS) is highlighted in this study. This study was constituted as a case study of one school in rural Omuthiya, in the Oshikoto region. The study investigated the opportunities for the integration of a focus on socio-ecological issues and risks, within the MFMC education programme. The study also investigated the way in which the program develops learners‟ capabilities to respond to HIV and AIDS related socio-ecological issues and risks/vulnerabilities. The study also presents the constraints and enabling factors influencing the implementation of the programme. This study used a qualitative, interpretive case study methodology. The research methods included the analysis of eight documents and nineteen semi-structured interviews, with the Programme Coordinator, the Programme Facilitator, the School Principal and with the programme participants. The analysis also included two focus group discussions with a group of learners; and two classroom observations; and the learners' submissions (reflection sheets). Convenience sampling was used, and ethical issues were taken into consideration throughout the study. The study revealed the following as key findings:  The aims and objectives of the HIV and AIDS education programme can enhance and constrain the development of capabilities, as well as opportunities and challenges for the integration of a focus on socio-environmental issues and risks as additional learning content.  Teaching and learning methods that are participatory and rooted within the learner centered approach can make the integration of HIV and AIDS inherent socio-environmental issues and risks into the MFMC education programme possible.  The values and beliefs inherent within the MFMC education programme stand as opportunities for the successful development of capabilities in the education programme. The study concluded by recommending that capabilities within the MFMC programme be developed through teaching learners about their rights, respect for human dignity, and the right to health and to living the life free from discriminatory practices, as a moral entitlement of each and every individual. While teaching learners about their right to health and the importance of healthy diets, this study found that the programme could include learning about food production and handling practices for the benefit of those living with HIV and AIDS, while caring for the environment. Another recommendation was that future research should consider actively involving young people in decision-making with regard to the programme, as this will allow them to choose and decide on what knowledge and skills they need and want to acquire. The study further explained that this will promote the programme participants‟ sense of agency, and their freedom to choose what they value being and doing as an important element in enhancing learner capabilities. Ultimately, this will also enable the learners to acquire the necessary skills and knowledge they need in order to respond to the socio-ecological problems they face in their communities.

Thesis (MPhil)--University of Stellenbosch, 2004.
ENGLISH ABSTRACT: Several studies have reported that thirty million people are living with HIV/AIDS in sub-Saharan Africa. Fifty percent of the infected adults are women aged between 15 and 49 years. In Lesotho, HIV/AIDS has also been declared a national emergency and an estimated 180,000 women out of 330,000 adults, and 27,000 children are living with HIV/AIDS. Statistics have shown that the majority of AIDS cases occur in adults aged 15 and 49 years in Lesotho. Presently women are the fastest growing infected population in Lesotho. Regardless of the growing numbers of women infected with HIV/AIDS, experiences of women living with HIV/AIDS have received little attention in Lesotho. Qualitative research in this area is necessary to gain access to women's perceptions of their HIV positive status. In this study, the experiences and coping strategies of Basotho women living with HIV/AIDS were investigated. The study used a feminist approach to research. Feminist research stresses the multiplicity of knowledge and it is useful to understand the subjective experiences of women. Indepth, face-to-face interviews were conducted with five women ranging between 29 and 46 years, purposefully drawn from Positive Action Society Lesotho (PASL). Grounded theory was used to analyse the data. Findings indicate that women's risk for exposure to HIV is related to their ability to protect themselves by negotiating a safe sexual relationship. Women who feel powerless in their relationships are less likely to protect themselves against HIVexposure. These perceptions of powerlessness are the result of a broad array of experiences that may include exposure to gender-based violence and restricted economic opportunities. The results show that it is common for women to be shocked, depressed, and discouraged when they find that they are living with HIV/AIDS as can be expected. It is also difficult for women to disclose their HIV positive status to family, friends and community members because of stigma attached to HIV/AIDS. Participants developed different ways of coping with their status such as religion, healthy life style, AIDS counselling and social networks. There was a profound sense of anxiety about the future care of children. The study concludes with a number of recommendations to promote an environment that will make it possible for women living with HIV/AIDS to cope with their illness.
AFRIKAANSE OPSOMMING: Studies het bevind dat daar ongeveer dertig miljoen mense in sub-Sahara Afrika is wat met MIVNIGS leef. Vyftig persent van geinfekteerde volwassenes is vroue tussen die ouderdom van 15-49 jaar. In Lesotho is MIVNIGS as 'n nasionale ramp verklaar en daar word beraam dat 330,000 volwassenes, 180,000 vroue en 27,000 kinders MIVNIGS het. Statistiek het ook getoon dat die meerderheid VIGS gevalle in Lesotho voorkom by volwassenes in die ouderdomsgroep 15-49 jaar. Vroue is tans die vinnigste groeiende groep. Ten spyte van die groeiende getalle vroue wat met MIVNIGS geinfekteer is, het die ervaringe van vroue in Lesotho wat met MIVNIGS saamleef tot dusver relatief min aandag geniet. Kwalitatiewe navorsing in hierdie verband is nodig om toegang tot vroue se persepsies te verkry rakende hul eie MIV positiewe status. In hierdie studie is die ervaringe en hanteringsmeganismes van Basoetoe vroue wat MIVNIGS het, ondersoek. Die studie het 'n feministiese benadering gebruik, wat die multiplisiteit van kennis en die subjektiewe ervaringe van vroue beklemtoon. In-diepte aangesig-tot-aangesig onderhoude is met vroue tussen 29-46 jaar gevoer. Gegronde teorie is gebruik om die data te analiseer. Bevindinge dui aan dat vroue se risiko vir blootstelling aan MIV verband hou met hul vermoë om hulself te beskerm deur te onderhandel vir 'n veilige seksuele verhouding met 'n maat. Vroue wat magteloos in hul verhoudings voel, is waarskynlik minder suksesvol om hulself teen MIV blootstelling te beskerm. Hierdie persepsies van magteloosheid is die resultaat van 'n breë spektrum ervaringe wat sekondêre status, blootstelling aan geweld, en beperkte ekonomiese geleenthede insluit. Soos wat verwag word, toon die bevindinge dat dit algemeen vir vroue is om geskok, deppressief en ontmoedig te wees wanneer hulle uitvind dat hul MIVNIGS het. Dit is ook moeilik vir vroue om hul MIV status aan familie, vriende en gemeenskapslede bekend te maak weens die stigma wat aan MIVNIGS kleef. Respondente het verskeie wyses ontwikkelom hul status te hanteer, soos godsdiens, 'n gesonde leefstyl, VIGS raadgewing en sosiale netwerke. Daar was ook 'n intense bekommernis by vroue oor die toekomstige sorg vir hul kinders. Die studie sluit af met 'n aantal aanbevelings om 'n omgewing te promoveer wat dit vir vroue wat met MIVNIGS leef moontlik sal maak om hul siekte te hanteer.

This chapter aims to provide a physician with the foundation and principles of philosophy in medicine for freer and independent thinking. In previous chapters, a sub-branch of the philosophy of medicine related to epistemological concepts and metaphysical implications was highlighted, including ethical and even moral principles. The philosophy of medicine is a blend of medical education and training with philosophical aspects to achieve improvements and innovative findings for public health services. The philosophy of medicine includes the contra-active interactions of diseases, health and the search for effective reciprocity. By asking questions about how medical and health professionals know what to do, and detailed information is given in terms of practical medical wisdom. How should they make the right and wise decisions in morally complex and uncertain situations? And what is the patient’s role in this decision-making process? In medical practice and research, it is recommended to start problem-solving with philosophical thinking and then logical evaluations in order to reveal a better diagnosis, treatment and healing qualities for patient care.