Confidentiality as value in the management of HIV/AIDS in South Africa

[摘要] ENGLISH ABSTRACT: AIDS is the most important threat to world health. Recent years have seen a dramaticspread of HIVand AIDS in South Africa. Health education directed at modifying riskbehaviour appears to be the only way in which the disease can be contained. ControllingAIDS is not only by controlling the virus, but also involves tackling social, economic andpolitical 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 frompopulation dynamics, through to research on individual behaviour and its socio-economicimpact; so that we can dispel the myths and rumours that surround AIDS and answersearching questions that will be asked by the community.In South Africa, HIV-AIDS remains a stigmatized disease. There have been calls fromcourageous and influential people for those who are living with HIV-AIDS to be openabout their status and to destigmatise the disease. Institutions too have been drawn intothe controversy about whether to remain silent or speak out. Southern African Anglicanbishops, as well as some politicians declared their intention to undergo testing for HIVstatus in order to sensitise the public to the seriousness of the epidemic.Were AIDS not regarded as intolerable, the entire issue of confidentiality would fallaway. Calls to destigmatise the disease through openness cannot stand alone.Government must put effective treatment programmes in place. In the absence oftreatment, AIDS may represent only frustration and hopelessness to those who testpositive; 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 importantprinciple in the management of disease. In HIV -AIDS, confidentiality is a more sensitiveissue as AIDS is particularly viewed as a social stigma, accompanied by discriminationand harassment. The chapter also addresses HIV infection, transmission, counseling andscreemng.Chapter 2 deals with the principles of biomedical ethics namely, autonomy, to enable thepatient to determine his/her course of treatment; informed consent, designed to protectthe interests of patients from exploitation and harm, and encourage health professionalsto act responsibly; beneficence and nonmaleficence, to protect the welfare of others; andjustice, to ensure access to health care for all. It also highlights the aspectsof and limitations to confidentiality.Chapter 3 discusses broadly the ethical dilemmas pertammg to professional-patientrelationships, women and HIV-AIDS, religion, prisoners and employer-employeerelationships. When the AIDS epidemic started, very few people suffered from thedisease, and the disease was treated with great caution and confidentiality. Today, AIDSis 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 ofinfection. The chapter also examines the role of the Department of Health, theparticipation of health professional bodies and the legal aspects relating to confidentialityin HIV-AIDS.Chapter 4 attempts to construct an argument to destigmatise HIV-AIDS by arguing theresponsibility of the government to make sufficient resources available for the treatmentand control of the pandemic. Health professionals are challenged to engage theirexpertise and skills in the service of the sick with dignity and respect. The community isencouraged to support the drive towards controlling the spread of HIV infection andenable people living with AIDS to disclose their status without fear of harassment.

[发布机构] Stellenbosch University