Desperately seeking targets: the ethics of routine HIV testing in low-income countries
Desperately seeking targets: the ethics of routine HIV testing in low-income countries
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DOI：
10.2471/blt.05.025536
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发表时间：
2006-01-01
期刊：
影响因子：
--
通讯作者：
Behets, Frieda
中科院分区：
文献类型：
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作者：
Rennie, Stuart;Behets, Frieda
人体免疫机能丧失病毒/后天免疫机能丧失综合症（艾滋病毒/艾滋病）大流行病及其防治工作暴露了国家之间和国家内部明显的政治、社会和经济不平等。这种不平等最突出的表现是获得艾滋病治疗的机会。在富裕国家，抗逆转录病毒疗法正在成为艾滋病患者的标准治疗方法，而在大多数资源贫乏的国家，目前只有少数特权阶层才能获得同样的治疗。没有足够的经济和社会资本的患者-即，大多数艾滋病患者每天都有数千人死亡。最近的艾滋病治疗倡议，如艾滋病规划署和卫生组织的“三五”方案，旨在纠正这一全球不公正现象。然而，这些举措的成功取决于通过迅速和大规模扩大艾滋病毒检测来确定需要治疗的人。在本文中，我们简要探讨了资源匮乏国家加速艾滋病毒检测所带来的关键伦理挑战，重点关注联合国艾滋病规划署和世界卫生组织建议的2004年常规（“选择退出”）艾滋病毒检测政策。我们认为，在贫困、保健和民间社会基础设施薄弱、性别不平等以及艾滋病毒/艾滋病感染者持续遭受耻辱的环境中，选择不接受艾滋病毒检测的政策可能与最初促使人们呼吁普及艾滋病治疗的人权理想脱节。我们对是否应实施选择退出政策的道德问题不作定论，但我们建议，每当在资源贫乏的国家实行艾滋病毒常规检测政策时，应对其对个人和社区的影响进行实证研究、人权监测和道德审查。
The human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) pandemic, and responses to it, have exposed clear political, social and economic inequities between and within nations. The most striking manifestations of this inequity is access to AlDS treatment. In affluent nations, antiretroviral treatment is becoming the standard of care for those with AIDS, while the same treatment is currently only available for a privileged few in most resource-poor countries. Patients without sufficient financial and social capital - i.e., most people with AIDS - die each day by the thousands. Recent AIDS treatment initiatives such as the UNAIDS and WHO "3 by 5" programme aim to rectify this symptom of global injustice. However, the success of these initiatives depends on the identification of people in need of treatment through a rapid and massive scale-up of HIV testing. In this paper, we briefly explore key ethical challenges raised by the acceleration of HIV testing in resource-poor countries, focusing on the 2004 policy of routine ("opt-out") HIV testing recommended by UNAIDS and WHO. We suggest that in settings marked by poverty, weak health-care and civil society infrastructures, gender inequalities, and persistent stigmatization of people with HIV/AIDS, opt out HIV-testing policies may become disconnected from the human rights ideals that first motivated calls for universal access to AIDS treatment. We leave open the ethical question of whether opt-out policies should be implemented, but we recommend that whenever routine HIV-testing policies are introduced in resource-poor countries, that their effect on individuals and communities should be the subject of empirical research, human-rights monitoring and ethical scrutiny.