From modeling to morals: imagining the future of HIV PREP in Lesotho.
From modeling to morals: imagining the future of HIV PREP in Lesotho.
复制标题
从榜样到道德：想象莱索托艾滋病毒准备工作的未来。
DOI：
10.1111/dewb.12029
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发表时间：
2013
影响因子：
2.2
通讯作者：
Bulled,Nicola
中科院分区：
文献类型：
--
作者：
Kenworthy,NoraJ;Bulled,Nicola
随着全球越来越多地认可新的生物医学艾滋病毒预防策略，基于ARV的暴露前预防（ARV PrEP）作为一种潜在的有前途的预防策略获得了相当大的关注。虽然它可能为某些高危人群提供比传统预防策略（如减少性伴侣，使用避孕套和预防母婴传播）更有效的保护，但PrEP成本更高。PrEP需要个人和提供者之间更多的持续接触，以及卫生系统的监测水平，这与其他预防措施无关。从这个意义上说，它代表了一种用于预防艾滋病毒的新生物技术，鉴于发展中国家的卫生系统和不完整的艾滋病毒治疗计划，它对全球实施提出了特别的挑战。由于PrEP的出现激发了对有效性和实施的不完整知识的伦理讨论，本文探讨了在一个资源匮乏的国家使用PrEP的可能情况的伦理参数。我们首先根据当前的PrEP研究开发了一个合理的PrEP部署和利用模型，同时仔细考虑了全球卫生方法的可行性和有效性的主导机构价值。借鉴艾滋病毒治疗和预防方法在莱索托的人种学研究，我们解决从这种情况下的PrEP交付所产生的伦理问题。莱索托提供了一个令人信服和具有象征意义的案例研究，说明PrEP在一个发展中国家的潜在成功和缺陷，因为该国艾滋病毒流行率很高，努力实现艾滋病毒治疗制度的普及，围绕这一流行病继续存在耻辱感，以及在解决助长感染的持续社会不平等方面的困难。
Amidst growing global endorsements of new biomedical HIV prevention strategies, ARV‐based pre‐exposure prophylaxis (ARV PrEP) has garnered considerable attention as a potentially promising prevention strategy. Though it may offer more effective protection for certain at‐risk groups than conventional prevention strategies (such as sexual partner reduction, condom use, and prevention of mother‐to‐child transmission), PrEP is more costly. PrEP requires more ongoing contact between individuals and providers, and a level of surveillance from the health system that is not necessary with other preventive measures. In this sense, it represents a new bio‐technology for HIV prevention that poses particular challenges for worldwide implementation, given developing countries’ struggling health systems and incomplete HIV treatment programs. Since the emergence of PrEP has stimulated ethical discussions premised on incomplete knowledge of efficacy and implementation, this paper explores the ethical parameters of a likely scenario for PrEP usage in a single, resource‐poor country. We first develop a plausible model for PrEP deployment and utilization based on current PrEP research, while carefully considering the reigning institutional values of feasibility and effectiveness in global health approaches. Drawing on ethnographic research of HIV treatment and prevention approaches in Lesotho, we address ethical questions arising from this scenario of PrEP delivery. Lesotho presents a compelling and emblematic case study of PrEP's potential successes and pitfalls in a developing country, given the country's high HIV prevalence, struggles to achieve universal access to HIV treatment regimes, continued existence of stigma around the epidemic, and difficulties in addressing persistent social inequalities that fuel infections.