HIV & AIDS: Ethical Considerations

Instructor: Adrianne Baron

Adrianne has a master's degree in cancer biology and has taught high school and college biology.

We are going to take an in-depth look at the human immunodeficiency virus and acquired immune deficiency syndrome from the aspect of the ethical considerations surrounding both. We will look at specifics and learn why the ethical considerations exist.

HIV and AIDS

A few letters carrying a lot of meaning have been a source of fear for a few decades now. Most people can remember where they were when they first learned about HIV, the human immunodeficiency virus, a viral infection that attacks the body's immune system. These fears were increased when people learned about the disease that can develop as a result of HIV called AIDS, the acquired immune deficiency syndrome, a terminal disease in which the immune system isn't able to defend the body against pathogens.

The thing about HIV and AIDS that was the kicker was that there were no cures and very little treatment available. So essentially, an HIV or AIDS diagnosis was viewed as a death sentence. Regulations were put into place regarding testing and other aspects of HIV and AIDS due to likelihood of death and fears of transmission. These became laws in some states, but only recommendations in others. Most healthcare facilities and other entities followed these based on their own ethics.

Ethical Considerations

Personal

The taboo and fear surrounding HIV and AIDS prompted several ethical considerations. The first area of ethical concern is related strictly to individuals. People taking the HIV test must be educated on the infection and AIDS prior to testing. This is important because some people may opt to not take the test if they're made aware that there's no cure for the infection. Giving this information prior to testing allows people to decide whether they even want to know - quite a few people feel that it's pointless to know something that you can't do anything about.

Another ethical matter for the individual is the test result. HIV is a sexually transmitted disease, or STD, and STD results are usually reported to the local and state health departments and then relayed to the CDC. This information used to be, and still is in most cases, conveyed to the government using identifiable information, such as the person's name. This began to change with HIV reporting. HIV test results are reported to the CDC using unique identifiers, rather than easily-recognizable personal information. This allows the government to track the disease, but allows the HIV-positive individual to remain somewhat anonymous.

That being said, there are some instances when permission to test and HIV test result reporting isn't at the discretion of the person being tested. One instance is if the person is accused or convicted of a sexual crime. Another exception to the usual guideline is when states have mandatory HIV testing for pregnant women. The test isn't optional because the result definitely affects another person.

Healthcare

Nurses and other healthcare workers may need to inform a person at risk of contracting HIV that they're at risk due to their interactions with an HIV-positive person. This mainly comes up when a person is sharing needles or sexually active with a person that has tested positive for HIV or AIDS.

The goal is to protect another individual from becoming infected and prevent the further spread of the HIV epidemic. There are arguments for both sides of this ethical debate. Some feel as though the obligation still remains to keep a person's healthcare status confidential, while others feel that the obligation to warn others is more ethical than withholding HIV status.

The other ethical issue surrounding HIV in healthcare has to do with the healthcare workers themselves. Healthcare workers that perform invasive procedures where their own blood may be exposed are evaluated periodically. The evaluation is to determine if they can perform the procedure and/or if they need to let patients know that they are HIV positive.

This continues to be heavily debated. Some people feel that anyone who is HIV positive should not be able to work in healthcare at all because the risk is too great. Other people feel that HIV positive healthcare workers should have to disclose their status to their patients. Yet, others feel that this is an unfair invasion of healthcare workers' privacy.

Money

The realization of anti-retroviral drugs to treat HIV and prolong the development of AIDS brought along another ethical debate. The costs of HIV and AIDS drugs are astronomical, making them out of reach for many individuals. The argument is that this is a way of discriminating who can be treated based on economic status. Furthermore, not all health insurance companies cover the cost of drugs. There are several that feel that the drugs need to be more accessible to everyone equally.

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