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AIDS – the time for changes in law and policy is now

Published online by Cambridge University Press:  20 September 2011

Udo Schüklenk  and
Sean Philpott
Udo Schüklenk*
Affiliation:
Queen's University, Department of Philosophy, Kingston, Canada
Sean Philpott
Affiliation:
The Bioethics Program, Union Graduate College, Schenectady, NY, USA
*
Udo.schuklenk@gmail.com
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Abstract

Existing policies on HIV testing were developed decades ago when HIV infection led nearly inevitably to AIDS and death. Since then rapid clinical progress has occurred. HIV infected people with access to life-preserving care and treatment no longer experience an existential threat to their life and wellbeing. HIV infection today, at least in North America and Western Europe, represents a chronic but manageable illness. Moreover, with treatment most infected people are rendered, to all intents and purposes, non-infectious. In this paper, we discuss the ethical, policy and legal implications of the changing clinical picture of HIV/AIDS. In particular, we propose significant changes to existing HIV testing policies as well as to policies pertaining to the criminalisation of infected people's sexual behaviour in North America and Western Europe.

Type
Articles
Information
International Journal of Law in Context , Volume 7 , Special Issue 3: Health and Human Rights , September 2011 , pp. 305 - 317
Copyright
Copyright © Cambridge University Press 2011

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References

Bayer, Ronald (1989) Private Acts, Social Consequences. New York: Free Press.Google Scholar
Bayer, Ronald (1999) ‘Clinical Progress and the Future of HIV Exceptionalism’, Archives of Internal Medicine 159(10): 1042–48.CrossRefGoogle ScholarPubMed
Bayer, Ronald, Levine, Carol and Wolf, Susan M. (1986) ‘HIV Antibody Screening: An Ethical Framework for Evaluating Proposed Programs’, Journal of the American Medical Association 256: 1768–74.CrossRefGoogle ScholarPubMed
BBC (2010) ‘German Singer Nadja Benaissa Apologises at HIV Trial’. Available at: www.bbc.co.uk/news/world-europe-10983227 (accessed 27 January 2011).Google Scholar
Birkhead, Guthrie S., Pulver, Wendy P., Warren, Barbara L., Klein, Susan J., Parker, Monica M., Caggana, Michele and Smith, Lou C. (2010) ‘Progress in Prevention of Mother-to-Child Transmission of HIV in New York State: 1988–2008’, Journal of Public Health Management and Practice 16(6): 481–91.Google Scholar
Bokhour, Barbara G., Solomon, Jeffrey L., Knapp, Herschel, Asch, Steven M. and Gifford, Allen L. (2009) ‘Barriers and Facilitators to Routine HIV Testing in VA Primary Care’, Journal of General Internal Medicine 24(10): 1109–114.Google Scholar
Bwambale, Francis M., Ssali, Sarah N., Byaruhanga, Simon, Kalyango, Joan N. and Karamagi, Charles A. S. (2008) ‘Voluntary HIV Counselling and Testing Among Men in Rural Western Uganda: Implications for HIV Prevention’, BMC Public Health 8: 263–74.CrossRefGoogle ScholarPubMed
Cameron, Edwin (2005) Witness to AIDS. London: IB Tauris.Google Scholar
CDC [Centers for Disease Control and Prevention] (1981a) ‘Pneumocystis Pneumonia–Los Angeles’, Morbidity and Mortality Weekly Report 30(21): 250–52.Google Scholar
CDC [Centers for Disease Control and Prevention] (1981b) ‘Kaposi's Sarcoma and Pneumocycstis Pneumonia Among Homosexual Men–New York City and California’, Morbidity and Mortality Weekly Report 30(25): 305–307.Google Scholar
CDC [Centers for Disease Control and Prevention] (1994a) ‘Zidovudine for the Prevention of HIV Transmission from Mother to Infant’, Morbidity and Mortality Weekly Report 43(16): 285–87.Google Scholar
CDC [Centers for Disease Control and Prevention] (1994b) National HIV Serosurveillance Summary: Results through 1992. Volume 3. Atlanta, GA: US Department of Health and Human Services.Google Scholar
CDC [Centers for Disease Control and Prevention] (2003) ‘Advancing HIV Prevention: New Strategies for a Changing Epidemic’, Morbidity and Mortality Weekly Report 52(15): 329–32.Google Scholar
CDC [Centers for Disease Control and Prevention] (2009) ‘Late HIV Testing–34 States, 1996–2005’, Morbidity and Mortality Weekly Report 58(24): 661–65.Google Scholar
CDC [Centers for Disease Control and Prevention] (2010) ‘Diagnoses of HIV Infection and AIDS in the United States and Dependent Areas, 2008’, In HIV Surveillance Report. Volume 20. Atlanta, GA: US Department of Health and Human Services.Google Scholar
Center for HIV Law & Policy (2010) HIV Criminalization Fact Sheet. New York: Center for HIV Law & Policy. Available at: www.hivlawandpolicy.org/resources/view/560 (accessed 27 January 2011).Google Scholar
Cohan, Deborah, Gomez, Elvira, Greenberg, Mara, Washington, Sierra and Charlebois, Edwin D. (2009) ‘Patient Perspectives with Abbreviated versus Standard Pre-Test HIV Counseling in the Prenatal Setting: A Randomized-Controlled, Non-Inferiority Trial’, PLoS ONE 4(4): e5166.Google Scholar
Connor, Edward M., Sperling, Rhoda S., Gelber, Richard, Kiselev, Pavel, Scott, Gwendolyn, O'sullivan, Mary Jo et al. (1994) ‘Reduction of Maternal Infant Transmission of Human Immunodeficiency Virus Type 1 with Zidovudine Treatment’, New England Journal of Medicine 331: 1173–80.Google Scholar
Davies, P. M., Hockson, F. C. I., Weatherburn, P. and HUNT, A. J. (1993) Sex, Gay Men and AIDS. London & Bristol, PA: Falmer Press.Google Scholar
Donnell, Deborah, Baeten, Jared M., Klarie, James, Thomas, Katherine K., Stevens, Wendy, Cohen, Craig R. et al. (2010) ‘Heterosexual HIV-1 Transmission After Initiation of Antiretroviral Therapy’, Lancet 375(9731): 2092–98.Google Scholar
Ehrenkranz, Peter D., Pagán, José A., Begier, Elizabeth M., Linas, Benjamin P., Madison, Kristin and Armstrong, Katrina (2009) ‘Written Informed-Consent Statutes and HIV Testing’, American Journal of Preventive Medicine 37(1): 57–63.Google Scholar
European Mode of Delivery Collaboration (1999) ‘Elective Caesarean-Section Versus Vaginal Delivery in Prevention of Vertical HIV-1 Transmission: A Randomised Clinical Trial’, Lancet 353(9158): 1035–39.Google Scholar
Fang, Chi-Tai, Hsu, Hsu-Mei, Twu, Shiing-Jer, Chen, Mao-Yen, Chang, Yu-Yin, Hwang, Jing-Shiang et al. (2004) ‘Decreased HIV Transmission After a Policy of Providing Free Access to Highly Active Antiretroviral Therapy in Taiwan’, Journal of Infectious Disease 190(5): 879–85.Google Scholar
Fowler, Mary G., Lampe, Margaret A., Jamieson, Denise J., Kourtis, Athena P. and Rogers, Martha F. (2007) ‘Reducing the Risk of Mother-to-Child Human Immunodeficiency Virus Transmission: Past Successes, Current Progress and Challenges, and Future Directions’, American Journal of Obstetrics and Gynecology 97(3 Suppl): S3–9.Google Scholar
Gange, Stephen J., Barron, Yolanda, Greenblatt, Ruth M., Anastos, Kathryn, Minkoff, Howard, Young, Mary et al. (2002) ‘Effectiveness of Highly Active Antiretroviral Therapy Among HIV-1 Infected Women’, Journal of Epidemiology and Community Health 56(2): 153–59.CrossRefGoogle ScholarPubMed
Gerbert, B., Maguire, B. T., Bleeker, T., Coates, T. J. and Mcphee, S. J. (1991) ‘Primary Care Physicians and AIDS: Attitudinal and Structural Barriers to Care’, JAMA 266(20): 2837–42.Google Scholar
Gostin, Lawrence O. (2000) Public Health Law: Power, Duty and Restraint. Berkeley, CA: University of California Press.Google Scholar
GNP+ and THT [Global Network of People Living with HIV/AIDS Europe and Terrence Higgins Trust] (2005) Criminalisation of HIV Transmission in Europe: A Rapid Scan of the Laws and Rates of Prosecution for HIV Transmission Within Signatory States of the European Convention of Human Rights. Amsterdam: GNP+. Available at: www.gnpplus.net/criminalisation (accessed 27 January 2011).Google Scholar
Granich, Rueben M., Gilks, Charles F., Dye, Christopher, De cock, Kevin M. and Williams, Brian G. (2009) ‘Universal Voluntary HIV Testing with Immediate Antiretroviral Therapy as a Strategy for Elimination of HIV Transmission: A Mathematical Model’, Lancet 373(9657): 48–57.Google Scholar
Guay, Luara A., Musoke, Philippa, Fleming, Thomas, Bagenda, Danstan, Allen, Melissa, Nakabiito, Clemensia et al. (1999) ‘Intrapartum and Neonatal Single-Dose Nevirapine Compared with Zidovudine for Prevention of Mother-to-Child Transmission of HIV-1 in Kampala, Uganda: HIVNET 012 Randomised Trial’, Lancet 354(9181): 795–802.CrossRefGoogle ScholarPubMed
Hastings Center Report (1985) Special Supplement: AIDS – The Emerging Ethical Dilemmas. Hastings Center Report 15(4): S1–31.Google Scholar
Henry J. Kaiser Foundation (2009) The National HIV Prevention Inventory: The State of HIV Prevention Across the U.S. – July 2009. Menlo Park, CA: The Henry J. Kaiser Foundation.Google Scholar
Hiv-Causal Collaboration (2010) ‘The Effect of Combined Antiretroviral Therapy on the Overall Mortality of HIV-infected Individuals’, AIDS 24(1): 123–37.Google Scholar
Illingworth, Patricia (1990a) AIDS and the Good Society. London: Routledge.Google Scholar
Illingworth, Patricia (1990b) ‘Review Essay’, Bioethics 4: 340–50.Google Scholar
Lima, Viviane D, Bangsberg, David R., Harrigan, P. Richard, Deeks, Steven G., Yip, Benita, Hogg, Robert S. and Montaner, Julio S. (2010) ‘Risk of Viral Failure Declines with Duration of Suppression on Highly Active Antiretroviral Therapy Irrespective of Adherence Level’, Journal of Acquired Immune Deficiency Syndromes 55(4): 460–65.Google Scholar
Malta, Monica, Bastos, Francisco I., Da silva, Cosme M. F. P., Pereira, Gerson F. M., Lucena, Francisca F. A., Fonseca, Maria G. P. and Strathdee, Steffanie A. (2009) ‘Differential Survival Benefit of Universal HAART Access in Brazil: A Nation-Wide Comparison of Injecting Drug Users Versus Men Who Have Sex With Men’, Journal of Acquired Immune Deficiency Syndromes 52(5): 629–35.Google Scholar
Mohr, Richard D. (1987) ‘Gays, AIDS and State Coercion’, Bioethics 1: 35–50.Google Scholar
NAPWA [National Association of People with AIDS] (2011) The Denver Principles – 1983 and Today. Silver Spring, MD: NAPWA. Available at: www.napwa.org/content/denver-principles-1983-and-today (accessed 23 January 2011).Google Scholar
Sax, Paul E. and Baden, Lindsey R. (2009) ‘When to Start Antiretroviral Therapy – Ready When You Are’, New England Journal of Medicine 360(18): 1897–99.Google Scholar
Schüklenk, Udo (2008) ‘Should We Use the Criminal Law to Punish HIV Transmission?’, International Journal of Law in Context 4(3): 277–84.Google Scholar
Schüklenk, Udo and Kleinsmidt, Anita (2007) ‘Rethinking Mandatory HIV Testing During Pregnancy in Areas with High HIV Prevalence Rates: Ethical and Policy Issues’, American Journal of Public Health 97: 1179–83.Google Scholar
Shisana, Olive and Simbayi, Leickness (2002) Nelson Mandela/HSRC Study of HIV/AIDS: South African National HIV Prevalence, Behavioural Risks and Mass Media: Household Survey 2002. Cape Town: HSRC.Google Scholar
Smith, Julia H. and Whiteside, Alan (2010) ‘The History of AIDS Exceptionalism’, Journal of the International AIDS Society 13: 47.Google Scholar
Sperling, R. S., Shapiro, D. E., Coombs, R. W., Todd, J. A., Herman, S. A., McSherry, et al. (1996) ‘Maternal Viral Load, Zidovudine Treatment, and the Risk of Transmission of Human Immunodeficiency Virus Type 1 from Mother to Infant. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group’, New England Journal of Medicine 335(22): 1621–29.Google Scholar
UNAIDS (2000) HIV and AIDS-related Stigmatization, Discrimination and Denial: Forms, Contexts and Determinants: Research Studies from Uganda and India. Geneva: UNAIDS.Google Scholar
UNAIDS/WHO (2010) AIDS Epidemic Update 2009. Geneva: UNAIDS/WHO.Google Scholar
Vernazza, Pietro, Hirschel, Bernard, Bernasconi, Enos and Flepp, Markus (2008) ‘Les Personnes Séropositives ne Souffrant d'aucune Autre MST et Suivant un Traitement Antiretroviral Efficace ne Transmettent pas le VIH par Voie Sexuelle’, Bulletin des médecins Suisses 89(5): 165–69.Google Scholar
Wade, Nancy A., Birkhead, Guthrie S., Warren, Barbara L., Charbonneau, Tina T., French, P. Tyler, Wang, Ling, Baum, Jeanne B., Tesoriero, James M. and Savicki, Robert (1998) ‘Abbreviated Regimens of Zidovudine Prophylaxis and Perinatal Transmission of the Human Immunodeficiency Virus’, New England Journal of Medicine 339(20): 1409–414.CrossRefGoogle ScholarPubMed
WHO [World Health Organization] (2007) Guidance on Provider-Initiated HIV Testing and Counselling in Health Facilities. Geneva: WHO.Google Scholar
WHO [World Health Organization] (2010) Antiretroviral Therapy for HIV Infection in Adults and Adolescents. Recommendations for a Public Health Approach. 2010 Revision. Geneva: WHO.Google Scholar
Wynia, Matthew K. (2007) ‘Ethics and Public Health Emergencies: Restrictions on Liberty’, American Journal of Bioethics 7(2): 1–5.Google Scholar
Zivi, Karen (2005) ‘Contesting Motherhood in the Age of AIDS: Maternal Ideology in the Debate over HIV Testing’, Feminist Studies 31: 347–74.CrossRefGoogle Scholar