The Front Line in the African AIDS Crisis. (Research Notes)

Article excerpt

The AIDS crisis extends far beyond its death toll. Because more than 70 percent of the 36 million people with HIV/AIDS live in sub-Saharan Africa, the disease has been described as a development crisis: it is profoundly disrupting the economic and social bases of families and entire nations.

Much is being done at various levels to fight the disease in Africa. But because of the extent and impact of the pandemic in the everyday lives of Africans, it is also important to address the human rights, ethical, and legal implications of the disease, as well as responses to it. And while some countries are taking measures to promote and protect human rights in the context of HIV/AIDS, there is a dramatic gap between professed policy and implementation on the ground.

In light of this problem, a new project at The Hastings Center has decided to take one group in the center of the crisis--medical practitioners--and address some of the day-to-day challenges they face. The project has three aims: (1) to establish a regional pilot forum for dialogue among medical practitioners in East and Southern Africa; (2) to develop and present informative material on the major ethical, legal and human rights issues faced by health care workers on the AIDS front line; and (3) to help develop guidelines or problem-solving tools that will be useful to health care workers, physician associations, patients, legislators, educational institutions, and the general public as they address the ethical and legal challenges of the epidemic.

Although the evolution of HIV/AIDS in Africa is fundamentally different from that of the United States, in both cases doctors face novel ethical questions. Unfortunately, doctors working on the frontlines in Africa have little opportunity to discuss the ethical and legal complexities involved in their work. As a result, questions remain unresolved on such issues as confidentiality and privacy (particularly in the context of the extended family, polygamy, wife inheritance, and gender inequality), discrimination, standards of care, risks to health care workers, the use of alternative methods of treatment, and so on. There are countless cases in which medical practitioners feel that they are forced to take actions that could be considered unethical, at least in other contexts.

Such cases are particularly difficult given the link between human rights and health and the need for health professionals to be sensitive to rights issues not only to ensure that their patients' dignity is upheld but also to promote and protect their health. …