HIV Prevention with Positives in Thailand: Ethical Dilemma of HIV Status Disclosure in intimate relationship.
Abstract
Every year, there are about ten thousand new HIV infection cases in Thailand. The majority of new HIV transmissions in Thailand have changed from commercial sex to intimate relationships while HIV prevention generally focuses on self protection and universal precaution. In 2003, Center for Disease Control and Prevention recommend to integrate HIV preventive measure into routine HIV care. According to a survey of People Living with HIV and AIDS (PLWHA) in Thailand, 45% of HIV infections came from transmission between spouses and 10% believed that their partners knew their HIV status before having a relationship.
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Most of these preventive measures aim at self protection of the general HIV-negative population and vulnerable groups. HIV-positive people have not been included in prevention strategies and messages. Fear of further stigmatization exclude concept of responsibility for health of sexual partner as an alternative strategy and prevention program. (Bayer 1996) However research has shown that after most PLWHA learn their HIV status they reduce their unprotected sex, though some still engage in unsafe sex.(Janssen, Holtgrave, Valdiserri et al. 2001; Marks, Richardson, Crepaz et al. 2002) In 2003, the Centers for Disease Control recommended the ‘Prevention with Positives’ strategy to promote sexual health among PLWHA attending HIV/AIDS clinic and to help reduce onward HIV transmission.(Centers for Disease Control and Prevention 2003) Positive prevention was recommended by UNAIDS (the Joint United Nations Program on HIV/AIDS); it has been implemented in industrialized countries, and should be a priority in high-prevalence regions.(Bunnell R, J. and K 2006)
Advance in medical treatment, especially antiretroviral treatment have improved quality of life and prolongs survival. Antiretroviral treatment also reduces the probability of HIV transmission by reducing virus to undetectable level. (Vernazzaa, Hirschelb, Bernasconic et al. 2008)
The AIDS epidemic began in the early to mid-1980’s and since it’s recognition in America it has become a very heated and debated topic among health professionals, the gay community, and most of all for the ones that are carrying the virus. The real debate is not over the virus itself but, rather about the infected individuals and whether or not they should be made morally obligated to tell their sexual partners if they are in fact infected. Both sides of the argument make very valid points. From one standpoint you have the gay community that believe in “safer sex ethic”, which keeps their partners in the dark about their overall health status and feel they are not morally obligated to tell their
Our second team project answers five questions about Case Study #2, Preventing HIV/AIDS and Sexually Transmitted Infections in Thailand and Chapter 10, Introduction to Global Health. This project will talk about the characteristics of the high-risk population that permitted this intervention to work and the implications of this for replication in other settings. It will explain why Thailand is a model for programs in other countries. Since cost-effectiveness assessment was never done for this program, it will evaluate the assessments that should have taken into account in terms of costs measured.
Based on the CDC website, cultural norms such as traditions, values, and character have a great impact the risk of getting HIV. As result, it serves as somewhat of a strain towards promoting and practicing healthy sex practices. Some customs such as polygamy, and multiple partners will increase the risks of contraction. On the other hand, due to cultural modernization, such practices such as abstinence before marriage are slowly being eradicated. One method towards breaking this barrier would be to learn and understand about the different cultural beliefs and practices, and according to the circumstances may the implementation of laws/ regulations towards a certain might
According to the CDC (2015), more than one million people are living with HIV in the United States, and more than 50,000 become newly infected each year. Unfortunately, one in five Americans living with HIV are unaware of their infection. I believe using the strategy which stresses the use of the 10 essential services of public health will help reduce the incidence of HIV in our
Since the first cases of HIV were detected among female sex workers (FSW) in Chennai, India in 1986, dramatic progress has been made in the last three decades in the battle against HIV both in India and globally (Mayer, 2011). Despite this progress, new infections continue to occur - in 2012, there were an estimated 2.3 million persons newly infected with HIV globally (UNAIDS, 2013). Many new infections often occur within the context of a serodiscordant relationship – an infected partner in a relationship transmits HIV to the uninfected partner. Over the past thirty years, several interventions have been identified to prevent HIV transmission from HIV-infected persons to uninfected persons in serodiscordant relationships. Yet, transmissions continue to occur. Interventions such as voluntary counseling and testing, condom promotion, and risk reduction counseling are very effective in preventing transmission among serodiscordant couples but are underutilized in India despite their widespread availability (Kumar et al., 2011). Interventions such as pre-risk exposure prophylaxis (PrEP) and universal antiretroviral therapy (irrespective of CD4 count) have been newly identified but face several challenges that impede their widespread implementation in India (Kumar et al., 2011). Serodiscordant couples in India also face certain unique socio-cultural issues such as marital and fertility pressure (Gupta et al., 2010).
One of the main goals of my study is to examine the impact of status disclosure from HIV positive individuals to their sexual partners and the affects associated with the disclosure. Mary O’ Grady (2011) Mary O’Grady measured a sample of 60 individuals (30 men and 30 women) and examined the disclosure of their HIV positive statuses to their sexual partners and the ethnics’ behind the disclosure. She investigates the rights to self-preservation, privacy and confidentiality. The study found that such disclosure could result in negative impacts, including stigma and discrimination towards individuals who are HIV positive. This study was done in order to protect individual’s right to privacy, to show how prevention behaviors should be practiced more widely and how to promote public health with the goal of a decreasing the spread of HIV in the future. While examining the disclosures of these individual’s showed results, In the future I would suggest more research on the specific health guidelines that protect individuals who are HIV positive from disclosing their status. “Only by understanding why this is the case can public health practitioners, legal professionals, and others working on the response to the HIV epidemic globally have greater effect in protecting the rights of PLHIV and achieving the goals of increased positive disclosure and decreased spread of HIV.” (p.79)
Many individuals are afraid to get tested for HIV and are afraid of the stigma associated with HIV when disclosing their status to partners. They are often subject to their own psychological and other social stress which often hinders appropriate management of the infection. This is not always without reason as disclosure of an HIV status can lead to exclusion from ones family, friend-circle or dismissal from the workplace. However disclose to a family member, partner or friend can provide psychological and later physical support. Also the fear of individuals they love finding out that they are HIV positive may lead to anxiety or isolation. Non-disclosure can often affect healthcare and management of the persons’ disease as the fear of dependents finding out will require the individual to hide taking the medication and use personal funds to pay for treatment to avoid the medical insurance company from informing co-dependants (Alonzo & Renolds 1995).
In the last three decades HIV/ AIDS has become the one of the most notorious and widely spread diseases in the modern world. Its discovery in the late seventies prompted worldwide concern. The one thing that has become the most bothersome thing about the HIV/ AIDS epidemic is prevention. Prevention or stopping the transmission of the diseases is hindered by factors such as: denial or non-acceptance by infected persons, unsafe sex, and non-disclosure by infected persons to their at risk sexual partner(s). According to Alghazo, Upton, and Cioe (2011):
It was estimated that 80.7 incident infections were expected in the absence of the interventions deployed. This resulted in a 4.75 per 100 person-years incidence. It was found out that the intervention was highly effective in all the categories examined that is effectiveness =93%,p<0.0001,those that were HIV negative and were less than 25 years effectiveness was 94% and couples with partners living with HIV and HIV RNA≥50000 copies/ml at baseline the effectiveness was 95% with a p value of 0.0001.
"HIV does not make people dangerous to know. You can shake their hands and give them a hug. Heaven knows they need it.” (Diana, 1987) Princess Diana declared these words at an Aids Center in London as she sat on the bed of a patient and held his hand. She did this to destroy the notion that a majority of the population believed that the virus could be spread through casual contact (Thompson, 2007). HIV remains for human immunodeficiency infection. The infection can lead to acquired immunodeficiency syndrome, or AIDS. Dissimilar to some different infections, the human body can 't dispose of HIV. That implies that once you have HIV, you have it forever (Centers for Disease Control and Prevention, 2015). Today, scientists are still working to find a treatment for HIV and the recent studies show that a new vaccine will be developed by 2025 (Fauci,2008). These are quite promising studies for the whole world. However, it is important to understand people who are living with that virus are also struggling with social, economic and psychological problems.
Another vector, agent of propagation of the disease, called At-Risk groups, is formed of prostitutes and drugs addicts. These groups should be subjected to a HIV/testing every six months. Lots of evidence existing in venereal diseases cases, identified by the Control of Disease Center (CDC), show prostitution and intravenous drugs use are the potential foci of the HIV infection. The multiplication of sexual partners and the exchange of needles in drugs use have caused the proliferation of the disease. In 1991, the Thailand’s government had enumerated “143, 000 new infections cases accrued in a country of roughly 65 millions people” (Behrman 113). The same year, that government had projected “10 million HIV infection cases by 2010” (114). Therefore Thailand has set up an educational program of prevention and control of the AIDS, massive public information campaign, mass condoms distribution among prostitutes rings, and a comprehensive needle exchange program”(114). From 1991 to 1995, a behavioral change of the prostitutes has been registered bringing Thailand’s annual rate of infection “from 143,000 to
The growth of HIV cases in Indonesia is one of the most rapid ones among the countries in Asia (UNAIDS 2013). Indonesia’s Ministry of Health estimates that more than 500.000 people in Indonesia will become infected with HIV in 2014 unless there is an acceleration of HIV prevention programs (UNICEF Indonesia 2012). In Indonesia, the testing of HIV currently is done in voluntary counseling and testing (VCT) clinics in selected hospitals. The patients are required to visit the clinic to do the testing and counseling. VCT has been shown to have a role in both HIV prevention and as an entry point to treatment (UNAIDS 2000). This program has been one of the most important parts of national strategic plan to prevent and control HIV in Indonesia
Thailand kingdom is one of the success stories related to HIV incidence reduction. Located in the middle mainland peninsula of South East Asia region and surrounded by other 5 South East Asia countries (Burma, Cambodia, Vietnam, Laos and Malaysia), Thailand population has growth rapidly from 20.6 million in 1950 to around 66 million in 2015 (1,2). During 1980-1991 Thailand kingdom is one the countries that have a high rate of HIV/AIDS in South East Asia. It grouped with Cambodia, Burma and some part (states) of India as countries in Asia that got hit early by HIV epidemic and have more than 1% prevalence of adult living with HIV (3). The first few detected cases of AIDS in Thailand were found among men who had sex with men in 1984 (4,5), then followed by the case among injecting drug users in 1988, but the most concerning group is commercial sex worker (2).
The main reliable source of information for this dissertation was secondary data. A research conducted by international clinical research center, department of Global, university of Washington formed the basis of this research. The project was determining the uptake, use and effectiveness of pre-exposure prophylaxis for HIV negative persons with partners living with HIV. Related to this study was another research conducted by the same researchers but this time they investigated antiretroviral prophylaxis for HIV-1 prevention among heterosexual men and women. In another study conducted by AIDS (London), the study was based on determining effectiveness and safety of HIV pre-exposure prophylaxis for all populations. A study conducted by Emory
Because of the prevalence of HIV in India, several organizations help aid in the fight against HIV. The National AIDS Control Organization is primarily responsible for implementing new programs in India to help prevent and stop the transmission of HIV. One of their main goals is to target these high risk groups and provide HIV treatment, education and support for them. For female sex workers that entails educating them on the spread of HIV, providing them with condoms to use to lower the rate of transmission to their male clients, who in turn the male clients will have a lower transmission rate to their female partners. There is a project designed specifically for men who have sex with other men and transgender people called Project Pehchan, which allows these type of individuals to get