HIV Prevention with Positives in Thailand: Ethical Dilemma of HIV Status Disclosure in intimate relationship.
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. Unprotected sex increased in those who did not disclose HIV status to partners. Health professionals reported the limitation of time for counseling and recognized the risk of HIV transmission between sexual partners. Health care providers face ethical dilemmas regarding disclosure of HIV status in intimate relationships. In this ethical dilemma, most exempt notifying patients’ sexual partner with the reason that it is the right and confidentiality of HIV patients. This paper argues that disclosure of HIV must be promoted in intimate relationships, because the right to healthy life of the sexual partner outweighs the right to privacy of the HIV positive individual and condom use is low and difficult to put in practice in intimate relationships. Given the largest proportion of spousal transmissions, the principle of responsibility should be complementary with the principles of self-protection and universal precaution. HIV prevention campaigns focusing on universal vulnerability are not effective in intimate partnerships where trust, fidelity and monogamy are mostly expected and are barriers of condom use. The legal requirements are unclear in Thailand and the policies are not explicitly determined. This paper proposes that PLWHA should not be legally bound to disclose their HIV status to all sexual partners but should morally or legally decide with supporting counseling to disclose to intimate partner. Only if this fails the health care provider should have a right to inform partners of HIV positive patients in some cases.
Keywords: Disclosure of HIV status, intimate relationship, Ethic, HIV prevention
HIV Prevention generally aims at general population and high risk group. However it is crucial both public health and ethical perspective to combine prevention service and policy for both uninfected population and PLWHA. This article provides an analysis of ethical and public health issues in disclosure of HIV status to sexual partner. Collecting evidence regarding HIV prevention in PLWHA and argument to support disclosure of HIV status to intimate sexual partner were showed.
HIV prevention in Thailand and Prevention with Positives
The HIV epidemic and the 100% condom use campaign in commercial sex establishments, which began in 1992 contributed to national change in behavioral norms in commercial sex and decreased the number of new HIV infections in Thailand. However, efforts to promote safe behavior in other risk networks were less thorough and, thus, infections have continued to occur.(Rojanapithayakorn 2006; National AIDS Prevention and Alleviation Committee 2008) Estimation of the Asian Epidemic Model showed that in Thailand in 2007, there were 12,659 new cases of HIV, 1,100,297 cumulative cases and 544,275 people living with HIV and AIDS (PLWHA). During the early epidemic, transmission occurred mainly through paid sexual services, i.e., from female prostitutes to male clients. However, in 2007, the majority of new cases occurred in heterosexual transmission: husband to wife (38%), wife to husband (10%), clients to sex workers (4%), sex worker to clients (8%) and through casual sex (3%) Other large proportions came from men who have sex with men (29%) and injecting drug users...
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