The Examined Life Chinese Perspectives

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East meets West: Chinese Duty-based Confucianism meets opt-out system in HIV testing and Biobank Yonghui Ma

This chapter is comprised of two parts: in contrast In contrast to the previous chapterto the previous chapter, the first partthis chapter concerns with the applicability of and compatibility between Western ideas or practices and Chinese context, in particular, a popular right-based opt-out approach to HIV testing encounter with duty-based Confucian tradition. Note it should not be generalised as human rights, perceived as by and large a Western norm, at odds with Chinese culture and categorically not applicable in any domains of activities in China.[1] Rather, it is perhaps the sensitivity of HIV/AIDS make the conflict between opt-out system in HIV testing and duty-based familism tradition a particular example. To provide a comprehensive understanding of duty-based familism tradition, the second part of this chapter will continue to discuss its application in another booming subject, Biobank, which presents to be a better alternative to rights-based approach. I hope this chapter demonstrates the complex of cultural difference and the importance of being attentive to the nature of context when we are conducting cross-cultural bioethics.

Introduction

‘Too little, too late’ is the characteristic of the situation of HIV testing in many societies. It is widely recognised, by policy makers, health practioners, and human rights advocates alike, that the low uptake of HIV testing and counselling is a major challenge in the response to the epidemic that needs to be urgently addressed. At the end of 2007, in China, approximately 75% of people infected with HIV remain undiagnosed while in the United States it is 25%.[2][3] It has been also observed that many people who present symptoms of HIV infection, and others who would otherwise benefit from knowing their HIV status through contact with health facilities are often not offered an HIV test. Many people are indentified with HIV only when they have progressed to AIDS, among these late testers some have been infected for 10 years or longer, unknowingly exposing their partners to HIV. Moreover, healthcare cost related to late stage of HIV infection especially accompanied by opportunistic complications, would increase massively.

Indentifying the “hidden epidemic” of those HIV infected but undiagnosed people represent the biggest challenge for HIV/AIDS control in many societies. More timely diagnosis of HIV can improve treatment and care of those infected with HIV, prolong survival, and reduce the spread of HIV. Therefore, sScaling up the access to HIV testing is an urgent task faced by many countries. Currently, the dominant model of HIV testing is the Voluntary HIV Counselling and Testing (VCT)..Although the existing VCT programme has showed remarkable success worldwide, some inherent barriers associated with VCT uptake remains, including clients have to initiate testing themselves, lengthy pre and post testing counseling, implementation difficulties and patient concerns about confidentiality. Various possible strategies for expanding HIV test have been proposed, such as ‘know your HIV status’ campaigns, mobile VCT services, community and home based HIV testing. The most innovation and radical one is perhaps the ‘provider-initiated HIV testing and counselling’ (PITC)[4], also referred to as ‘opt-out’ HIV testing or ‘routine offer of HIV testing’, proposed by the Joint United Nations Program on HIV/AIDS (UNAIDS) and The World Health Organisation (WHO) in 2007. and This approach is raised under a wider political commitment made by governments to provide “Universal Access” to HIV prevention, treatment, care and support services to all those in need by 2010.[5]

What is PITC (provider-initiated HIV testing and counselling) and opt-out system?

According to the Guidance on PITC in Health Facilities, an “opt-out” approach is strongly recommended along with...
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