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ETHICAL ISSUES ARISING FROM THE AIDS EPIDEMIC

HIV will continue to spread in the population due to several factors: (1) a large reservoir
of millions of HIV-infected persons may not know they are infected. (2) knowledge of infection
may not modify sexual behavior or other practices such as injection drug use. (3) there is no
effective vaccine or curative treatment available. (4) even with knowledge of infection, basic
human rights cannot be restricted enough to curb the spread of this disease.
In spite of mandatory testing of blood and blood products, cases of accidental exposure to
HIV from these sources will rarely occur. Complex testing schemes have eliminated much of the
risk, but the testing systems are not perfect. Additional HIV subtypes, such as HIV-2, may
become prevalent. These problems will require even more complex screening programs,
particularly in blood banking, and medical liability problems with blood products will continue
to exist.
The adoption of the criterion that a CD4 lymphocyte count of <200/µL is indicative of
AIDS when HIV infection is present has significance because the low CD4 count itself implies a
high probability of HIV infection. Thus, laboratories and other agencies performing CD4
lymphocyte count must be aware of the implications of the test results and provide for
confidentiality of testing, as with tests for HIV, where appropriate.
Discrimination against HIV-infected persons on the job or in the community will lead to
conflicts. Recent court cases in the United States have established the rights of HIV-infected
persons against discrimination on the job, in housing, and at school. This protection against
discrimination has even been extended to health care workers who, though not infected by HIV,
provide essential services for persons who are HIV-infected. The courts have not generally
condoned discriminatory practices by health care workers against patients with HIV by refusing
to offer treatment or by refusal to accept occupational hazards.[1110,1111]
Access of AIDS patients to new treatments not yet approved by governmental agencies
will be debated. HIV-infected persons may knowingly donate blood or commit purposeful acts
in an attempt to transmit the infection to others, prompting criminal charges. Clinical diagnosis
or death certification of congenital AIDS may have implications for surviving family members
with regard to placement of children in foster homes and investigation of parents. Death
certification in cases of suspected AIDS may have profound sociopsychological and
socioeconomic implications for surviving family members (i.e., insurance claims or risks of
exposure relating to HIV infection).
The CDC have adopted guidelines which indicate that there is no basis either for
mandatory HIV testing of health care workers or for restricting the practice of HIV-infected
health care workers who perform non-exposure prone invasive procedures using recommended
technique with adherence to universal precautions. Exposure prone procedures are to be
delineated by organizations and institutions, which oversee medical or dental practice, and health
care workers who perform such procedures should know their HIV status. HIV-infected health
care workers should not perform exposure prone invasive procedures unless they have sought
counsel from an expert review panel and have informed the patient. HIV-infected health care
workers should, it is recommended, be provided opportunities to continue appropriate patient-
care activities through career counseling and job retraining.[1112]
The risk for HIV infection from infected patients to health care workers, or from health
care workers to patients, cannot be completely eliminated, but remains negligible. Screening of