|Opening up the HIV/AIDS Epidemic: Guidance on Encouraging Beneficial Disclosure, Ethical Partner Counselling, and Appropriate Use of HIV Case Reporting (UNAIDS, 2000, 43 p.)|
UNAIDS and WHO are UN-system agencies dedicated to the promotion of health, human rights and ethical principles. As such, they work with and call upon governments to promote, protect and implement the international human rights obligations found in international human rights instruments44, and the ethical principles found in various texts on ethical principles45. In the context of the subjects of this paper - disclosure, partner counselling, and HIV case reporting - UNAIDS and WHO promote the following general principles when governments and policy-makers plan appropriate national strategies:
44For a full explanation of the human rights relevant in the context of HIV/AIDS, see United Nations, HIV/AIDS and Human Rights, International Guidelines ,HR/PUB/98/1, New York and Geneva, 1998
45There are many relevant ethical codes. For example, see International Code of Medical Ethics, World Medical Association, 1949,1963, 1983; The Hippocratic Oath; The World Medical Association Declaration of Helsinki, adopted in 1964 and most recently amended in 1989; the International Ethical Guidelines for Biomedical Research Involving Human Subjects, CIOMS, Geneva, 1993; UNAIDS Ethical Guidelines on HIV Vaccine Research, ???
· People living with HIV/AIDS and affected communities should be consulted and involved in decision-making, policy formulation, programme planning, implementation and evaluation.
· Respect and protection of human rights and ethical principles (e.g. the right to privacy, confidentiality, informed consent, the duty to do no harm) will directly facilitate the acceptance, implementation and success of HIV prevention and care measures - particularly if they require the active participation of the community. On the other hand, measures that erode human rights and ethics and create an environment of fear, intolerance, and coercion will undermine public health interventions that aim to encourage disclosure, partner counselling and appropriate use of HIV case surveillance.
· Human rights and ethical principles should be upheld in every policy. If limitations of human rights are to be justifiable, these limitations should be prescribed by law, and not be arbitrary. They should be strictly necessary for the attainment of a legitimate goal, and be the least restrictive measure to achieve this purpose.
· Policies and programmes should be assessed on the basis of the following parameters:
· whether the proposed policy or programme can be effectively implemented
· whether it is a rational allocation of resources in light of other competing needs
· what are the benefits and possible adverse consequences of a policy both for individuals, and for broader public health and social goals
· whether the benefits outweigh the harms; and
· whether the longer-term consequences of policy decisions are beneficial.
· Data collection, collation, analysis and dissemination should be undertaken for a specific and valid purpose, namely to enable appropriate and constructive action for the prevention and control of the epidemic and provision of care and support of people infected, affected and vulnerable to HIV/AIDS.