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CASE#1

HIV/AIDS: Disclosure of People with HIV/AIDS

People living with HIV/AIDS themselves, as well as public health researchers,


and community-based HIV/AIDS service providers and advocates, have
defended the importance of protecting the confidentiality of health
information, particularly for people living with HIV/AIDS. People living with
HIV/AIDS suffer discrimination as a result of the unauthorized disclosure of
their HIV status. However, the current spike in the incidence of HIV/AIDS in
the Philippines including in Dumaguete raises once again the question of
how far-reaching the veil of privacy will extend.
It has been observed that some persons with HIV are reluctant to voluntarily
notify their sexual partners of their status. Some have taken the attitude that
my sexual habit is nobodys business, or if my partner doesnt ask, I dont
tell. This non-disclosure has contributed to the spread of the virus.
ISSUE: Because of the risk of a full-blown AIDS epidemic there are talks in
government and policy-makers to make HIV screening mandatory for those
who are high-risk of HIV and disclosure about their status.
Mandatory HIV screening and enforced disclosure raises several ethical
issues. The government must strike a balance between the infected
individual's right to keep his illness confidential and the overriding public
policy concern of stemming the spread of the virus.
FACTS: According to Department of Health-Negros Oriental, reported
in the media in 2015, among four provinces in Region 7, Negros Oriental
ranked third in the number of persons with Acquired Immuno- Deficiency
Syndrome. 1 In 2015, it was reported that the number of HIV cases in the
Philippines has increased by more than 277 percent over the last five years.
According to official statistics, 84 percent of the 27,138 HIV cases in the
Philippines were reported between 2010 and 2015. According to the UN, the
Philippines is one of only a handful of countries at risk of a full-
blown AIDS epidemic. 2

1 "Region 7: Negros Oriental 3rd in number of AIDS cases ..."


http://www.philstar.com/region/2015/05/23/1457879/region-7-negros-
oriental-3rd-n accessed 14 Nov. 2016
2 Pulitzer Center. "HIV in the Philippines: State of Emergency."
http://pulitzercenter.org/projects/hiv-philippines-state-emergency
accessed 14 Nov. 2016. See also http://www.rappler.com/nation/93839-
who-ph-response-hiv accessed 14 NOv 2016

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HIV is a virus and, medically speaking, AIDS is the consequence of viral
infection. It is contagious and transmitted only through specific activities.
Most commonly, people get or transmit HIV through sexual behaviors and
needle or syringe use.
Only certain body fluidsblood, semen (cum), pre-seminal fluid (pre-cum),
rectal fluids, vaginal fluids, and breast milkfrom a person who has HIV can
transmit HIV. These fluids must come in contact with a mucous membrane or
damaged tissue or be directly injected into the bloodstream (from a needle
or syringe) for transmission to occur. Mucous membranes are found inside
the rectum, vagina, penis, and mouth. 3
Transmission of HIV in the Philippines remains predominantly via sexual
contact, with 90% of infection occurring through unprotected sex.
Heterosexual transmission remains the main mode of sexual transmission,
and more men (73%0) are infected. However, men who have sex with men
(MSM) transmission has been rapidly increasing, and may overtake
heterosexual transmission at some point in the future.
HIV is not spread through air, water or mosquitoes, according to AIDS.gov.
Nor can HIV be transmitted through saliva, tears or sweat if there is no blood
present. Shaking hands, sharing glasses, closed-mouth kissing and using a
toilet will not spread HIV.4
Ethical Analysis
1. Public safety
Since HIV is transmitted through sexual intercourse, persons living with HIV
infection should disclose their HIV-positive status to prospective sex partners
to decrease the likelihood of unsafe sex and HIV transmission. There should
be a law that everyone has to get tested for HIV and everyone's results are
available to everyone else. Saving lives is more important than an
individual's right to privacy. A law making test results public can help people
have important information available to them before they expose themselves
to HIV. Public health authorities should have the authority to restrict the
human rights of a person living with HIV in the interest of protecting public
health and public safety.
The right to privacy respecting medical information is not absolute.
Disclosure may be justified where there is a risk of harm to a third party.
Health protection and disease prevention are legitimate public interest
3 http://www.cdc.gov/hiv/basics/transmission.html accessed 11 Nov 2016
4 Here Are the Facts and Myths About How HIV Is Transmitted. (n.d.).
Retrieved from https://mic.com/articles/137695/here-are-the-facts-and-
myths-about-how-hiv-is-tr accessed 14 Nov 2016

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objectives that may justify a limitation of the right to respect for private life.
Disclosure may be an obligation to protect the right to health of others. In
the Philippines, people living with HIV (PLHIV) are protected by RA 8504,
which guarantees the protection of their right to privacy and confidentiality.
2. Stigmatization and discrimination
A stigma is a mark of disgrace. A stigma may be real, or perceived. A person
whose is HIV positive is known by relatives, friends, or co-workers, may be
victimised, rejected, or become the object of malicious gossip. Societys
treatment of the disease causes a person infected with AIDS to have not only
emotional but financial consequences as well, such as the loss of the
persons job and health insurance. In addition, HIV-positive persons are often
considered by society to be individually responsible for contracting HIV.
Gender roles, religion and cultural norms can contribute to stigmatisation.
The UN International Covenant on Civil and Political Rights Article 26, says
that
All persons are equal before the law and are entitled without any
discrimination to the equal protection of the law. In this respect, the
law shall prohibit any discrimination and guarantee to all persons equal
and effective protection against discrimination on any ground such as
race, colour, sex, language, religion, political or other opinion, national
or social origin, property, birth or other status.
Mandatory testing and enforced disclosure may lead to more discrimination
and stigmatization of persons living with HIV. The biggest barrier to HIV
testing is fear of discrimination. This fear is founded on the narratives about
the day-to-day experiences of people living with HIV: getting rejected by
loved ones and community, abuse and violence, discrimination, etc. It is
preferrable not knowing ones status than having the knowledge and getting
exposed to stigma associated with HIV and AIDS. Mandatory testing and
enforced disclosure become counterproductive to the aims of HIV/AIDS
prevention and improved care and does not help control the epidemic.
3. Rights Issue: Right to Privacy and Confidentiality
Mandatory testing and enforced disclosure violate human rights specifically,
the right to privacy and right against discrimination.
The International Covenant on Civil and Political Rights Article 17 states
that:
1. No one shall be subjected to arbitrary or unlawful interference with
his privacy, family, home or correspondence, nor to unlawful attacks on
his honour and reputation.

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2. Everyone has the right to the protection of the law against such
interference or attacks.
Privacy is a particularly important principle in the HIV/AIDS context given the
risks of violence, discrimination and abandonment that many persons face
upon disclosure of their status. According to the Office of the High
Commissioner for Human Rights (OHCHR); The rights of people living with
HIV often are violated because of their presumed or known HIV status,
causing them to suffer both the burden of the disease and the consequential
loss of other rights. Stigmatisation and discrimination may obstruct their
access to treatment and may affect their employment, housing and other
rights. This, in turn, contributes to the vulnerability of others to infection,
since HIV-related stigma and discrimination discourages individuals infected
with and affected by HIV from contacting health and social services.5
Biblical-Theological Warrants
In 1996, the World Council of Churches issued a statement about HIV/AIDS. It
stated that: The churchs response to the challenge of HIV/AIDS comes from
its deepest theological convictions about the nature of creation, the
unshakable fidelity of Gods love, the nature of the body of Christ and the
reality of Christian hope.6 It suggested that such convictions might be
worked out in practice in a threefold model in which God who is Father, Son
and Holy Spirit offers a model of intimate interaction, of mutual respect and
of sharing without domination.

The bible constantly reminds us that God gives, sustains, and protects life
(John 1:4; Amos 5:4; cf. Ezekiel 18:32). Thus our theological reflection on the
HIV/AIDS pandemic must be grounded in a theology of the value of human
life. For our warrants, the WCC and CCA have provided Churches with rich
theological resources for reflection.
In a statement of Christian Conference of Asia (CCA),7 it states that

5 : HIV/AIDS and Human Rights,


http://www.ohchr.org/EN/Issues/HIV/Pages/HIVIndex.aspx (accessed
November 15, 2016).
6 Statement of the Central Committee of the World Council of Churches,
1996, reproduced in Facing AIDS; The Challenge, the Churches Response,
World Council of Churches, Geneva, 1997, p 100. See also
https://www.oikoumene.org/en/resources/documents/wcc-
programmes/justice-diakonia-and-responsibility-for-
creation/ehaia/trainingteaching-material/facing-aids accessed 14 Nov
2016
7 https://www.oikoumene.org/en/resources/documents/other-ecumenical-
bodies/church-statements-on-hivaids/christian-conference-of-asia
accessed 14 Nov 2016.

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God created all and cares for everyone. The God we strive to
follow is one who hears the cries of suffering people and inspires
us to work for a better world.

Jesus the great and beloved physician, the good shepherd, the
rock and the refuge, calls us to be good and compassionate
neighbors, loyal and faithful friends like those who lowered their
sick friend from the roof of the house.

Churches and faith-based organizations are challenged to follow


in the footsteps of the Lord

who stood with people who were marginalized,


discriminated against and stigmatized,

who healed not only physical ailments but understood and


healed the deep scars and wounds inflicted by society

who wept and empathized with human suffering

Why should the Churches (Christians) get involve in HIV/AIDS


issues?

The Church is a servant of Christ. Jesus Christ said: I came so that they
might have life and have it more abundantly (Jn 10:10), he made it a point
to reach out to the marginalized. He proved to be a good shepherd who gives
his life for his flock. He also went all around Galilee, teaching in the
synagogues, proclaiming the gospel of the kingdom, and curing every
disease and illness among the people (cf. Mt 4:24). The Church is sent out to
proclaim the love of God by attending to the sick and the marginalized in
society to live out and realize the mission of Christ.

The Church as the servant of the Gods Kingdom on earth takes up this
challenge and reaches out to those who are suffering. She is urged to reflect
on the words of the Lord about the last judgment, which challenge Christians
to act: I was hungry thirsty a stranger sick in prison and you fed
me, clothed me, took care of me, visited me (Mt 25:35-36).

This understanding is expressed in the UCCP Mission statement on the


Healing Ministry that the UCCP engages itself in wholistic health ministry in
obedience to the will of our Lord Jesus Christ for abundant life for all. In
affirmation of this conviction, we thus further state that health is a basic
human right.

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What can the Church do?

In 1996 the WCC adopted the Statement on the Impact of HIV/AIDS and the
Churches' Response.8 The statement suggested the following
1. We ask the churches to provide a climate of love, acceptance and
support for those who are vulnerable to, or affected by, HIV/ AIDS.
2. We ask the churches to reflect together on the theological basis for
their response to the challenges posed by HIV/AIDS.
3. We ask the churches to reflect together on the ethical issues raised by
the pandemic, interpret them in their local context and to offer
guidance to those confronted by difficult choices.
4. We ask the churches to participate in the discussion in society at large
of ethical issues posed by HIV/AIDS, and to support their own members
who, as health care professionals, face difficult ethical choices in the
areas of prevention and care.

8 https://www.oikoumene.org/en/resources/documents/central-
committee/1996/the-impact-of-hivaids-and-the-churches-response
accessed 14 Nov 2016