How would you choose?

In my ethics class this week, we talked about the ethical issues raised by an antiretroviral treatment (ART) protocol in Lesotho, a small country landlocked within South Africa. The protocol was meant to give ART to people who needed it the most and people who would stick with it. Sticking with the treatment was paramount to prevent resistance to the treatment. The people developing the protocol decided that ideal candidates would have the knowledge and ability to take the medicine themselves on time every time, and that the candidates would also disclose their HIV-positive status to a friend or family member. That friend or family member would be their “coach” or “advocate” and help keep the patient in line with their treatment, a sort of peer pressure to keep the patient in compliance.

There were several problems with this protocol. For instance, not everyone in the community who was HIV-positive knew about the program. There were also instances when people who didn’t qualify for some reason were still taken into the protocol because they knew the right person or managed to have a compelling story. Also, people who were too sick from AIDS would not be able to go to the clinics and get the medication on their own. And then there were all of those people who would not disclose their status for fear of the very real and many times very bad stigmatization in the community. Continue reading