To what extent are individuals, communities, and societies responsible for the prevention and control of HIV/AIDS, tuberculosis, and STDs?
In the case of communicable diseases, also referred to as infectious diseases or transmissible diseases which kill more people worldwide than any other single cause, the question of who should shoulder the responsibility of prevention and control has long been a debated issue (Medline Plus, 2014). Autonomy-based bioethics, many argue, fails to address the sociological roots of these particular diseases. Reflecting on such sociological origins of disease causation raises concerns about the extent in which liberty and individual autonomy should be upheld (Azetsop & Rennie, 2010). Communicable diseases like that of HIV/AIDS, tuberculosis, and STDS take on a social significance as they heavily rely on the social interplay between individuals in the community (Cheyette, 2011). Indeed the interactions between the individual, as the infectious agent, and the environment focuses on the social determinants of disease epidemiology. The theory that best addresses this issue is that of the communitarianism philosophy. This theory stresses the connection between the individual and the community. In fact, it identifies social responsibility as a shared duty to assure the common good for society. It perpetuates the idea that was highlighted in the Smith v. Baker case in 1884 where the responsibility to prevent the spread of a communicable disease took precedence over individual liberty. Keeping this in mind, there is a duty to society that individuals are held responsible for their negligent actions in the case of knowingly spreading an infectious disease.
Is it possible to develop public health policies for HIV/AIDS, tuberculosis, and STD testing and screening that respect both individual privacy and community needs for controlling the spread of these diseases?
While, many individuals predominately concerned with the advocacy of civil rights, oppose the traditional public health measures which have commonly focused on controlling disease transmission by imposing restrictions on an individual's rights, it has undoubtedly been an effective approach toward transmission management (Gruskin & Tarantola, 2002).
Governments are legally and dually responsible for the instituting of policies and programs to help reduce both the spread and impact of HIV/AIDS, tuberculosis (TB), and STDS while still attempting to maintain the protection of individual liberty and privacy. In the case of TB control for example, it becomes a conflict of attempting to fulfill the patients' human rights but also the human rights of those who may receive the infection of TB if exposed (Nagai et al., 2005). In the case of HIV/AIDS and STDS, while testing may help identify the incidence of the disease, privacy can be maintained by giving public agencies access to information about results of both STD and HIV tests without using personal information that would identify the persons being tested(Greene, Parrott & Serovich, 1993). In this respect, controlling the transmission of diseases can be achieved while simultaneously respecting the privacy of individuals tested.
When is it acceptable to impose limits on personal freedoms to reduce the spread of HIV/AIDS, tuberculosis, or STDs?
This question also addresses the fundamental issue of the extent in which a state can justifiably restrict personal liberties for the sake of the common good- which is the essential debate to many of the communicable disease and human rights arguments. In the case of tuberculosis (TB), where patients must be hospitalized due to TB's airborne means of transmission, patient cooperation is imperative to treatment completion. Therefore, in the case of noncooperative patients where the conflict of whose human rights should take precedence, that of the patient or that of the community members at potential risk of exposure, it creates acceptable conditions in which to impose on personal freedoms for the greater good of society. In the case of both STDS and HIV/AIDS as it refers to epidemic conditions, it is in the best interest of public health officials to refer to that of the Jacobson v. Commonwealth of Massachusetts landmark ruling where the government's right to use 'police powers' in order to control epidemic diseases were justified(Bayer, 2007).
As it also refers to individuals knowingly spreading STDS and HIV/AIDS, I think personal freedoms should be infringed upon under the premise of communal good as well.
What is required from the global health community to address the public health implications of infectious diseases such as HIV/AIDS?
An estimated 1,500 people die each year as a result of an infectious disease according to The World Health Organization (WHO). These subsequent fatalities of infectious diseases make addressing this issue a priority in global health by national leaders, health policy makers and philanthropic organizations(NIH, 2001). Financial investment in both the fields of biomedical research and health care delivery are required in addressing the implications of infectious diseases. The National Institute of Allergy and Infectious Diseases (NIAID) has developed a Global Health Research Plan for HIV/AIDS which highlights the goals and plans of the Institute to fight infectious diseases with advanced research and enhanced international partnership. The plan also emphasizes the strategic effort to produce effective prevention and treatment methods while concurrently maintaining their feasibility-which burdens many poor countries in particular. As it refers to addressing HIV/AIDS in particular, the development of a vaccine that protects against HIV infection is of the most highest of priorities of global health research as efficacious vaccines have substantially contributed to the reduction of many infectious diseases before.
Azetsop, J., & Rennie, S. (2010). Principlism, medical individualism, and health promotion in resource-poor countries: can autonomy-based bioethics promote social justice and population health?.Philosophy, Ethics, and Humanities in Medicine,5(1), doi: 10.1186/1747-5341-5-1
Bayer, R. (2007). The continuing tensions between individual rights and public health. talking point on public health versus civil liberties.The European Molecular Biology Organization, Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2267241/
Greene, K., Parrott, R., & Serovich, J. (1993). Privacy, hiv testing and aids.Health Communication,5(1), 59-74. Retrieved from http://comminfo.rutgers.edu/~kgreene/research/pdf/hc93.pdf
Gruskin, S., & Tarantola, D. (2002, April).human rights and hiv/aids. Retrieved from http://hivinsite.ucsf.edu/InSite?page=kb-08-01-07
Medline Plus. (2014).Infectious diseases. Retrieved from http://www.nlm.nih.gov/medlineplus/infectiousdiseases.html
Nagai, H., Inagaki, T., Toyoda, E., Kawabe, Y., Fuijwara, K., Masuyama, H., & Takahashi, S. (2005). Tuberculosis and human rights].Kekkaku,80(1), 31-45. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15839061
NIH. (2001, May 7).Niaid global health research plan. Retrieved from http://www.niaid.nih.gov/about/whoWeAre/Documents/global.pdf