Social aspects ol AIDS

Social aspects ol AIDS W HO's Global Programme on AIDS (GPA) has actively helped governments in developing over 100 national pro- grammes for the prevention and control of AIDS throughout the world. While these national pro- grammes operate in substantia lly different epidemiological , social, economic and political environ- ments, they have been faced w ith a similar range of complex social issues, involving such areas as screening, employment, housing, access to health care and school- ing . In the light of the experience of these national programmes to date, and in the light of current knowledge about human immu- nodeficiency virus (HIV) infection and the disease, the Global Pro- gramme on AIDS lays particular emphasis on certain social aspects of its prevention and control . Firstly, GPA underlines that AIDS prevention and control strategies can be implemented effectively, and efficiently, and can be evaluated, in a manner that respects and protects hu- man rights. Secondly, GPA firmly believes that that there is no public health rationale to justify isolation, quarantine, or any discrimina- tory measures based solely on the fact that a person is suspect- ed or known to be HIV infected. The modes of H IV transmission are limited (sex, blood, mother-to- child), and HIV spreads almost entirely through identifiable beha- viours and specific actions which are subject to individual control. In most instances, the active partici- pation of two people is required for HIV transmission , such as in sexual intercourse and in sharing contami- nated needles or syringes . And on the other hand, the spread of H IV can also be prevented through the W ORLD HEALTH, March 1988 Above : In a graphic display of a nation's loss, a giant patchwork quilt-laid out before the Capitol in Washington - testifies to victims who have died of AIDS. Photo Contact-Press/A. Reininger © Right and below : The condom or "rubber " used to be almost a taboo word in polite society, but times have changed. A New York poster and the African boy inflating a con- dom as a party balloon convey the message of "safer sex." Photo Magnum/C. S. Perkins © A RUBBER IS A FRIEND IN YOUR POCKET ~~~~~":OhtfCHOTUNE: 212-807-6655 17 Uganda's national AIDS control pro- gramme uses a minibus to reach remote communities. Note the WHO symbol on the door. Below: Several countries have now organized " buddy services " through which dedicated volunteers can comfort the victims of AIDS, as here in the Federal Republic of Germany. Neither victims nor "buddies " are necessarily homosexuals. Photos WHO/E. Hooper and P. Hendricks ©(a winning entry in WHO 's Photo Competit ion) health system (for instance by en- suring the safety of blood, blood products, artificial insemination and organ transplantation, and prevent- ing re-use of needles, syringes and other skin-piercing or invasive equipment without proper sterilisation). HIV infection is not spread through casual contact, routine social contact in schools, the workplace or public places, nor through water or food, eating utensils, coughing or sneezing, insect bites, toilets or swimming pools. Accordingly, an AIDS prevention and control strategy should include: - providing information and education to the general public, to persons with behaviours that place them at risk of HIV infec- tion (risk behaviour groups), and to HIV-infected persons; - counselling of HIV-infected persons; - ensuring the safety of blood and blood products, skin-pierc- ing practices and other invasive procedures. In accordance with this strategy, persons suspected or known to be HIV-infected should remain inte- grated within society to the maxi- mum possible extent, and should be helped to assume responsibility for preventing HIV transmission to others. Exc lusion of persons sus- pected or known to be HIV-infect- ed would be unjustified in public health terms, and would seriously jeopardise educational and other efforts to prevent the spread of HIV. Furthermore, discriminatory measures create additional prob- lems and cause unnecessary human suffering. The avoidance of discrimination against persons known or suspected to be H IV- infected is important for AIDS prevention and control; failure to 18 prevent such discrimination may endanger public health. Finally, GPA points out that de- termining an individual's HIV infec- tion status may occur through me- dical examination for suspected H IV-related illness, voluntary testing programmes, screening of blood donors, or in other settings. Test- ing for the purpose of determin- ing an individual's HIV infection status should involve informed consent and counselling and should ensure confidentiality. GPA has published criteria for HIV screening programmes which emphasise the need to consider carefully the public health rationale for such screening, as well as to address explicitly the technical, operational, economic, social, legal and ethical issues inherent in screening programmes. W HO's Global Programme on AIDS intends to continue informing the public and updating its guidance, on the basis of its continuing ex- perience with AIDS prevention and control programmes worldwide, and as additional knowledge about HIV infection and AIDS becomes available. • WORLD HEALTH, March 1988