This is in response to Kuensel’s editorial, “Who are we protecting” on December 9. Unfortunately, there are still people – even today in 2015 – who do not know enough about HIV, the virus that can cause AIDS. Because of this, people who are living with HIV; or are allegedly living with HIV can face prejudice and discrimination. The Government of Bhutan strongly supports a human rights approach to HIV, and encourages a passionate partnership with civil society, including people living with HIV.
Evidence and global experience shows that the best public health approach is ‘beneficial disclosure’ of HIV status. This approach emphasizes that individuals must have control over if, how and when to tell others about their HIV-positive status.
Beneficial disclosure is disclosure that is voluntary; respects the autonomy and dignity of the affected individuals; maintains confidentiality as appropriate; leads to beneficial results for the individual, his/her sexual and drug-injecting partners, and family; leads to greater openness in the community about HIV; and meets ethical standards so as to maximize good for both the uninfected and the infected.
What is raised in Kuensel’s editorial is the question if the need to protect others in the community is more important than the person living with HIV’s right to confidentiality. The answer is clear: The best public health approach, to which the Ministry of Health of Bhutan subscribes, encourages consistent use of condoms; especially in high-risk situations such as “picking up strangers in the street” and “being under the influence of alcohol.”
Only adequate public education, and awareness about the importance of one’s own protection against HIV infection, will solve these problems. Education of the public about HIV has made great progress since the early years when HIV was first discovered. However, there are still a lot of misconceptions about the means of transmitting HIV and the ability of people with HIV to lead normal lives. We need to educate people that people living with HIV are parents, spouses, friends, co-workers, teachers, professionals, and mentors. Until the public fully understands the reality of life with HIV, an infected person will probably want to, and has the right to, maintain some control over public knowledge of his/her status.
Using information about people living with HIV for public health goals must be balanced against the rights of individuals to privacy and confidentiality. UNAIDS stresses that individual and public rights must be balanced, and must be based on human rights principles. Countries need to develop and implement privacy and confidentiality laws. The development and review of such laws and procedures related to HIV information needs active participation from relevant stakeholders, including people living with and affected by HIV; health care professionals, and legal and ethical experts. It is important to adopt privacy and confidentiality laws, because prejudice and discrimination constitute the greatest barriers to dealing effectively with the HIV epidemic.
The woman, described in this article, therefore, poses no risk to others if not “preyed upon as an easy target” and there is no risk of spreading HIV when the strangers, who pick her up, always use condoms.
Breeching the right to confidentiality is not an effective tool for combating HIV, and is a distraction from programmes that we know work.
Dr Ruben F del Prado
UNAIDS Country Director for Nepal and Bhutan