Balancing the Socio-political and Medico-ethical Dimensions of HIV: A Social Public Health Approach

Description

Responding to public health challenges at the global and local levels can give rise to an array of tensions. To assure sustainable public health, these tensions need to be meaningfully balanced. Using empirical evidence and lived experiences relating to HIV from the global south, this book enunciates the many dimensions of national-level responses to HIV/AIDS including conceptual, philosophical, and methodological perspectives from public health, public policy, bioethics, and social sciences. Calling out glaring neglects, the book makes a bold recommendation for the destabilization of the naturalness with which national HIV/AIDS responses ignore the socio-political and medico-ethical dimensions of HIV. The case made is grounded in the philosophy of social public health. Such a critical perspective is not unique to Ghana’s response to HIV/AIDS but serves as emblematic voice for similarly situated settings of the global south. The book is also timely. It is written at a time when public health actors are repositioning themselves to be competent users of not only pharmaceutic vaccines, but also social vaccines. Topics explored in the chapters include Public health approaches to HIV and AIDS Access to life-saving public health goods by persons infected or affected by HIV “They are criminals”: AIDS, the law, harm reduction, and the socially excluded Developing socially and ethically responsive National AIDS policies Balancing the Socio-political and Medico-ethical Dimensions of HIV: A Social Public Health Approach is compelling reading for a broad spectrum of readers. The book will appeal to professionals, scholars, and students in public health, public policy, bioethics, and social sciences, as well as medical anthropologists, sociologists, and global health scholars. Public health economists, lay politicians, and civil society organizations advocating for health equity will find the book useful as well. Foreword Preface Acknowledgments Contents List of Figures List of Tables About the Author Abbreviations Chapter 1: The Practice of Public Health 1.1 Introduction 1.2 Indigenous African Concepts of Health 1.3 Public Health Practice 1.4 Surveillance 1.5 Public Health Research Versus Public Health Practice 1.6 Public Health Practice: Then, Now, and in the Future 1.7 From Pre-history to the Hippocratic Traditions and Public Health Practice 1.8 Public Health Practice During the Middle Ages 1.9 The Industrial Revolution and Public Health Practice 1.10 Public Health Practice in the Nineteenth Century: The Emergence of Bacteriology and Contribution of Epidemiology to Public Health 1.11 Public Health Practice in the Twentieth Century 1.12 Public Health Practice in the Twenty-First Century and Beyond References Chapter 2: Public Health Approaches to HIV and AIDS 2.1 Introduction 2.2 The Global Public Health Response to the HIV Pandemic 2.3 Epidemiology of HIV 2.4 HIV Surveillance and Testing/Screening 2.5 HIV Testing 2.6 HIV Prevention Strategies: From Classic Public Health Interventions to Modern Innovations 2.7 Recent Innovations in HIV Prevention 2.8 Prevention of Mother-to-Child Transmission of HIV (PMTCT) References Chapter 3: HIV Interventions: Which Should Count? Which Should Not? And Why Not? 3.1 Introduction 3.2 HIV Prevention Strategies 3.3 Implementing Combination Prevention Programs References Chapter 4: Access to Life-Saving Public Health Goods by Persons Infected with or Affected by HIV 4.1 Introduction 4.2 Early Efforts at Ensuring Access to Antiretroviral Therapy (ART) in the Developing World 4.3 Cost of Antiretroviral Therapy (ART): A Significant Barrier 4.4 ART and HIV-Related Service Delivery in Ghana 4.5 Improving Access to Care Will Require Interventions That Address Financial Constraints 4.6 Improving Access to Care Will Require Interventions That Address Malnutrition and Food Insecurity 4.7 Improving Access to Care Will Require Interventions That Address HIV-Related Stigma and Discrimination 4.8 Improving Access to Care Will Require Interventions That Improve Experience at Treatment Centers (Including Service Satisfaction) References Chapter 5: “They Are Criminals”: AIDS, the Law, Harm Reduction, and the Socially Excluded 5.1 Introduction 5.2 Human Rights and Key Populations in the HIV Response 5.3 Criminalization of HIV and Key Population Groups 5.4 Key Populations and Criminal Laws in Ghana 5.5 Impacts of Criminalizing HIV on Key and Vulnerable Populations 5.6 Key Populations and Harm Reduction 5.7 Current Efforts at Availing Health Services to Key Populations and Proposed Future Directions References Chapter 6: Developing Socially and Ethically Responsive National AIDS Policies 6.1 Responding to Pandemics 6.2 General Context 6.3 HIV Context 6.4 Ghana’s National Response to HIV 6.5 Ethical Tensions in National HIV Response Policies/Documents and Programmatic Deficiencies 6.6 Rights of Key Populations to Public Health Services 6.7 Geographic Prioritization of Public Health Services 6.8 Guidance on Rationing Limited Prevention, Treatment, Care, and Support Resources and Services 6.8.1 Rationing ARVs Based on Utilitarian Principle 6.8.2 Rationing ARVs Based on Equity or Equal Worth Principles 6.8.3 Rationing ARVs Based on Urgent Need Principle 6.8.4 Rationing ARVs Based on Prioritarian Principle References Chapter 7: Making National HIV/AIDS Response Responsive to Social Public Health: Lessons from Ghana 7.1 Introduction 7.2 Attempts at Introducing Social Public Health Initiatives into Ghana’s National Response References Index