Bioethics in public health: protection and assurance in HIV/AIDS
Abstract
The HIV/AIDS pandemic has withstood traditional preventive measures of epidemiology.
Such measures not only are inefficient, but have generated social attitudes of discrimination and rejection. The evident disproportion between minimal efficacy levels and the high risks of social exclusion, has built on an epidemiological exceptionalism with relation to sexually transmitted diseases, which is reflected on the resulting omission of preventive and control measures. Respect for individual autonomy is undermined in cases such as pregnant women, in whom the detection of seropositivity would enable the delivery of a therapy decreasing vertical transmission from 25% to less than 8%. Such efficient protection of the newborn has resulted in the advice for the implementation of a mandatory HIV/AIDS serodiagnosis during pregnancy, a recommendation that is supported by the recent availability of a fast test, which would enable the screening of women presenting belatedly to obstetrical controls.
Clinical bioethics, a principleist and individualist discipline, is inspired on respect towards people and fosters autonomy while rejecting all compulsoriness, even if it should result in a benefit for children and to decrease the prevalence of HIV/AIDS. Bioethics in public health, however, are based on protection, considers the convenience of restrictions on individual autonomy when the latter hinders the implementation of efficiency-proven preventive and therapeutic measures. As long as protection [bio]ethics become an inalienable goal of public health, citizen assurance and participation in public policies will be leveraged.
