A respect for ethics is an important part of effective HIV/AIDS-related treatment. This involves the principles or morals that shape people's personal and professional behaviour and their attitudes towards others.

An ethical approach to treatment is based on the principles of proactively doing no harm and minimizing risk. Ethics are particularly important in the context of work on HIV/AIDS as it is a highly personal and sensitive subject. In addition, work on access to HIV/AIDS-related treatment is, at times, complex and controversial, especially as it highlights issues of inequality.

Some examples of an ethical approach to HIV/AIDS-related treatment work include:

• empowering people living with HIV/AIDS and allowing them to choose for themselves;

• not discriminating against people - for example, because of their HIV status or because they use illegal drugs;

• maintaining confidentiality;

• ensuring suitable and equal participation by all those involved;

• ensuring that benefits and difficulties are shared appropriately among those involved; and

• appropriate referral.

Wherever possible, an ethical approach to HIV/AIDS-related treatment should be developed in a participatory way, involving both providers and receivers. This will help to ensure that everyone is following an agreed way of working.

Participatory group activity

Aim

To identify an ethical approach to HIV/AIDS-related treatment work.

Instructions

Before starting this activity, the facilitator needs to develop three role plays about providing treatment to people living with HIV/AIDS in the community. Each role play should highlight a key ethical issue relating to treatment work, such as:

Role play 1: a person living with HIV/AIDS being refused treatment;
Role-play 2: a person living with HIV/AIDS refusing to take treatment;
Role-play 3: a health worker testing someone for HIV without their consent, and then breaching confidentiality about the result.

The role plays should involve a variety of treatment providers (not just doctors), and should try to show people living with HIV/AIDS in different types of family or community situations.

1. Explain the aim of the activity.

2. Ask a small group of participants to act out the first role play.

3. Facilitate a group discussion about what ethical issues about HIV/AIDS-related treatment were highlighted by the role play. Ask participants how the situation could have been improved. Encourage the participants to ask each other questions and to make comments.

4. Repeat the process for the second role play.

5. Repeat the process for the third role play.

6. Facilitate a group discussion about what has been learned from the activity, based upon questions such as:

• Why might people act unethically? How can you help them to change their behaviour?

• Is it ever appropriate to breach a person's confidentiality when providing HIV/AIDS-related treatment?

• How can treatment providers respond if their ethics are different from other caregivers or the person living with HIV/AIDS?

Facilitators' notes

• Select enthusiastic and appropriate participants to act out the role plays and give them an outline of the story in advance so that they can prepare.

• Encourage those acting out the role plays to be creative - for example, by wearing costumes or using objects - in order to bring the situations to life.

• Encourage participants to draw the links between ethics and the other aspects of an 'ideal' treatment provider - namely, knowledge, skills and attitudes (see previous activity).

• Encourage participants to consider how their personal beliefs (for example, about religion) might affect their professional ethics when involved in treatment work.

Example

At a skills-building workshop, NGO/CBO participants acted out the following role play about a person living with HIV/AIDS being refused treatment:

Tilak is known in his community as a drug user. He is feeling very ill so he goes to see the doctor at the local NGO clinic. Dr Singh suspects that Tilak may have meningitis and TB.

Dr Singh recommends that Tilak be taken to the government hospital for more specialized care. A staff member from the NGO accompanies Tilak to the hospital.

Tilak is refused treatment in the outpatient department and denied admission to the hospital.

After the role play the participants identified the key ethical issues highlighted by it and how the situation could be improved. The participants then followed the same process for two further role plays - the first about a person living with HIV/AIDS refusing to take treatment, and the second about a health worker testing someone for HIV without their consent and breaching their confidentiality about the result.

Afterwards, the facilitator led a group discussion about what had been learned from the activity. For example, participants agreed that refusal to treat someone who is thought to be HIV-positive is discrimination and a violation of their right to health.

Reference: Adapted from a workshop on access to HIV-related treatment, India HIV/AIDS Alliance and the International HIV/AIDS Alliance, India, February 2001.