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Ethics of the HIV/AIDS Response

  • Ruotao WangEmail author
  • Jia Miao
  • Dapeng Zhang
  • Jennifer M. McGoogan
Chapter

Abstract

Since HIV came to China in the mid-1980s, many ethical issues have challenged Chinese public health workers, officials, and policymakers. This chapter reviews many of the controversies, dilemmas, and other ethical issues related to the HIV/AIDS response in China, as well as HIV/AIDS research. Specifically, ethical issues surrounding harm reduction measures (i.e. condom promotion, needle exchange, and methadone treatment), HIV testing formats (i.e. anonymous testing, active testing, mandatory testing), disclosure of HIV status, and antiretroviral therapy (ART; i.e. methods and funding) are discussed. Finally, ethical concerns regarding HIV research (i.e. protection of human subjects, responsible conduct of research) are described, and means of addressing those concerns are discussed. These ethical issues and others have been complex and difficult to navigate. However, the Chinese Central Government, as well as leading public health and research institutions have shown increasing commitment to the careful and thoughtful analysis of these problems, debate and discussion of all viewpoints, and development of policies, regulations, and guidelines that focus on the well-being of all peoples.

References

  1. Borges ÁH, Neuhaus J, Babiker AG, Henry K, Jain MK, Palfreeman A, et al. INSIGHT START Study Group. Immediate antiretroviral therapy reduces risk of infection-related cancer during early HIV infection. Clin Infect Dis. 2016;63(12):1668–76.  https://doi.org/10.1093/cid/ciw621.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Chen FF, Wang L, Han J, Wang LY, He WS, Guo W, et al. HIV sero-conversion rate and risk factors among HIV discordant couples in Zhumadian city, Henan province. Zhonghua Liu Xing Bing Xue Za Zhi. 2013;34(1):10–4.PubMedGoogle Scholar
  3. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.  https://doi.org/10.1056/NEJMoa1105243.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Cyranoski D. China introduces sweeping reforms against misconduct. Nature. 2018;558(7709):171.  https://doi.org/10.1038/d41586-018-05359-8.CrossRefPubMedGoogle Scholar
  5. Grinsztejn B, Hosseinipour MC, Ribaudo HJ, Swindells S, Eron J, Chen YQ, et al. Effects of early versus delayed initiation of antiretroviral treatment on clinical outcomes of HIV-1 infection: results from the phase 3 HPTN 052 randomised controlled trial. Lancet Infect Dis. 2014;14(4):281–90.  https://doi.org/10.1016/S1473-3099(13)70692-3.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Gruskin S, Mills EJ, Tarantola D. History, principles, and practice of health and human rights. Lancet. 2007;370(9585):449–55.  https://doi.org/10.1016/S0140-6736(07)61200-8.CrossRefPubMedGoogle Scholar
  7. He Y, Yang H, Feng S, Yan Z. Study on the behavioral intervention by using condom to prevent STD/HIV. Chinese J Dis Control Prev. 2003;7:152–3.Google Scholar
  8. He N, Duan S, Ding Y, Rou K, McGoogan JM, Jia M, et al. Antiretroviral therapy reduces transmission in discordant couples in rural Yunnan, China. PLoS One. 2013;8(11):e77981.  https://doi.org/10.1371/journal.pone.0077981.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Jia H. China gets serious about research integrity. New York, NY: Nature Index; 2018. https://www.natureindex.com/news-blog/china-gets-serious-about-research-integrity. Accessed 24 Aug 2018.Google Scholar
  10. Li J, Ma YM, Sun DY, Zhu Q, Wang Z. Analysis on sero-conversion status of HIV-discordant spouse from 2006–2010 in Henan province. Zhonghua Liu Xing Bing Xue Za Zhi. 2012;33(1):71–4.PubMedGoogle Scholar
  11. Lim L. Plagiarism plague hinders China’s scientific ambition. Washington, DC: National Public Radio; 2011. http://www.npr.org/2011/08/03/138937778/plagiarism-plague-hinders-chinas-scientific-ambition. Accessed 24 Aug 2018.Google Scholar
  12. Lima VD, Reuter A, Harrigan PR, Lourenço L, Chao W, Hull M, et al. Initiation of antiretroviral therapy at high CD4+ cell counts is associated with positive treatment outcomes. AIDS. 2015;29(14):1871–82.  https://doi.org/10.1097/QAD.0000000000000790.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Lin P, Fan ZF, Yang F, Wu ZY, Wang Y, Liu YY, et al. Evaluation of a pilot study on needle and syringe exchange program among injecting drug users in a community in Guangdong, China. Zhonghua Yu Fang Yi Xue Za Zhi. 2004;38:305–8.PubMedGoogle Scholar
  14. Lundgren JD, Babiker AG, Gordin F, Emery S, Grund B, Sharma S, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;373(9):795–807.  https://doi.org/10.1056/NEJMoa1506816.CrossRefPubMedGoogle Scholar
  15. Ma Y, Dou Z, Guo W, Mao Y, Zhang F, McGoogan JM, et al. The human immunodeficiency virus care continuum in China: 1985–2015. Clin Infect Dis. 2018;66(6):833–9.  https://doi.org/10.1093/cid/cix911.CrossRefPubMedGoogle Scholar
  16. Martin NK, Devine A, Eaton JW, Miners A, Hallett TB, Foster GR, et al. Modeling the impact of early antiretroviral therapy for adults coinfected with HIV and hepatitis B or C in South Africa. AIDS. 2014;28(Suppl 1):S35–46.  https://doi.org/10.1097/QAD.0000000000000084.CrossRefPubMedGoogle Scholar
  17. Nature. Chinese checkers—China sets a strong example on how to address scientific fraud. Nature. 2018;558(7709):162.Google Scholar
  18. Nie JB, Walker ST, Qiao S, Li X, Tucker JD. Truth-telling to the patient, family, and the sexual partner: a rights approach to the role of healthcare providers in adult HIV disclosure in China. AIDS Care. 2015;27(Suppl 1):83–9.  https://doi.org/10.1080/09540121.2015.1071772.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Nordrum A. China’s scientific credibility marred by wrongdoing, top medical journals says. New York, NY: International Business Times; 2015. http://www.ibtimes.com/chinas-scientific-credibility-marred-wrongdoing-top-medical-journal-says-1877209. Accessed 24 Aug 2018.Google Scholar
  20. Pisani E, Wu Z. HIV in China: 30 years in numbers. In: Wu Z, editor. HIV/AIDS in China—beyond the numbers. Singapore: People’s Medical Publishing House; 2017. p. 150–73.Google Scholar
  21. Rahman SM, Vaidya NK, Zou X. Impact of early treatment programs on HIV epidemics: an immunity-based mathematical model. Math Biosci. 2016;280:38–49.  https://doi.org/10.1016/j.mbs.2016.07.009.CrossRefPubMedGoogle Scholar
  22. Resnik D, Zeng W. Research integrity in China: problems and prospects. Dev World Bioeth. 2010;10(3):164–71.  https://doi.org/10.1111/j.1471-8847.2009.00263.x.CrossRefPubMedPubMedCentralGoogle Scholar
  23. WHO. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. Geneva: World Health Organization; 2016. http://apps.who.int/iris/bitstream/10665/208825/1/9789241549684_eng.pdf?ua=1. Accessed 24 Aug 2018.Google Scholar
  24. Wu Z, Sun X, Sullivan SG, Detels R. Public health. HIV testing in China. Science. 2006;312(5779):1475–6.  https://doi.org/10.1126/science.1120682.CrossRefPubMedGoogle Scholar
  25. Wu Z, Zhao Y, Ge X, Mao Y, Tang Z, Shi CX, et al. Simplified HIV testing and treatment in China: analysis of mortality rates before and after a structural intervention. PLoS Med. 2015;12(9):e1001874.  https://doi.org/10.1371/journal.pmed.1001874.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Wu Z, Pisani E, Chaddah A. Finding those at risk, China’s way. In: Wu Z, editor. HIV/AIDS in China—beyond the numbers. Singapore: People’s Medical Publishing House; 2017a. p. 63–77.CrossRefGoogle Scholar
  27. Wu Z, Tang Z, Mao Y, Van Veldhuisen P, Ling W, Liu D, et al. Testing and linkage to HIV care in China: a cluster-randomised trial. Lancet HIV. 2017b;4(12):e555–65.  https://doi.org/10.1016/S2352-3018(17)30131-5.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Xia G, Yang X. Social gender, temporary migration and risk of HIV/AIDS. China Soc Sci. 2006;6:88–99.Google Scholar
  29. Yap L, Reekie J, Liu W, Chen Y, Wu Z, Li J, et al. HIV testing in re-education through labour camps in Guangxi Autonomous Region, China (a cross-sectional survey). Sex Transm Infect. 2015;91(6):401–6.  https://doi.org/10.1136/sextrans-2014-051658.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Zhang L, Yap L, Reekie J, Liu W, Chen Y, Wu Z, et al. Drug use and HIV infection status of detainees in re-education through labour camps in Guangxi Province, China. Int J Environ Res Public Health. 2015;12(5):4502–19.  https://doi.org/10.3390/ijerph120504502.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Zhao Y, Wu Z, McGoogan JM, Shi CX, Li A, Dou Z, et al. Immediate antiretroviral therapy decreases mortality among patients with high CD4 counts in China: a nationwide, retrospective cohort study. Clin Infect Dis. 2018;66(5):727–34.  https://doi.org/10.1093/cid/cix878.CrossRefPubMedGoogle Scholar
  32. Zhao Y, Wu Z, McGoogan JM, Sha Y, Zhao D, Ma Y, et al. Nationwide cohort study of antiretroviral therapy timing: treatment dropout and virological failure in China, 2011–2015. Clin Infect Dis. 2019;68:43.  https://doi.org/10.1093/cid/ciy400.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Ruotao Wang
    • 1
    Email author
  • Jia Miao
    • 2
  • Dapeng Zhang
    • 1
  • Jennifer M. McGoogan
    • 1
  1. 1.NCAIDSChina CDCBeijingChina
  2. 2.Hong Kong University of Science and TechnologyHong KongChina

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