Balancing the Socio-Political and Medico-Ethical Dimensions of HIV: A Social Public Health Approach

ISBN-13: 9783031091902 / Angielski / Miękka / 2022

Amos Laar

Opis

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. 

Spis treści

CHAPTER 1: The practice of public health then, now, and in the future

This introductory chapter presents relevant concepts and principles of public health practice. It highlights relevant historical, extant, and emerging approaches in public health – emphasizing their application to the AIDS pandemic. From surveillance, quarantine, data-driven interventions, to social public health approaches (including advocacy, community engagement, and empowerment, responding to political controversies, countering misinformation, disinformation, and conspiracy theories). The chapter also takes a peek into the future of public health practice (e.g. precision public health). Thus, the chapter, overall presents highlight of the practice of public health -then, now, and in the future.

 

CHAPTER 2: Public health approaches to AIDS

Beginning from the early days of AIDS, the chapter describes the conceptualizations of AIDS, (including AIDS as public health emergency of international concern), and the global/local public health responses to the pandemic. It examines the application of cardinal public health principles to curbing AID in different contexts. The chapter discusses the achievements of traditional public health response measures (including surveillance, contact tracing, testing, the counting and reporting AIDS cases and deaths) as well as relatively recent innovations (including combination prevention measures, treatment as prevention, the reimagined HIV prevention efforts). The chapter also examines how to respond to AIDS denialism, conspiracy theories, and other political controversies. The chapter concludes with a discussion on the prospects and challenges of current efforts aimed at eliminating HIV.

 

CHAPTER 3: AIDS interventions: which counts? which should not? Why not?

This chapter identifies the many public health interventions being deployed in response to AIDS. Including the classic HIV prevention efforts of abstinence, fidelity, use of condoms, treatments with antiretroviral medications (ARVs), nutrition interventions, as well as care and psychosocial support.  Deploying a bioethical method of interest analysis, the chapter debates the relative importance of these interventions – emphasizing not just whether they work, but for whom and under what circumstances.  Through this, the chapter responds to the questions of “which AIDS interventions count? which do not or should not? And why not?”. The chapter concludes with a recommendation to ensure a meaningful intervention-mix - integration of the social interventions into what is currently predominantly a medical response.  

 

CHAPTER 4: Access to live-saving public health goods by persons infected or affected by HIV

Assuring equitable access to life-saving public health commodities (including nutritious foods, and AIDS medications) remains a challenge globally. This chapter examines, medical, and cultural constructions of access, and the evolving discourses on access to life-saving AIDS medications. It traces the discourses from the era of rationing of AIDS medications to current era of “test and treat”. Drawing on case studies on access in general, and access to AIDS medications in particular, the chapter identifies gaps in the current notion of access. The chapter argues that the current global aspirational goal of “treat all”/ “test and treat” requires a nuanced understanding of the multiple notions of access, discourses of therapeutic citizenship, and their variegated political economies.

 

CHAPTER 5: “They are criminals”: AIDS, the law, harm reduction, and the socially excluded

The right to the highest attainable standard of health, without qualification, is acknowledged universally as a fundamental human right. Unfortunately, this right, depending on the setting, eludes some populations deemed to be at higher risk of acquiring or transmitting the AIDS virus - Human Immunodeficiency Virus (HIV).  For instance, in line with her half century old penal code, Ghana criminalizes and penalizes behaviors of men who have sex with men (MSM), and sex workers, a practice that arguably interferes with their access to public health resources. This chapter provides an analysis of how enactment and implementation of rights-limiting policies, regulations, or laws not only limit rights, but also amplify risk and vulnerability to HIV in key and general populations. Drawing on prevailing rights discourses and pedagogy, the chapter offers two approaches to responding to the syndemic of AIDS, and rights violations. The proposed approaches are abolitionism and instrumentalism.

 

CHAPTER 6: Development of socially and ethically responsive National AIDS policies

Responding to AIDS at the global, regional, or local levels can give rise to a multitude of tensions. To facilitate sustainable attainment of AIDS response goals, these tensions need to be deliberately balanced. This chapters presents the findings and recommendations of an exercise that examined the social, cultural, political, ethical, and medical sensitivity of Ghana’s National AIDS policy documents/guidelines. The chapter highlights key measures to developing and implementing National AIDS response policies that do not lose sight of how structural violence, social forces, and other structural determinants of health. Although focused on Ghana’s AIDS response guidelines, the analysis presented in the chapter enable identification of gaps in similar national public health policies.

 

CHAPTER 7: Introducing social public health into National AIDS response: Lessons from Ghana

The concluding chapter of the book illustrates an effort to introduce social public health into Ghana’s national response to AIDS. The chapter shares the concept, implementation approaches, challenges, achievements, as well as lessons from this initiative. The chapter emphasizes the need to demystify public health practice as well as destabilize dated public health orthodoxies (e.g. the naturalness with which public health actors ignore its social, cultural, ethical, and political dimensions). The chapter will admonish that ending AIDS as a public health threat requires a marriage of the social and the medical. 

O autorze

Amos Laar, PhD obtained his BSc (in Nutrition and Biochemistry), MPH, PhD (in Public Health) from the University of Ghana, and MA (in Bioethics) from the University of Minnesota, USA.  He is a Bioethicist, and a Tenure-Track Academic at the School of Public Health, University of Ghana - Accra, Ghana. His earlier work makes significant contribution to public health scholarship on women’s reproductive health, particularly the socio-cultural, socio-ethical, and medico-ethical dimensions of HIV. Currently his research and professional practice straddle three distinct yet related areas of public health: Bioethics; Public Health Nutrition; and Social Public Health. Through these, his scholarship contributes to a deeper understanding of how physical environments, social environments, and structural forces affect realization of health. He has authored over 90 scholarly works on the above topics. He is a mentor – having supervised over 70 graduate and undergraduate theses from universities in Africa (University of Ghana, University of South Africa), Asia (Nagasaki University of Japan), Europe (University of Sheffield, UK), and North America (University of South Carolina, USA).