Ethical Implications of Social Stigma Associated with the Promotion and Use of Pre-Exposure Prophylaxis for HIV Prevention.

Identifying sources of and eliminating social stigma associated with the promotion and use of pre-exposure prophylaxis (PrEP) for the prevention of sexually acquired HIV infection among men who have sex with men (MSM) is both a moral imperative and necessary requirement to ensure that public health objectives of HIV prevention can be met. This article will examine and address ethical concerns and criticisms regarding the use of PrEP, barriers to its promotion, and use among MSM and examine the types of social stigma associated with PrEP. An ethical justification for both healthcare and LGBT communities to address and overcome social stigma regarding the use of PrEP among MSM is offered.

Cultural conundrums: the ethics of epidemiology and the problems of population in implementing pre-exposure prophylaxis.

The impending implementation of pre-exposure prophylaxis (PrEP) has prompted complicated bioethical and public health ethics concerns regarding the moral distribution of antiretroviral medications (ARVs) to ostensibly healthy populations as a form of HIV prevention when millions of HIV-positive people still lack access to ARVs globally. This manuscript argues that these questions are, in part, concerns over the ethics of the knowledge production practices of epidemiology. Questions of distribution, and their attendant cost-benefit calculations, will rely on a number of presupposed, and therefore, normatively cultural assumptions within the science of epidemiology specifically regarding the ability of epidemiologic surveillance to produce accurate maps of HIV throughout national populations. Specifically, ethical questions around PrEP will focus on who should receive ARVs given the fact that global demand will far exceed supply. Given that sexual transmission is one of the main modes of HIV transmission, these questions of 'who' are inextricably linked to knowledge about sexual personhood. As a result, the ethics of epidemiology, and how the epidemiology of HIV in particular conceives, classifies and constructs sexual populations will become a critical point of reflection and contestation for bioethicists, health activists, physicians, nurses, and researchers in the multi-disciplinary field of global health. This paper examines how cultural conundrums within the fields of bioethics and public health ethics are directly implicated within the ethics of PrEP, by analyzing the problems of population inaugurated by the construction of the men who have sex with men (MSM) epidemiologic category in the specific national context of South Africa.

Correlates of human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing and disclosure among HIV-negative collegiate men who have sex with men.

OBJECTIVE: To determine the extent to which personal, behavioral, and environmental factors are associated with human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing and disclosure. PARTICIPANTS: Nine hundred thirty HIV-negative collegiate men who have sex with men (MSM) who completed an online survey about alcohol use and sexual behavior. METHODS: Correlates of testing and disclosure significant in bivariate analyses (p < .05) were grouped into personal, behavioral, or environmental factors and entered into multivariable logistic regression models. RESULTS: About half of participants tested for HIV (51.9%) and for STIs (45.8%) at least annually. Over half (57.8%) of participants always/almost always discussed HIV status with new sex partners; 61.1% with new unprotected sex partners. Personal and behavioral factors (age and outness) explained differences in testing, and the behavioral factor (routine testing) explained differences in disclosure. CONCLUSIONS: Collegiate MSM should be supported in coming out, encouraged to engage in routine testing, and counseled on discussing HIV/STI status with potential sex partners.

Sexuality and consumers of mental health services: the impact of gender and boundary issues.

The importance of sexuality to humanity is clearly acknowledged. However, for consumers of mental health services, it tends to be a neglected topic. Although nurses are at the forefront of mental health service delivery, evidence suggests they are reluctant to include sexuality as part of their care. This article describes the findings from a qualitative exploratory research project that examined mental health nurses' attitudes to discussing sexuality with consumers. Fourteen mental health nurses from a service in Queensland participated in this study. Data analysis revealed two main themes: the impact of gender, and professional boundary issues. In terms of gender, participants referred to the impact of sexual dysfunction experienced by young adult male consumers. For female consumers the discussion centred on vulnerability to sexual exploitation and the need to exercise protective measures to ensure safety. Participants indicated concerns about being professionally compromised when discussing sexuality with consumers of the opposite sex. These findings highlight the need for further exploration of mental health nurses' attitudes towards discussing sexuality with consumers as part of their practice.

Responsibility for HIV prevention: patterns of attribution among HIV-seropositive gay and bisexual men.

The Seroconversion Narratives for AIDS Prevention (SNAP) study elicited narratives from recently infected seropositive gay and bisexual men that described the circumstances of their own seroconversion. This analysis of the narratives explored participants' attributions of responsibility for HIV prevention before and after they became infected. Before becoming infected with HIV, responsibility for prevention was often attributed to HIV-negative individuals themselves. These retrospective attributions revealed themes that included feelings of negligence, a sense of consequences, followed by regret. After seroconversion, responsibility for HIV prevention was primarily attributed to HIV-positive individuals themselves. Themes within these attributions included pledges to avoid HIV transmission, a strong sense of burden related to the possibility of infecting someone, and risk reduction strategies that they implemented in an attempt to avoid HIV transmission. Greater understanding of ideas related to responsibility has the potential to increase the effectiveness of HIV prevention interventions.

Conductos sexuales de riesgo y prevención del sida en la adolescencia / No disponible

En este trabajo se revisan las investigaciones sobre conductas sexuales adolescentes y se sintetizan los principales modelos teóricos que explican la adopción de medidas de protección ante situaciones de riesgo relacionadas con el sida. La falta de información puede inducir a realizar comportamientos con riesgo de transmitir el VIH y de tener embarazos no deseados, si bien otras variables de tipo social, conductual y cognitivo también explican las conductas sexuales de riesgo. Se destaca la importancia de que el adolescente perciba el riesgo potencial y se sienta competente para desarrollar comportamientos protectores, y que los beneficios de tomar estas medidas sean más valorados que los costes (AU)

This article reviews some studies about sexual behavior by adolescents, and synthesizes the main theoretical models that explain the adoption of protective behaviors under situations of HIV risk. The absence of information as well as social, behavioral, and cognitive variables could also account for some behaviors associated with pregnancy and HIV risk. The relevance of individual risk perception and feelings of self-efficacy to develop protective behavior in adolescents is discussed. It is argued that the benefits of adopting these behaviors outweigh the costs (AU)

AIDS and sex: is warning a moral obligation?

Common-sense holds that morality requires people who know that they are infected with the Human Immunodeficiency Virus (HIV) to disclose this fact to their sexual partners. But many gay men who are HIV-positive do not disclose, and AIDS Service Organizations (ASOs) promote public-health policies based on safer sex by all, rather than disclosure by those who know that they are infected. The paper shows that the common-sense view follows from a minimal sexual morality based on consent. ASOs' seeming rejection of the view follows from their need to take seriously widespread weakness of will in the realm of sexuality. The author argues that gay men take themselves to follow the common sense view, but hold that the possibility of a partner's HIV infection is background information that need not be disclosed for sexual consent. This suggestion is criticized. The paper concludes with a consideration of HIV disclosure and sexual ethics outside of the gay community and of legal restrictions on the sexuality of the HIV-positive.