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Many contentious issues were raised. On some there was immediate agreement (the need for pre- and post-test counseling), on others, a reasonable consensus was gradually forged (pregnant mothers in vulnerable groups could be persuaded to undergo tests (for HIV as well as hepatitis) since their children might then receive better treatment). Inevitably, a few differences remained (the right of the sero-positive person to practice unsafe sex, versus the right of the partner to be told).
The difficult issues revolved around an individual’s right to control his/her own body (and the right to decide whether to know or not to know) versus the rights of other people, including the community, to be free from the disease. For instance, if 95% of children with HIV are not native to the host country, should testing of women from this ethnic minority be encouraged? required? If two-thirds of the HIV positive heterosexual population belongs to a particular minority, should this information be made available?
Discrimination of every kind was condemned, but non-discriminatory automatic testing of all blood (collected routinely from blood tests for whatever reason) from everybody was not favoured.
The reality has to be faced that in some countries asylum seekers are tested, in other countries, foreign students are tested and in many places, people undergoing surgery in hospitals are illegally but routinely tested. Given this situation, psychological damage could be minimized by skilled pre- and post-test counseling. Since the influence available to our experts and their institutions is limited, it may be reasonable to concentrate policies on achievable objectives like the introduction of skilled counseling. At the same time, extended dialogues could influence the imperfect values sustaining existing national and institutional practices.
We agreed that, on balance, laws can and often do change behaviour, but should be reinforced by education and dialogue between institutions and further strengthened by a monitoring procedures. When a clear legal transgression takes place, HIV/Aids organizations should fight the issue through the courts (and have been successful in doing this).
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Several other examples of learning and clarification have already been given. The overall reduction in dissonance on many of the ethical issues raised was due to a gradual and subtle shift in the position of the arguments over time. It seems that there is now a wider acceptance that sex is a natural and enjoyable activity and not necessarily linked only to traditional marriage, genders or ordained objectives. As a consequence, catching a disease through a natural and enjoyable activity is a misfortune, but not a disgrace. From this it follows, that people who contract HIV/Aids can be treated like sufferers from other infectious diseases, the difference being that this one, at least for the time being, is lethal. Consequently, sufferers from this disease deserve our sympathy and must be helped, and others must be protected from the infectiousness of the disease, but there is a little less need now to shield the sero-positive from condemnation for reprehensible, unnatural and unethical activity. However, our experts thought that people have a right not to know their sero-state. This change in attitudes and values has only just begun and has to go much further so that sero-positives will not be prevented from competing on an equal level for jobs and sharing other activities.
Dissonance reduction as a consequence of this changed ethical imperative has shifted, or made more flexible, the ‘politically correct’ position on some of the issues under discussion.
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