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From modeling to morals: Imagining the future of HIV PREP in L esotho
Author(s) -
Kenworthy Nora J.,
Bulled Nicola
Publication year - 2013
Publication title -
developing world bioethics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.398
H-Index - 27
eISSN - 1471-8847
pISSN - 1471-8731
DOI - 10.1111/dewb.12029
Subject(s) - stigma (botany) , condom , human immunodeficiency virus (hiv) , medicine , developing country , pre exposure prophylaxis , treatment as prevention , public relations , economic growth , political science , family medicine , psychiatry , men who have sex with men , antiretroviral therapy , viral load , economics , syphilis
Amidst growing global endorsements of new biomedical HIV prevention strategies, ARV ‐based pre‐exposure prophylaxis ( ARV PrEP ) has garnered considerable attention as a potentially promising prevention strategy. Though it may offer more effective protection for certain at‐risk groups than conventional prevention strategies (such as sexual partner reduction, condom use, and prevention of mother‐to‐child transmission), PrEP is more costly. PrEP requires more ongoing contact between individuals and providers, and a level of surveillance from the health system that is not necessary with other preventive measures. In this sense, it represents a new bio‐technology for HIV prevention that poses particular challenges for worldwide implementation, given developing countries’ struggling health systems and incomplete HIV treatment programs. Since the emergence of PrEP has stimulated ethical discussions premised on incomplete knowledge of efficacy and implementation, this paper explores the ethical parameters of a likely scenario for PrEP usage in a single, resource‐poor country. We first develop a plausible model for PrEP deployment and utilization based on current PrEP research, while carefully considering the reigning institutional values of feasibility and effectiveness in global health approaches. Drawing on ethnographic research of HIV treatment and prevention approaches in L esotho, we address ethical questions arising from this scenario of PrEP delivery. L esotho presents a compelling and emblematic case study of PrEP's potential successes and pitfalls in a developing country, given the country's high HIV prevalence, struggles to achieve universal access to HIV treatment regimes, continued existence of stigma around the epidemic, and difficulties in addressing persistent social inequalities that fuel infections.