An ethical assessment of the adoption of pre-exposure prophylaxis as a potential HIV prevention method in Zambia
Chilukwa, Mwimba Martin
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The aim of this dissertation is to evaluate, from an ethical point of view, whether Pre-exposure Prophylaxis a method used to prevent HIV infection by administering anti-retroviral drugs to HIV negative people should be implemented in Zambia. The current HIV prevention methods include condoms and Post-exposure Prophylaxis. The specific objectives of the study are to explain methods aimed at preventing HIV infections, to investigate the current situation in Zambia on Pre-exposure Prophylaxis, and to assess, from an ethical point of view, whether Pre-exposure Prophylaxis should be adopted in Zambia. Clinical trials have shown that the drug Truvada given to HIV negative people can reduce HIV infection by 73 percent. The study used empirical and ethical methods. The empirical methods, face to face interviews were conducted with a purposive sample of health workers and NGO representatives using a semi-structured interview schedule. The ethical method consisted in an application of the Precautionary Principle and Utilitarianism. The main empirical findings of this study are that a majority of 80 percent of the respondents have already heard of Pre-exposure Prophylaxis. The benefits of Pre-exposure Prophylaxis include reduction in the risk of HIV transmission. A majority of 85 percent mentioned kidney failure and 31 percent liver toxicity as side effects. The study has shown that 50 percent cited high cost of implementation as a concern. The study also shows that 60 percent preferred early adoption of Pre-exposure Prophylaxis. On the other hand 31 percent cited resistance, monitoring and high cost as the general harms. Compared to other options, most participants preferred Pre-exposure Prophylaxis for high risk groups with more emphasis on monitoring and adherence services so as to reduce new HIV infections. The result of the ethical evaluation is that according to both, the Precautionary Principle and Utilitarianism, implementing Pre-exposure Prophylaxis for high risk groups is morally better than the current policy of not adopting Pre-exposure Prophylaxis. This study shows therefore that implementing Pre-exposure Prophylaxis for high risk groups is ethically preferable to the current Zambian policy of not adopting Pre-exposure Prophylaxis.