ByBy

Gunawan Pratama YogaGunawan Pratama Yoga

Ethics groupEthics group

OutlineOutline

• Introduction– History of HIV/AIDS– Pandemic disease– South east Asia

• The Role of Law– Proscriptive role of law– Protective role of law– Instrumental role of law

• The case of Thailand• Conclusion

IntroductionIntroduction

• History of HIV/AIDS First identified in1981; Kaposi sarcoma and

Pneumocyctis carinii pnuemonia (PCP) Failure of the body’s immune system Gay-Related Immune Deficiency (GRID) Acquired Immune Deficiency Syndrome

• Pandemic disease

• WHO By the year 2000, 30-40 M HIV+; 12-18 M AIDS and 1,8 M will die 90% will be in developing world,

particularly Asia

• Southeast Asia First appeared in the late 1980s Diversity than in Africa because of

The nature of CSW, major determinant IDU, sharing contaminated injection

equipment Individual mobility, Travelers, Fishermen,

Truckers, Traders and Migrant workers

• Not simply a medical disease• Socio-economic and political disease• The function of law and its interrelationship

with ethics pose several challenges to the dimension of HIV/AIDS

• Legal or policy responses to HIV/AIDS are useless, harmful and counterproductive

The Role of The LawThe Role of The Law

• Analyzed in detail by Julie Hamblin (1991)• Three main models

Proscriptive role of law Protective role of law Instrumental role of law

Proscriptive Role of The LawProscriptive Role of The Law

Traditionally penalizes certain forms of conduct

Often obstruct rather than facilitate effective policy implementation

Need for proper saveguards to prevent the misuse

Proscriptive Role of The LawProscriptive Role of The Law

• Compulsory for reporting of HIV and AIDS• Penal sanctions for knowingly spreading HIV• Mandatory testing for AIDS• Disclosure of HIV-positive status• etc

•Alienating people at risk of HIV

•Consultation with public health officer

• Protect individuals or classes of individuals from harmful and undesirable occurences

• Central importance because of discrimination against people with HIV/AIDS

• Help to enlist the support and cooperation in prevention strategy

• Required in the context of measures to protect the rights of people with HIV

Protective Role of The LawProtective Role of The Law

DiscriminationDiscrimination

• Double jeopardy Facing death Fighting for lives ------facing discrimination

• Poverty becomes a reality in relation to HIV Become poor because of AIDS People who are poor can be more at risk

• Successively used to direct blame, stigmation, prejudice and even violence

General terms :

“Any form of distinction, exclusion or restriction affecting a person, usually, but not

only, by virtue of an inherent personal characteristic, irrespective of whether or not there is any justification for these measures”.

Effects of DiscriminationEffects of Discrimination

• Persons HIV/AIDS persons

• Homosexual• Prostitutes• IDU• Foreigner in some country

Efforts to prevent the spread of HIV Community

• Common Forms of Discrimination Denying a person with AIDS the opportunity to

participate; Providing different or separate benefits or

services; Failure to stop harassment; Pre-employment inquiries about your health status

or disability; Questions about a disability when selling or

renting a house;

Questions about your sexual behavior or sexual orientation;

Denial of housing based on a disability; Discrimination because you are friends with a

person with AIDS; Failure to make reasonable changes to

accommodate your needs; Violating the confidentiality of a person with AIDS; Failure to stop discrimination.

Continue

What the Law Says About Discrimination

• The law tries to halt many kinds of illegal treatment, but people don't always agree on how to enforce these laws

• First need to understand the different ways these laws can be interpreted

• Laws are like tools; how much they help you depends on how well you use them.

• Need to learn a few legal terms

Legal Terms Legal Terms

• Action and Inaction; Harm and Injury You have to prove that someone, through an

ACTION or INACTION, is being discriminatory. If someone dislikes you, you must understand that

this is not a violation of the law unless they actually cause you some harm or injury

• No one will work near me anymore (inaction) so I'm being segregated (harm, injury)

• People are harassing me (action) so I'm subjected to abuse (harm or injury)

• I asked for an accommodation, but got no response (inaction) so I was denied an accommodation (injury)

• Disparate or Unequal Treatment Treated differently or worse than others because

of AIDS The witnesses must be willing to repeat what they

have heard.

• Disparate or Unequal Impact (Unfair Results or Unequal Effect) The result of a certain policy is unfair to people

who have AIDS, even if the policy attempts to treat everyone equally

Generally not caused by vindictiveness, and can usually be resolved through discussion.

• Separate Treatment Illegal, unless it is the only way to provide the

service you are seeking. Some types are legal and sensible

• Reasonable Accommodation and Undue Hardship To change something so that you can do your job

or benefit from a program or service, even if you have a disability.

Must be related to the physical limitations and it must be related to the job or activity.

Failure is a violation of law, unless can be proved costly or too difficult (UNDUE HARDSHIP)

Preventing and Redressing Discrimination

• Not simply go away if it is ignored• It will not cease simply because people

become better informed about the virus and its means of transmission

• A carefully planned and appropriately resourced strategy is necessary

• Enforcement of human rights legislation• AIDS is considered a disability• Prevention is more important than redress

• Barriers of seeking redress for discrimination through courts: Takes time and resources Publicity would lead to loss of confidentiality Fear of further discrimination and reprisal Fear that the process would be lengthy, stressful,

and ultimately futile Lack of protection by existing laws and statutes

• To promote the changes in values and patterns of social interaction that lead to susceptibility to HIV infection

• Operates on a broader and more far-reaching level• The law can play a proactive role • Require a creative approach to the law; more than

just a direct proscriptive or protective role• Require a recognition of all the implications of a

particular legal intervention on the direct, indirect and symbolic levels

Instrumental Role of LawInstrumental Role of Law

1990s1990s

• The most significant factors are not sexual or drug-use activity as such

• Socio-economic dependency• Preventable for who :

Can access to information Can Appropriate preventive measures Have the means to implement

• The most vulnerable Because of economic need or powerless to control

their sexual relationshipSexual activity for economic supportCondom is not accessible and affordablePoor health care

• The challenge is also the underlying social and economic factors that deprive of power to protect against HIV infection

Proscriptive Role

1985 - 1991

“The diseases requiring notification”• Order infected persons to appear for examination,

detain them and measures of protection

• Order to desist from action which may lead to spread of the disease

• Order to leave the employment

• Report information about HIV/AIDS in 24 hr

• Non compliance/violation lead to fines and/or imprisonment

1991-Now

Deletion of AIDS from “the disease requiring notification”

•No compulsory notification to the authorities•Reporting is done on a voluntary basis and sentinel surveillance system

•Voluntarily HIV testing

• The Thai Constitution Do not include non Thais

• Labour legislation No case concerning discrimination by reasons of

HIV/AIDS come to court even several employers have been dismissing

Fear of exposure of one’s identity

Protective RoleProtective Role

• Immigration– Announcement No. 11, 1986: Foreigners with

HIV/AIDS were prohibited from entering the country or becoming residence

– It Was Revoked in 1991

• Confidentiality– Criminal code and civil code– Never been used against doctors

• General reticence to sue doctors, inaccessibility of judicial system, fear of exposure of one’s identity

National Plan for the Prevention of AIDS• Empowerment of women to help the women

affected, and the elevation of their educational capacity as well as improved sexual negotiating skills so as be on par with their male counterparts

Instrumental RoleInstrumental Role

ConclusionConclusion

• The three models of legal can play a role in the response to HIV/AIDS

• The three models of legal are potentially relevant

• The proscriptive and the protective roles of the law have already been widely utilised

• Must fully exploit the potential of the law • Change the traditions and values that place

people at risk of HIV infection

Conclusion of Conclusion of ThThaaililaandnd

• Thailand has a myriad of laws relevant to HIV/AIDS

• In several instances, they are remedial rather than preventive

• At times, they are reactive rather than proactive and humane

• Poor law enforcement• National Plan for Prevention of AIDS

– Better performance towards those with HIV/AIDS

AcknowledgmentsAcknowledgments

• Dr. Maria

• Dr. Suvit

• All of the Bioengineering class