Development of ethically appropriate HIV epidemic response strategy in a resource poor setting: the case of Ghana_

Abstract

Responding to HIV at global, regional, or local levels can give rise to a multitude of ethical tensions. To provide a comprehensive response to her HIV epidemic, Ghana has developed national plans, policies, and protocols. This thesis aimed to assess the ethics sensitivity of these guiding documents. The assessment included the quality of ethical reasoning and argumentation. Documents were assessed in their entirety using leading frameworks from public health ethics. The documents I reviewed have many strengths and also notable weaknesses. Generally, the documents reflect an underdeveloped understanding of potential and real ethical concerns. These documents provide inadequate responses to diminished rights of key populations. The prioritization schemes delineated in the documents, while sound from a public health perspective, lack adequate ethical justifications. The universal acknowledgement of chronic shortage of antiretroviral medications in the documents is not accompanied by practical recommendations concerning how to address such shortages. Guidelines addressing how to ethically allocate this scarce commodity do not exist.