Aids fighters are split on ethics for Africa projects
As health minister of Lesotho, Motloheloa Phooko has little time for the finer points of western medical ethics. He is struggling to stem an Aids epidemic in a country where the HIV virus has already infected more than a quarter of the adult population.
The tiny southern African kingdom not only has one of the highest rates of HIV prevalence in the world. It also has among the lowest per capita incomes to help tackle it.
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Radical times, radical measures: Lesotho made international headlines late last year when it launched a programme that aims to screen everyone aged over 12 years old for infection, as the first step towards preventing and treating the disease.
Yet Dr Phooko, a physician by training, still feels trapped by guidance from international public health organisations that insists HIV screening programmes should remain optional, with extensive counselling offered before patients are asked to decide whether or not they wish to be tested.
“We should have mandatory testing,” he says. “When you have such a high infection rate, what choice do you have? . . . If you have to spend half an hour seeking permission to do one test, how many counsellors should we train and at what cost?”
His dilemma is one of a growing number of ethical issues around research, prevention and treatment that will spark debate at the week-long international Aids conference that gets under way in Toronto today. As HIV infection continues to grow globally
