Nursing ethics in the care of people with HIV

Elizabeth Crock: Bolton Clarke HIV Program, Melbourne

Donna Tilley: Western Sydney Local Health District, Sydney

Introduction and background

Nurses work along the continuum of HIV care, from prevention and testing, engagement in care, sexual and reproductive health, long-term management through to palliative care.  They work in a wide variety of environments and care for people with HIV across the lifespan.  In all settings, ethical issues arise in nursing practice every day, and can often be relatively simple to deal with. In relation to HIV infection, the ethical issues may be extremely complex and difficult to resolve.[1]  It is therefore imperative that nurses ‘have the knowledge, skills, and “right attitude” to be able to respond to the issues in an appropriate, ethically warranted and just manner’.[2]

Ethics is essentially the branch of knowledge that deals with moral principles, or ways of thinking about, understanding and examining ‘how best to live a moral life’.[3] ‘Ethics’ is derived from the Greek ethikos, meaning custom or habit.[4][5] In 1991, ethicist Fredrick Reamer observed that the HIV epidemic has tested ‘the moral mettle of [health] professionals in a way perhaps that no prior public health crisis has.’[6] Despite much progress over the past 35 years, this statement remains true.  HIV as a disease and as a social phenomenon has challenged health professionals to examine their personal and professional ethical values and to uphold the ethical values of their professions in the face of profound stigmatisation of those affected.

Ethical issues such as those relating to privacy and confidentiality, access to new or experimental treatments, and reproductive rights have taken on a heightened emphasis throughout the HIV epidemic, often due to HIV-related stigma.  Moreover, the inextricable link between human rights violations and the spread and impact of HIV on individuals and communities is now well understood.[7]