LEGAL, ETHICAL, PSYCHOSOCIAL & REHABILITATION ISSUES RELATED TO

HIV/AIDS
INTRODUCTION
From we were very young we began to learn what was right and what was wrong. We
learned this from our parents, relatives, friends and teachers. By the time we became
adults, we had a personal set of ethics to guide our behaviour as well as activities in daily
life. We may believe that honesty is important and necessary in our daily life. We will try to
be honest because we believe it is right to do so. Being dishonest would then be wrong for
us.

DEFINITION:
According to Melanie and Evelyn “Ethics refers to the moral code for nursing and is based
on obligation to service and respect for human life”. Ethics are the rules or principles that
govern right conduct and are designed to protect the rights of human beings.

ETHICAL PRINCIPLES:
1. RESPECT FOR PERSONS: treat someone politely & kindly.
1. RESPECT FOR AUTONOMY:respect for the individual and their ability to make
decisions about their own health and future.
2. RESPECT FOR FREEDOM: provide freedom to direct one’s own life to choose
between good & bad.
3. RESPECT FOR BENEFICENCE (DOING GOOD):actions are intended to benefit the
patient or others.
4. RESPECT FOR NON- MALFEASANCE (AVOIDING HARM TO OTHERS):actions intended
not to harm or bring harm to the patient and others.
5. RESPECT FOR VERACITY (TRUTH TELLING): it is being honest & telling the truth about
the event.
6. RESPECT FOR JUSTICE (FAIR AND EQUAL TREATMENT):being fair or just to the wider
community in terms of the consequences of an action.
7. RESPECT FOR RIGHTS: respect the all rights of everybody.
8. RESPECT FOR FIDELITY (FULFILLING PROMISES): respect the loyalty, faithfulness and
commitments& also maintain the promises that is fixed.
9. CONFIDENTIALITY (PROTECTING PRIVILEGED INFORMATION): maintain the privacy &
respecting someone’s wish i.e. the professionals shouldn’t share personal details about
someone with others unless that person has said they can or it is absolutely necessary.
LEGAL & ETHICAL ISSUES:
1. Disclosure: Ethical disclosure is essentially a self-initiated action with the intent to be
honest and complete, to provide personal and professional information in order to
remain ethically compliant with the Code. To tell or not? Decisions whether to
disclose the diagnosis in the workplace.e.g. A doctor with HIV needs not to disclose?
 2. Disability rights: The relationship between HIV/AIDS and disability is a cause for
concern as persons with disabilities are often at higher risk of exposure to
HIV.Additionally there is a growing understanding that persons living with HIV or
AIDS are also at risk of becoming disabled on a permanent or episodic basis as a
result of their condition.e.g. A check-out person at a local grocery store found out I
had AIDS and started wearing latex gloves every time she waited on me.
3. Economical resources: It meansfinancial help in HIV treatment.Different kind and
degree of services are provided to a person who is employed and who has health
insurance and other resources available.
4. Employment rights: In job sector the employeecan decide whether to stay in their
current position or not? e.g. A person doing a job as a nursing assistant was too high
risk, she/she had to leave.
5. Medication & Treatments: In this the main issues are is there is relaxation for
treatment, is the medications are provided by govt. in free of cost to all or not, is
there is any dissatisfaction with the treatment providers. e.g.A HIV affected person
had a very bad reaction to the drug as well as for staying in hospital also.
6. Suicide: There is the dilemma of the right to die in case of HIV affected person. High
suicidal rate& the relative risk of suicide in men with AIDS aged 20-59 years was
36.30 times that of men aged 20-59 years without this diagnosis. (New York City,
1988). Seven people during a 6 week period took their own lives after testing
positive for the virus even though they were asymptomatic.
7. Duty to warn: Is there a legal duty to protect or warn third parties. Whether a
therapist has a duty to protect third parties when his or her patient, if HIV- positive
persists in engaging in unprotected sex with an unknowing partner involves complex
clinical and legal questions which have not been adequately addressed. Here the
counsellor’s role is to guide the person to make an ethical decision, moral Principles
&ethical decision making model.
PSYCHOSOCIAL ASPECTS OF HIV CLIENT:
Psychosocial issues means social stigma, discrimination which has a bad impact over the
psychology of the HIV affected women. HIV Stigma can be defined as an act of identifying,
labelling or attributing undesirable qualities targeted towards those who are perceived as
being shamefully different and deviant from the social ideal. People with HIV/AIDS are
stigmatized and discriminated against for many reasons, including the following:
 HIV is a slow, incurable disease that eventually results in suffering and death.
 Many people regard HIV as a death sentence.
 The public often poorly understands how HIV is transmitted and is irrationally afraid
of acquiring HIV from people infected with it.
 HIV transmission is often associated with violations of social mores regarding
improper sexual relationships, so people with HIV are associated with having done
something “bad.” For example, in some cultures people believe that a woman
 becomes infected with HIV because she has violated the mourning period after her
husband died or she had a HIV affected husband.
Therapeutic protocols are lacking for anti-HIV medications that could control the spread
of the epidemic and prolong lives.
Even if stigma is minimized an incurable and often fatal disease requires enormous
psychosocial adjustments.
They commonly go through an initial stage of denial, in which they do not acknowledge
having the disease or deny its likely consequences. HIV threatens a person’s life, goals,
expectations and significant relationships, no wonder that many people are reluctant to
admit their diagnosis or their risk of infection. People who subject themselves to high-
risk situations or behaviours commonly deny that they are at risk of HIV infection. They
often avoid testing, and if they are tested they avoid following up on results, as if
avoiding a clinical diagnosis might prevent the disease.
HIV disease can be characterized as producing three major psychological concerns:
 A perception of HIV as a threat
 Feelings of vulnerability and loss of control
 Death-related concerns.
Other psychological mechanisms
1. Denial-- total refusal of acknowledging the truth of HIV infection
2. Splitting -- always present, to a lesser or greater extent because it allows some degree
of dissociation and denial
3. Projecting “bad” parts of self- associated with illness -- influenced by internalized
stigma &the self-concept is altered
4. Limitation of the ability to process and integrate symbols.
REHABLITATION IN HIV CLIENT:
Rehabilitation means to regain back as previous. To restore the good health or useful life as
through therapy & education rehabilitation for a patient is required. Physical medicine and
rehabilitation also known as physiatry or rehabilitation medicine which is a branch of
medicine that aims to enhance and restore functional ability and quality of life to those with
physical impairments or disabilities. Physical therapy also known as physical rehabilitation or
physiotherapy, treatments and exercises concerned with remediation of impairments and
disabilities through promotion of mobility, functional ability, and quality of life.Occupational
therapy enables individuals to engage in the occupations that are meaningful to them in
order to achieve the optimum quality of life for that individual. The profession has classified
the term ’occupation’ into three categories of activity these are as follows:
Self-care—This means able to take care of herself.
Leisure—To give some time for herself & do the activities as per the wish of the
person.
Productivity—To improve the growth of own health & also maintain normal health
pattern.
OCCUPATIONAL THERAPY & VOCATIONAL REHABILITATION FOR INDIVIDUALS LIVING
WITH HIV/AIDS:
Occupational therapy enables individuals to engage in the occupations that are meaningful
to them in order to achieve the optimum quality of life for that individual. Occupational
therapy can have a crucial role in assisting persons living with HIV/AIDS to re-engage with
life, particularly through vocational rehabilitation programmes. Vocational rehabilitation
was defined by the Canadian Labour Office in 1973 as "the continuous and coordinated
process of rehabilitation which involves the provision of those vocational services designed
to enable a disabled person to secure and retain suitable employment". Joss (2002) notes
that occupational therapy is one of the few disciplines to understand the relationships
between the employee’s medical condition, functional abilities, psychosocial status and
work demands. The American Occupational Therapy Association states that occupational
therapists have both a professional and ethical responsibility to provide services to persons
living with HIV/AIDS. Occupational therapy can provide the client with a series of learning
experiences that will enable the individual to make appropriate vocational choices and
develop the necessary work habits for eventual employment. Using a process for guiding
occupational therapists with the development of clinical programmes, a community-based
work rehabilitation programme for persons living with HIV/AIDS is developed. A four-phase
programme was designed by Grossman and Bortone in 1986based on the Model of Human
Occupation which includes both individual therapy and group education and support
sessions. The phases are as follows:
 First phase: It allows clients to explore and foster the necessary daily habits and
work skills to support a vocational role.
 Second phase: It allows further development of skills and habits through various
voluntary work placements. These experiences helped the client to determine his or
her tolerance for work and how fatigue and the side effects of various medications
affected work performance.
 Third phase: It allows the clients to be placed in paid employment or returned to or
entered formal education or job-training programmes.
 Fourth phase:It is concerned with long-term support, follow-up and the availability
of the programme’s staff to intervene and provide support as necessary.
Benefits:
Creek in 2002 identified a number of benefits of rehabilitation to the individual these are as
follows:
 Giving people a role in society
 A means of earning
 Giving structure and purpose
 Providing a source of self-esteem
 Social interaction
 Interest and satisfaction.
 provides a routine and a distraction away from the traumas of diagnosis or infection.
RESEARCH FINDINGINS:
ABSTRACT
2. This paper was presented by the author at the 'Seminar on AIDS and Laws', organised by
the Young Lawyers Forum on November 23, 1996, at Pune. It discusses the ethical and legal
aspects of HIV/AIDS and cautions against short-sighted legal solutions to the complex issue.
Legislation must play a positive role of integrating affected persons in society by protecting
them from discrimination. Besides the protective role, the proactive and instrumental role
of law is seen to be important in containing the HIV/AIDS pandemic. (Indian Journal of Social
Work, Hans, Gurmeet,1997)
3. A qualitative study was to develop an understanding of the psychosocial challenges as
well as protective influences promoting socio-emotional coping in HI adolescents in order to
inform mental health promotion and HIV prevention programming for this population in
South Africa. In-depth qualitative interviews were conducted with HIVadolescents (25) and
caregivers of HIVchildren (15) at a large HIV/AIDS Clinic in South Africa. Psycho-social
challenges for adolescents included dealing with loss of biological parents in the case of
orphans; coming to terms with their HIVstatus including identity difficulties; external stigma
and discrimination; and disclosure difficulties. There is a need for mental health promotion
programmes for adolescents to adopt an ecological approach, strengthening protective
influences at the individual, interpersonal, community and policy levels. (Petersen.I,
Bhana.A, Myeza.N, Alicea.S, John.S, Holst.H, McKay.M, Mellins.C., 2010)
4. Aging for people with HIV may be more challenging than for the general population
because of HIV-related stigma, loss of friends and social networks, and the detrimental
effects that HIV and antiretroviral treatment have on normal aging processes. Older people
with HIV are more likely to experience mental health and neurocognitive impairment than
their HIV-negative counterparts, as well as more social isolation as a result of decreased
social participation and engagement. People develop different approaches for coping with
the challenges associated with aging with HIV. (Rueda, S., Law, S., &Rourke, S. B., 2014)
5. The chronic medical conditions in the paediatric population pose a range of potential
psychosocial challenges not only to the child, but also to the family members and health
care providers. This paper comprehensively reviews the psychosocial issues of children
infected with HIV and AIDS and offer some of the strategies to address the issues
comprehensively by multidisciplinary team.(Vranda, M. N., &Mothi, S. N., 2013)
CONCLUSION:
The legal, ethical, Psychosocial & rehabilitation issues related to HIV patients are not so
much severe that can be easily accepted by every HIV affected mother during the pregnancy
also. So if we are concern about the HIV then we can educate others.