Bioethics in Tanzania: Legal and ethical concerns in medical care and research in relation to the HIV/AIDS epidemic

Cambridge Quarterly of Healthcare Ethics

Volumn 14, Issue 3, 2005, Pages 256-267

  Hellsten, Sirkku K ^a  

^a UNIVERSITY OF BIRMINGHAM   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ACQUIRED IMMUNE DEFICIENCY SYNDROME; EPIDEMIC; HEALTH CARE DELIVERY; HEALTH CARE PLANNING; HEALTH CARE POLICY; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; INFECTION PREVENTION; LAW; MEDICAL CARE; MEDICAL ETHICS; MEDICAL PERSONNEL; MEDICAL RESEARCH; NONHUMAN; PRACTICE GUIDELINE; RESEARCH ETHICS; REVIEW; TANZANIA; VIRUS DIAGNOSIS;

BIOETHICS AND PROFESSIONAL ETHICS; BIOMEDICAL AND BEHAVIORAL RESEARCH; HEALTH CARE AND PUBLIC HEALTH;

BIOETHICS; DELIVERY OF HEALTH CARE; DISEASE OUTBREAKS; ETHICS, CLINICAL; ETHICS, MEDICAL; ETHICS, RESEARCH; HIV INFECTIONS; HUMANS; TANZANIA;

EID: 21144437951     PISSN: 09631801     EISSN: None     Source Type: Journal    
DOI: 10.1017/S0963180105050358     Document Type: Review

References (21)

1. The United Republic of Tanzania is a union state formed in 1964 between mainland Tanganyika and Zanzibar islands. Tanganyika became independent in 1961 from a United Kingdom-administered United Nations trusteeship and Zanzibar became independent December 19, 1963, from the United Kingdom. Tanganyika and Zanzibar united in 1964 to form the United Republic of Tanganyika and Zanzibar.
2. Tanzania's economy is heavily dependent on agriculture, which accounts for half of it gross national product, provides 85% of its exports, and employs 90% of the work force. Topography and climatic conditions, however, limit cultivated crops to only 4% of the land area. Industry is mainly limited to processing agricultural products and light consumer goods.
3. It should be noted here that the salaries of medical professionals - particularly in public healthcare - are relatively low (compared, e.g., to salaries of various other professionals or doctors working in private or international hospitals). This has fueled unprofessionalism in the form of corruption in the healthcare sector in Tanzania.
4. In rural Southern Tanzania, for instance, paramedicals such as nurses and pharmacists (and, in the most extreme cases, even long-time receptionists) may have ended up being asked to perform professional medical tasks and procedures, such as prescribing medicine to patients or testing patients for various infections, and, thus, they have been given medical responsibilities beyond their level of competence that they may not wish to assume.
5. See Tangwa GB. International regulations and medical research in developing countries: Double standards or differing standards? Notizie di Politeia 2002;XVIII:46. National laws may or may not be based on these international recommendations. In Tanzania, for instance, abortion, though rigorously prohibited by law, is performed clandestinely, and hospital records show increasing numbers of women admitted to hospital for (incomplete) abortion. One reason for this is that maternal mortality rates are on the increase due to illegal abortion, frequent pregnancies, high parity, and women having children at ages recognized as high risk for pregnancy.
6. PABIN also holds conferences and workshops in collaboration with the African Malaria Network Trust (AMNET). Proceedings of the Third PABIN Conference, 28-30 April 2003, Addis Ababa 2003. Report available at http://www.who.int/sidcer/fora/en/pabin3rd.pdf.
7. The National Health Research Ethics Committee is composed of representatives of the following organizations: the Commission for Science and Technology (COSTECH), The National Institute for Medical Research (NIMR), Department of Zoology of the University of Dar es Salaam, Muhimbili University College of Health Sciences (MUCHS), Christian Social Services Commission (CSSC), The Muslim Council of Tanzania (BAKWATA), Kilimanjaro Christian Medical Centre (KCMC), Ministry of Education, the media, Ministry of Health (MoH), Human Rights Centre, Ministry of Community Development, Women Affairs and Children, Tanzania Gender Networking Programme (TGNP), and Mbeya Referral Hospital.
8. UNAIDS and WHO AIDS Epidemic Update, December 2003 and UNAIDS 2004 Report on the 4th Global AIDS Report. Reports available at http://www.unaids.org/en/ default.asp.
9. In comparison to other East African countries, in Kenya an estimated 2.5 million of the over 30 million population are living with the virus, yielding an adult prevalence of 15%. It is estimated that from Uganda's over 24 million population, 600,000 were HIV positive. Although all countries have National AIDS Control Programs and Policies, which aim to hold back the epidemic, only Uganda's wide efforts have been able to produce clear results in fighting the spread of HIV/AIDS. WHO. World Health Organization Reporting on HIV and AIDS. AIDS: Images of the Epidemics. WHO, 1994. USAID. Country Profiles HIV/AIDS, Tanzania, Uganda, Kenya. Washington, DC, 2004, http://www.usaid.gov.
10. UNAIDS. 2004 Report of the Global AIDS Epidemic. Geneva: UNAIDS, 2004, available at http://www.unaids.org.
11. Flemming A. The next generation and AIDS. AIDS 1994;4; United Republic of Tanzania (URT), National Policy on AIDS. Dar es Salaam, Government Printer, 2001. AIDS in Africa is taking a center stage also in the global political arena as Western governments became increasingly concerned that the epidemic could lead to the emergence of radicalism and the undermining of emerging democracies when people lose their lives, health, and hope, while large number of people are being marginalized and stigmatized. The decision by pharmaceutical companies to withdraw their patent suit in South Africa after the mid-April 2001 world protests was an important step toward wider access to HIV/AIDS treatment though the drugs are still in most cases much too expensive for people in developing countries.
12. Baylies C. Perspectives on gender and AIDS in Africa. In: Baylies C, Bujira J, eds. AIDS, Sexuality and Gender in Africa. London: Routledge, 2000.
13. Ndumbaro L, Siplon P. Tanzania's HIV/AIDS policy: Emerging ethical issues. Unpublished paper prepared for the 3rd AmFiTan Conference in Helsinki, August 2002; Rugemalila JB.
14. The epidemiology of AIDS in Tanzania. In: Proceedings of the 12th Annual Joint Scientific Conference, Arusha, Tanzania, 1994;
15. Swai RO. Epidemiology of AIDS in Tanzania. In: Killewo JZJ et al. (eds). Behavioral and Epidemiological Aspects of AIDS Research in Tanzania. Stockholm, 1992.
16. United Republic of Tanzania, National Policy on HIV/AIDS, 2001:18.
17. Ryder RW. Difficulties associated with providing HIV-free blood supply in tropical Africa. AIDS 1992:6.
18. This is partly because in its early days, AIDS in Tanzania, for instance, was attached to prostitution as well as to homosexuality (the existence of which, nevertheless, is still widely disputed and/or denied; Zanzibar passed a law in 2004 that can lead to the arrest of individuals suspected of homosexual activities/same sex relations and imprisonment for up to 25 years). As still deeply religious and spiritual nations (whether this spirituality appears in forms of Christianity, Islam, Hinduism, or indigenous belief system), many East Africans tend to see HIV/AIDS as God's punishment for those who commit adultery or other evil acts. Although perhaps hypocritical, with double standards in sexual relations and fidelity, this approach still tends to lead to intolerance and prejudice against people with HIV/AIDS. The negative attitude of many religious leaders toward condom use further fuels the spread of the epidemic, despite the attempts to encourage abstinence and sexual fidelity.
19. In the Tanzanian constitution, for instance, there are distinct clauses for the protection of collective rights, including national interest, that can be used to violate the protection of individual rights. Hellsten S. Human rights versus the common good in the African constitutional development and democratization process: The case of Tanzania. The African Review 1999;26:3-77.
20. See note 12, Ndumbaro, Siplon 2002.
21. Baylies C. Perspectives on gender and AIDS in Africa. In: Baylies C, Bujira J, eds. AIDS, Sexuality and Gender in Africa. London: Routledge, 2000; see note 9, UNAIDS 2004.