Tuesday, July 31, 2012

Forced sterilization in Namibia, criminalizing HIV infection in Zimbabwe

Bioethics culture in Africa is nascent. There are ethical dilemmas in research, public health and medical practice in Africa like there is no tomorrow, but explicit discussion in the press, teaching about bioethics issues in medical schools, public debate about the ethics of health policies ... not so much. That is why it is sometimes helpful to have African courts play the unintended role of bioethics catalyst. This week's news has a couple of juicy legal stories with ethical overtones. In Namibia, the High Court in Windhoek ruled that three women were sterilized without their informed consent, and the women will be given as-yet-to-be-determined damages. According to their lawyers, the women presented at government clinics in order to deliver their babies by caesarean section, and the government doctors said they would only be eligible for the surgery if they agreed to be sterilized at the same time. The judge sensibly ruled that the sterilization was coercive and that the women were not in a position to give free and informed consent. The judge, however, did not rule that the government doctors acted in this way because all three women were HIV positive. HIV rights groups and human rights activists contend that forced sterilization of HIV-positive women is by no means uncommon in Africa, so this court case might be the first in a long, pan-African series. It would be nice if this case and others like it raised the profile of informed consent in African medicine, and poke a few holes in the reigning medical paternalism, particularly as this relates to female patients.

Speaking of HIV and courts. A woman has been found guilty of infecting her husband with HIV in Zimbabwe. Zimbabwean Criminal Law Act (Section 79) has this dubious little chunk of legislation:

Any person who: (a) Knowing that he or she is infected with HIV; or (b) Realising that there is a real risk or possibility that he or she is infected with HIV; (c) Intentionally does anything or permits the doing of anything which he or she knows will infect, or does anything which he or she realises involves a real risk or possibility of infecting another person with HIV, shall be guilty of deliberate transmission of HIV, whether or not he or she is married to that other person, and shall be liable to imprisonment for a period not exceeding 20 years.

Samukeliso Mlilo finds herself on the wrong end of this elastically phrased law, even though it is uncertain whether she infected her partner or the other way around. Which would seem to matter. A Zimbabwean man accused of intentionally infecting his partner had better luck: he was acquitted by his (wonderfully named) lawyer,  Clever Tsikwa. When charged under Section 79, perhaps it helps if your lawyer is clever, or if you are a dude.


Blogger pprin006 said...

It is interesting and sad that the FDA would approve the use of this preventative drug Truvada for AIDs without knowing what the long-term effects will be on the people of Sub-Saharan Africa. Essentially these people, although at an extremely high risk for acquiring the disease, are being used to test out what will happen in the long term. It is sad that it is the poor and impoverished areas that are exposed to new and unknown consequences in order for others to benefit. It is not even clear that this drug will in fact prevent the transmission of the disease. Healthcare should focus on overall health of all human beings and not have different standards for those who are in underdeveloped areas.

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