An ethical analysis contrasting international HIV/AIDS relief efforts with relief efforts for other diseases and disasters BC Centre for Excellence In HIV/AIDS

Authors Timothy Christie, PhD, MHSc1,2 Getnet Asrat, MD3 Fred Koning, MTh2 Julio Montaner, MD, FRCPC1,2,3 BC Centre for Excellence in HIV/AIDS Providence Health Care University of British Columbia

Objective The objective of this study is to analyze, from an ethical perspective, international funding contributions to a selection of ‘man-made’ and ‘natural’ disasters.

Methods Literature review Selection Criteria required complete information on: Whether the relief needs have been met Number of deaths Number of people affected Amount of international funding contributed

Methods Defined period of time Crude calculations of ratios: amount of money given per death amount of money give per person affected Ethical Analysis using the principle of justice

Principle of Justice Principles of Justice Treat Equals Equally (Aristotle) Equal treatment means inequality is acceptable as long as it helps the worst off (Rawls) Inequality must be the result of some non-arbitrary difference between groups

Caution You cannot define something into or out of existence… EG. How do you define the number of people affected by HIV? Number of people who die from AIDS Number of people infected with HIV Number of grandmothers who have to care for grandchildren when parents die Number of orphans left by HIV

Caution EG. How do you define the number of people affected by a civil war? Regardless of how you define it and whether anyone agrees with your definition--people are affected by HIV, civil war, natural disasters, etc. Semantics: You cannot define something into or out of existence…

Results

Results

Results

Results

Results Money per Death Money per Affected Range: $29.00  $33.9 Million Median: $2,483.00 Average: $10,987 Money per Affected Range: $1.65  $11.9 Million Median: $54.00 Average: $1,424.70

Discussion Descriptive Question: Normative Question: Why is there such a funding disparity? Normative Question: Regardless of the reason “why,” is there any ethical justification for this disparity?

Conclusion These funding disparities are not the result of “RATIONAL BEHAVIOUR.” They violate the principle of justice There is no ethical justification for this disparity.

Limitation What constitutes the international community: “The international community response has been extraordinary, involving 12 governments, 100 local governments, more than 150 NGOs and partner organizations with 5,000 international staff in Banda Aceh alone.”

Self-Promotion Christie T, et al. Exploring disparities between global HIV/AIDS funding and recent tsunami relief efforts: An ethical analysis. Developing World Bioethics http://www.blackwell-synergy.com/toc/dewb/0/0

Contact Information Dr. Timothy Christie BC Centre for Excellence in HIV/AIDS St. Paul’s Hospital 613-1081 Burrard Street Vancouver, British Columbia (604) 806-9263 tchristie@cfenet.ubc.ca

THANK YOU

Avian Flue January 2006: WHO reports 160 cases and 85 deaths since 2003. 9 countries: Korea, Viet Nam, Japan, Thailand, Cambodia, Lao People’s Democratic Republic, Indonesia, China, and Malaysia.

HIV/AIDS 1981-Present over 25 million deaths Prevalence of HIV over 40 million 5 million new infections per year Over 3 million deaths per year

Pakistan Earthquake October 8, 2005 87,350 dead 4 million directly affected

Hurricane Stan October 4, 2005 Guatemala 1500 deaths El Salvador 72 deaths Mexico 28 deaths

Hurricane Katrina Mississippi and Louisiana 1836 deaths 1.4 million people affected

Tsunami December 26, 2004 South East Asia 12 Countries 273,000 dead 3 million people affected

DRC Second Congo War or African World War 1998-2003 but in 2004 1,000 deaths/day\ Nine African Nations involved 3.8 million dead 5 million affected