3153.0: Monday, October 22, 2001 - 3:10 PM

Abstract #32019

Culture of Medicine and the Moral Dilemmas of Disclosure: The Case of East Africa

Esther Mwaikambo, MD, MMed, Professor of Pediatrics and President, Tanzania Public Health Association, PO Box 4160, Dar es Salaam, Tanzania, , tpha@muchs.ac.tz, James M. Machoki, MD, MEd, Lecturer in Obstetrics and Gynaecology, University of Nairobi, Kenya, Kenya, and Mary Jo Good Del Vecchio, Professsor of Social Medicine, Harvard Medical School.

Background: In East Africa the medical profession faces major challenges on two fronts: economic constraints and HIV/AIDS. HIV/AIDS compels professionals to revisit and study aspects of how they are trained and conduct their practice. There is growing concern among medical and public health professionals about the future of medicine, medical education and the ethics of medical practice.

Methods: Since the early 1980s when HIV cases were first diagnosed in East Africa, hospitals have seen a steady increase in HIV/AIDS; current estimates are that 50 to 60% of in patients in Muhimbili Medical Center and other referral hospitals have HIV related illnesses. East African countries encourage testing and disclosure yet most patients are apparently unaware of their sero-status. In the face of an overwhelming HIV disease burden we study the culture of medicine, the moral dilemmas of disclosure and their effects on medical training and practice. A pilot study was conducted at three medical institutions in Tanzania and Kenya during January-February 1999 and involved a sample of 68 respondents in the medical professions.

Results: The study highlighted (i) informed consent issues and difficulties in the context of pre-test counseling and (ii) disclosure issues and difficulties for HIV positive patients and their loved ones.

Learning Objectives: Objectives: (i) to present results of a pilot study that examined the interplay between medical practice and the moral issues of disclosure with their public policy implications and (ii) to evaluate the use the pilot as the basis for a larger study.

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 129th Annual Meeting of APHA