Europe aims for just Aids approach

European Union countries should adopt a libertarian and progressive policy towards people with HIV and Aids, in contrast to the United States model which tends towards draconian measures in its attempt to control the spread of the virus.

This is likely to be the conclusion of an unprecedented Europe-wide study to be published soon under the EU biomedical and health research project.

A research team representing 14 countries has been investigating the ethics and justice of European policy in the complex field of HIV and Aids. John Harris of the new institute for medicine, law and bioethics launched by the universities of Liverpool and Manchester and leader of the research team, said the group was constructed to represent the diversity of ethical approaches to medicine across member countries - from the Netherlands which has legalised euthanasia to much more cautious nations such as Italy.

"We didn't expect a consensus although there was probably more agreement than we anticipated at the start," Professor Harris said.

The draft conclusions recommend a legislative framework underpinned by the notion of reciprocal obligations. "Society has an obligation towards people with HIV to protect them from discrimination and stigma," Professor Harris said. "But there is also a strong moral obligation on those who are HIV positive to protect others from infection."

The difficulty with this hypothesis is that in highlighting the moral obligations of HIV positive people, a form of unacceptable stigmatisation could be created. Professor Harris said this debate formed the most controversial aspect of the study. "Balancing the obligations of society versus individuals is immensely problematic," he said.

Particularly sensitive was the idea that those who knew they were HIV positive might have a duty to declare their status to dentists, doctors or others who could be placed at risk of infection. "In order to prevent any stigma being attached to a declaration of HIV status the state must fulfil its obligation towards individuals by implementing anti-discrimination legislation," Professor Harris said.

The criminalisation of HIV transmission, even if it could be proved to be deliberate, is strongly resisted by the research group since such a move would be more likely to reinforce discrimination. In any event criminalisation was unlikely to be an effective deterrent.

"The best way to protect against infection is through a liberal and progressive policy towards HIV," Professor Harris said.

Border controls, which exist in parts of the US, were "wholly inappropriate."

Much blind testing for HIV has been carried out in the UK and elsewhere among, for instance, pregnant women. Such testing presented another difficult area for the research group which acknowledged the need to collect epidemiological data while recognising the ethical problems this raised.