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Edited by J F Keenan SJ. Continuum, 2000, US$24.95, pp 351. ISBN 0826412300
This impressive and informative book deserves a wider readership than it is likely to get. Unfortunately there are still too many people who consider they have no need to read anything about the virus as it will, to their way of thinking, never touch them. In addition there will be those who think that a volume by Catholic ethicists will be too narrow in outlook to be worthwhile. Both sets of people are mistaken: HIV is here to stay, there is no cure nor is there likely to be and sooner or later it will affect, let alone infect, millions across the world. On the second count readers will be surprised and energised by the clear and honest debate concerning the teachings of the Catholic Church.
The first and longest section is made up of a series of case studies ranging from needle exchange in Puerto Rico, to confronting social stigma in Uganda, and matters relating to confidentiality in Australia. The second consists of seven chapters covering fundamental moral issues for HIV prevention; the chapter by Lisa Cahill (Boston, USA) on AIDS, justice and the common good and the one by Paulinnis Odozor (Attakuru, Nigeria) on Casuistry and AIDS, are particularly worthwhile. Kevin Kelly (Liverpool, UK) provides the conclusion. Readers would do well to get hold of his book, New Directions in Sexual Ethics, (Geoffrey Chapman, 1998) in which he highlights what is undoubtedly of paramount concern in developing countries namely poverty, the subjugation of women and related gender issues.
The most obvious moral issues are those surrounding the use of condoms but they are not the only ones. What if an infected person refuses to tell his or her partner of their status: is any duty incumbent on the doctor treating the positive person to inform the partner? Where does confidentiality begin and end? One of the saddest cases, and not as rare as it may seem, is of a married couple in Italy, both infected, who want to have a child. Will the child also be seropositive? Will one or both parents live long enough to look after the child? Who else should know of the situation?
The Catholic Church has always had high ideals even if many of its adherents, including some in positions of power and authority, have not lived up to them. Those ideals cover not just areas of chastity and fidelity but also those of charity and truth where each one of us has to strive constantly to live up to a more responsible way of living. The church has particularly strong teaching on fidelity in marriage and against premarital and extramarital sex. It is important to recognise the connection between this strong teaching and the basic values of family life and the worth of the individual, on the one hand and, on the other, the abuses that arise from pressures on innocent girls and women, particularly in some cultures. A universal approval of condom use would lead to even greater ills and abuses; how can we work towards the time when married couples have sufficient education and knowledge to work out for themselves the right use of conscience with regard to their sexual activity? Inevitably there are occasions when a solution is far from obvious: we have to remind ourselves frequently that we are fallible human beings with free will. This book goes a long way towards enabling the reader to consider and ponder at some considerable depth, a variety of dilemmas and questions.
In so many countries, including our own, a conspiracy of silence, of denial, has grown up in the face of HIV and AIDS. It is only when HIV is looked at objectively and dispassionately, regardless of the moral stigma that so often haunts those affected by the virus, that the real work of prevention will occur. Education is essential. Only when we understand what the virus is, how it is passed on, what it does to individuals and to families—not least the children—will the global epidemic begin to be contained. Just to know that on average 5,500 funerals take place each day in Africa as a result of HIV should go a long way towards impressing upon us what the consequences in terms of personal tragedy and economic structures are in that continent alone. The rapid spread of the virus in India, passed off as “a bad illness”, resulting from infidelity and prostitution, as well as from untreated blood products, gives cause for alarm. “It won't happen to me” remains an all too common remark, betraying a total lack of awareness of just how many people are now suffering from this virus, either in themselves or in those they love. This book should be widely read and used for discussion and reflection on just how far each of us has a responsibility for others in this desperately needy world. In our multicultural medical practices all doctors need to be more aware of HIV and its consequences.