Ethical Decision Making with Post-Exposure Prophylaxis (PEP): HIV/AIDS' Double Edged Sword

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Several ethical decision making processes help frame the series of actions leading to prevention of human immunodeficiency virus (HIV) infection for non-occupational exposure patients. The same post-exposure prophylaxis treatment regime recommended by the Centers for Disease Control and Prevention (CDC) for occupational exposure is appropriate in some circumstances. This article presents three ethical decision making processes described by Fremgen, Hinderer and Hinderer, and Nash. Ethical resolutions determined by using any of these processes, when applied by clinical practitioners and health care administrators, could greatly simplify this process. With dedicated commitment, treatment within the 48 hour maximum time frame recommended after initial exposure to HIV and instituting initial PEP treatment can occur. The literature and experience both indicate that fewer ethical dilemmas occur in the decision making body when the medication regime is adhered to by the at risk patient, and if drugs are prescribed in addition to providing prevention education which is designed to decrease repeat exposure to the virus. Additionally, lower viral load and potential prevention at initial or acute infection correlates with decreased cross infection to sexual partners unaware of their potential risk. Health care cost for HIV with progression to acquired immune deficiency syndrome (AIDS) is an ethical consideration for a seriously threatened health care economy. The literature supports a cost savings with the use of prophylaxis rather than treating HIV/AIDS. Implications for healthcare professionals when PEP is administered after rape and when requested after risky sexual activity are ethical considerations facing the 26th year of the HIV/AIDS pandemic.

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