THE ETHICS OF USING ALTERNATIVE THERAPIES IN HIV AIDS

The use of alternative treatment modalities by persons with HIV/AIDS p oses many ethical problems. Because the medical community and the AIDS community have differing opinions about alternative therapies, patien ts and physicians can have difficulty deciding exactly how they ought to deal with alternative treatments. On one hand, many doctors feel th at all alternative treatments are either examples of the placebo effec t or that they are fraudulent. On the other hand, there are patients w ho feel that no alternative treatments are beyond reason, and that mos t of these therapies are better than traditional medical therapies. Be cause of such widely differing opinions, the therapeutic alliance betw een physician and patient can be greatly strained. This strain has its roots in the power struggle between physicians and patients. ''Ethica l problems are embedded in a matrix of competing social, political, an d economic forces. Competition for power, resources, and influence is part of the context for ethics. The actual approaches to ethical probl ems in any age and culture, including the approaches to HIV infection and AIDS, cannot be adequately understood apart from issues of power.' '(1) Because physicians have traditionally had more power than patient s in medical settings, some doctors find it difficult to share power w ith patients.(2) Many physicians argue that because they are guardians of health for the entire population, it is important for them to main tain control over patients to a certain extent. Their years of trainin g and clinical experience make them far more qualified than patients t o make decisions about health care. This seems to be an especially com mon argument with regard to infectious disease control. However, HIV/A IDS patients have avoided this control and maintained a good deal of a utonomy throughout the course of the epidemic. Political activism with in the gay community, and a desire on the part of physicians to have f ull patient cooperation, has been largely responsible for the establis hment and maintenance of this autonomy. HIV/AIDS patients have been gi ven this autonomy in a setting where other patients normally would not . This approach has been called HIV exceptionalism.(3) Some might argu e that HIV exceptionalism has placed individual interests above those of society. Individuals have been favored in policy decisions regardin g such ethical issues as prevention strategies, confidentiality, scree ning, and obligation to inform. Unfortunately, evidence has begun to a ppear that HIV exceptionalism is being abandoned in favor of a public health ''control strategy.'' Because alternative treatment modalities offer patients large amounts of control over their own health care, it would seem that the promotion or support of such modalities would fit in with HIV exceptionalism. An in-depth analysis of alternative thera py decision making and use may reveal the relationship between alterna tive treatment and AIDS exceptionalism. It may also suggest several re asons why HIV exceptionalism continues to be essential to the well-bei ng of HIV/AIDS patients and why the principles of exceptionalism may b e valuable to the rest of society as well. HIV exceptionalism is based on the idea that HIV/AIDS patients and HIV are somehow ''special.'' P atients have become involved in decision-making processes traditionall y open to physicians only. This involvement has given patients power. Alternative therapy use has given many patients this same power over t heir disease. There are other diseases where a similar approach has be en applied. The disease of alcoholism/substance abuse is one such exam ple. Organizations such as Alcoholics Anonymous and Narcotics Anonymou s have been the most successful treatment modalities for alcoholics an d drug abusers. These organizations put a premium on patient involveme nt in treatment. Patients must be motivated and involved. The power pa tients derive from taking control of their own disease seems to be par amount to successful recovery. Even alcohol treatment centers based in hospitals have adopted the self-help approach these organizations use to help addicts recover. Certainly there are other areas of medicine where similar involvement by patients would help them with their disea se and promote improved quality of life. Patient involvement in decisi on making must be encouraged. Alternative therapy use by HIV patients can serve as a model for patient empowerment.