BioMed Analysis: Mixing Medicine and Morality

"...moral judgements - from any end of the political or religious spectrum - should not have a place in health policies. People should not be forced to choose different values as a precondition for receiving assistance."

This opinion piece critiques health policies on sex and drugs that are driven by personal judgements about how people such as sex workers and drug users should behave. Priya Shetty explains that the Vienna Declaration, due to be signed this week at the XVIII International AIDS Conference in Austria (July 2010), will call for the introduction of evidence-based drug policies, such as treating drug addiction as a medical condition rather than demonising it as a crime. In her opinion, this declaration's emphasis on sound evidence on behaviour change is an effective strategy.

Shetty traces the history of morality-based HIV/AIDS policy, noting that it reached its height during George W. Bush's administration in the United States, from 2001 to 2009, when the government strongly pushed for abstinence. She argues that this approach has not worked, nor has stigmatising behaviours: In the early 1990s, the state government of Maharashtra, India, established an HIV-prevention programme to stop the virus spreading in sex workers, Shetty explains. But the goal was not to improve sex workers' health - instead it was to stop the virus spreading from sex workers via migrant workers to "good" housewives.

She concludes that policies based on judgements about what people should do rather than an understanding of what they are likely to do go against the grain of good policymaking: Any policy must be rooted in reality and have an understanding of human behaviour.