End-of-life issues: Physician-assisted suicide and euthanasia in medical practice

End-of-life decisions are among the most profound and ethically challenging aspects of medical practice. The concepts of physician-assisted suicide (PAS) and euthanasia occupy a prominent place in this discourse, requiring healthcare providers to navigate a complex landscape of legal, medico-legal, and ethical considerations. In this article, we delve into the definitions of euthanasia, encompassing both active and passive forms, PAS, and the clear distinction from murder. Drawing from a spectrum of legal, medico-legal, and ethical sources, we explore the global landscape, examining examples of countries and regions where PAS is practised, and the methodologies employed. Additionally, we scrutinise the advantages and disadvantages of these practices, culminating in a medico-ethical review that underscores the intricate moral fabric woven into end-of-life care.

Will the hard-won gains in the battle against HIV be lost on the battleground of HPV?

The inception of HIV treatment programmes in sub- Saharan Africa (SSA) was marked by many challenges. It was clear that large numbers of people were going to require treatment and the question was, how were public health services going to deliver in the face of seemingly insurmountable obstacles? There were limited resources in both the human and health financing sectors, denialism on the part of politicians, and paralysing stigma for those living with HIV. Nevertheless, the battle began! Botswana was the first country in Africa to establish a national HIV treatment programme in 2002, with other countries rapidly following suit and by 2008, over 5 million people in the sub-continent had access to antiretroviral treatment (ART).

Pregnancy and HIV: Insights for new antiretroviral therapies in African settings

Antiretroviral therapy (ART) has become a cornerstone in the comprehensive care of people living with HIV (PLWH), including pregnant women, regardless of immune, clinical, or virological status. In Africa, where HIV prevalence is substantial, early access to ART extends lifespan of PLWH. An additional important goal of early and ART in pregnant women is to decrease the risk of vertical transmission of HIV. Approximately 1.5 million women living with HIV become pregnant each year, 90% of whom live in less resourced settings and who continue to present late (third trimester) in their pregnancy with untreated HIV. In South Africa around one in five pregnant women living with HIV start ART late. 

Triple therapy vs Dual Therapy: Is there a place for Dual Therapy in the Management of HIV?

For almost 30 years, the mantra has been that HIV is best managed with highly active antiretroviral therapy (HAART) compromising a three-drug regimen (3DR). Historically, these regimens compromised 2 nucleoside reverse transcriptase inhibitors (NRTIs) and 1 non-nucleoside reverse transcriptase inhibitor (NNRTI). The ADVANCE study showed non-inferiority to efavirenz (NNRTI) when dolutegravir, an integrase strand transfer inhibitor (INSTI), with a high genetic barrier to resistance, made up the 3DR.


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HIV Focus - Vol 1 no 3, Edition 3 - 2023