[HIV, AIDS and ethics]

The epidemic spread of HIV infections and the AIDS disease in the last two decades of the 20th century has quite unexpectedly confronted European civilization, including North America, with a great number of ethical problems. Today, two decades after the first signs of AIDS' possibly epidemic threat not only to individual regions but to the entire population of the world, we can already answer the questions whether Western society has learned from the past and whether the concern for the rights of the individual and of groups previously discriminated in one way or another (a concern increasing since the 1950 s initially in the USA and then in Europe) has led to a more sensitive stance in dealing with victims of the HIV and AIDS epidemic. In Europe and North America, after initial unrest and occasionally exaggerated reactions, the confrontation with HIV infection and AIDS has mostly shown a marked improvement over the way epidemics and their victims were dealt with in earlier centuries. A substantial difference from earlier epidemics is that the understandable temptation to identify the disease with a specific group of persons has meanwhile been overcome; instead of collectively discriminating against people whose style of life substantially contributes to the spread of the disease, the focus of investigation is on behaviors; increasingly, the actors are not mentioned. There is probably no other disease that touches upon a comparably broad spectrum of ethical principles. HIV infection and the AIDS disease provide models for evaluating almost all basic ethical principles that can find application in a medical context. From the identification of those infected, the search for an effective therapy, the treatment of the diseased, to the compassion with the dying and in many other respects a historically unprecedented degree of taking into regard the interests of groups at risk and of those affected have been taken into account. It is in view of the global dimension of the HIV/AIDS epidemic that a second challenge confronts European civilisation. Here the formulation of relevant politics has not been (and is unlikely to be) influenced by emotions or an abstract morale. Rather, it has been a recognition of a self-interest of Western nations vis-a-vis a possible scenario of a breakdown of public order and democratic structures in some parts of the world that has brought about a reorientation. Increasingly, the resources of governments, of science, and of private enterprise of Western nations are brought together to match the needs of those non-Western countries where the HIV/AIDS epidemic has reached catastrophic dimensions. It may well be that these efforts will support the development of vaccines and therapies affordable in these countries.