The purpose of this study is to investigate the right to confidentiality in the context of HIV/AIDS through an interdisciplinary lens. This study indicates that whilst confidentiality is important and should be preserved in order to protect persons living with HIV/AIDS against stigmatisation, discrimination and victimisation, this should be balanced by other equally important interests, such as the protection of public health and individual third parties who may be affected by the intentional or negligent infection of others with HIV. As the consideration of the legal issues relating to confidentiality and privacy cannot be divorced from the social context in which HIV/AIDS plays out in South African communities, the study will examine, amongst others, the victimisation, discrimination and stigmatisation experienced by persons living with HIV/AIDS, followed by a critical exploration of the present legal and ethical framework governing privacy and confidentiality, including medical confidentiality, as well as the duty to disclose a positive HIV-status, in the context of HIV/AIDS. Possible limitations on the right to privacy in this context are also examined, which include, amongst others, a consideration of making HIV/AIDS notifiable diseases in South Africa. The study suggests that it is imperative that legal interventions aimed at curbing the spread of HIV will need to be mindful of the unique social, cultural and economic forces that impact on the duty to disclose a positive HIV-status to partners and other affected third parties. Insights gained from philosophical theories relating to Africanism, individualism, communitarianism and utilitarianism are valuable tools in facilitating a clearer understanding of relevant social and cultural factors that keep South African society locked in the present stalemate with regard to the disclosure of HIV status. / Public, Constitutional, & International law / LLD

Thesis (MPhil)-- University of Stellenbosch, 2000 / ENGLISH ABSTRACT: It is a well-known fact that the sub-Saharan Africa is a continent most affected by HIV/AIDS. The HIV/AIDS pandemic has in other words become our disease. For many of us, this fact may be difficult to fully accept. There are elements of prejudice in our reactions. Ignorance and intolerance can be found around the world. Therefore, by presenting the facts about HIV/AIDS, this assignment challenges the misconceptions and focuses on the profound dilemmas confronting society. I think the success in combating the HIV/AIDS pandemic could be found in President Thabo Mbeki's terminology "Partnership against HIV/AIDS". In his speech, the President appealed to both the private and public sectors and all South Africans to work together with greater determination than before to fight against HIV infection and AIDS. Arguably, this was the best speech President Thabo Mbeki ever made on HIV/AIDS on October 9, 1998. Back then, the government seems to have had a direction and led from the front in the battle against HIV/AIDS. The title of this thesis reads: "Ethical perspectives on surveillance and preventive strategies for HIV/AIDS in South Africa". Presently, the South African Government through the Ministry of Health is seriously considering making AIDS a notifiable medical condition. This is a serious and a controversial move that has serious ethical and legal implications that will be discussed. Should partners of HIV-infected individuals be informed? If the answer is on the affirmative, who should inform them? I am also looking at the ethical obligation of health care workers to treat HIV/AIDS patients despite the fear of being accidentally infected. Tough questions need to be asked. Should health workers be informed of the HIV status of every patients they treat? On the other hand, some patients have some fears too that HIV-infected health professionals may infect them. Again, the fundamental ethical concerns related to confidentiality, privacy, the right to treatment will also be discussed. The country is divided on this issue. Ethical principles are directly involved in such a decision, for instance, the principle of confidentiality, respect for autonomy and informed consent. How can the government go about implementing this without disregarding these fundamental ethical requirements?Another ethical issue that comes to mind regarding HIV/AIDS concerns AIDS vaccine trials, which are so far dominantly manufactured in 'developed countries' while subjects of these trials are from 'third world' or 'developing countries '. The ethical concerns here are: How will informed consent be protected, especially where subjects of the trials are not educated and do not understand the terms used? What are the cost-effects or benefits of such trials? What are the risks involved? Together with this, other issues include ethical debates concerning market prices of drugs, which are too expensive for poorer countries and affordable for richer countries. Finally, this work does not treat everything that needs to be dealt with insofar as HIV/AIDS is concerned. However, I hope that this thesis will contribute (in a small way) in making people appreciate the ethical dilemmas that are presented by HIV/AIDS. / AFRIKAANSE OPSOMMING: Dit is algemeen bekend dat Afrika suid van die Sahara die gebied is met die hoogste voorkoms van MIV/vIGS. Die MIV/VIGS-pandemie het dus ons siekte geword. Dit is vir baie van ons moeilik om hierdie feit te aanvaar, en ons reaksies is dikwels bevooroordeeld. Onkunde en onverdraagsaamheid oor MIV/vIGS word trouens wereldwyd aangetref. Hierdie verhandeling Ie klem op die feite van MIV/VIGS, en konfronteer sodoende hierdie wanopvattings terwyl daar gefokus word op die diepgaande dilemmas waarmee die samelewing gekonfronteer word. President Thabo Mbeki se woorde "Vennootskap teen MIV/VIGS" verwoord myns insiens die enigste oplossing vir die MIV/VIGS-pandemie. Die President doen in sy toespraak 'n beroep op al1e Suid-Afrikaners, in private en openbare sektore, om met groter determinasie saam te veg teen MIV-infeksie en VIGS; Hierdie toespraak, gelewer op 9 Oktober 1998, toe die regering klaarblyklik nog rigting gehad het en op die voorfront was in die styd teen MIV/VIGS, was moontlik President Thabo Mbeki se beste ooit oor die onderwerp MIV/VIGS. Die titel van hierdie verhandeling is "Etiese perspektiewe ten opsigte van waarnemende en voorkomende strategiee vir MIV/VIGS in Suid-Afrika". Die Suid-Afrikaanse regering, by monde van die Ministerie van Gesondheid, oorweeg dit tans sterk om VIGS 'n aanmeldbare mediese kondisie te verklaar. Die ernstige etiese en regsimplikasies van so 'n daadwerklike en kontroversiele stap sal in die verhandeling bespreek word. Behoort die rnetgesel1e van MIV-positiewe persone ingelig te word? Indien wei, wie moet hulle in kennis stel? Daar sal ook gekyk word na die etiese verpligting van gesondheidsorgwerkers om MIV/VIGS-pasiente te behandel ten spyte van hul1e vrees om per ongeluk besmet te word. Indringende vrae moet gevra word. Behoort gesondheidsorgwerkers ingelig te word oor die MIV-status van elke pasient wat hul1e behandel? Aan die ander kant vrees sornmige pasiente dat hul1e deur MIV-positiewe gesondheisorgwerkers besmet kan word. Die fundamentele etiese aangeleenthede rakende vertroulikheid, privaatheid en die reg tot mediese behandeling sal ook bespreek word. Suid-Afrika is verdeeld oor hierdie kwessies. Etiese waardes, soos die beginsel van vertroulikheid, respek vir outonomie en ingeligte goedkeuring is direk betrokke by besluite oor etiese kwessies. Die regering kan nie hierdie aangeleenthede implementeer sonder om die fundamentele etiese vereistes in ag te neem nie. VIGS-entstofproefnemings is'n verdere etiese kwessie wat ter sprake kom. Hierdie proefnemings word grotendeels deur "ontwikkelde" lande uitgevoer, tewyl die proefpersone van "derdewereldse" of "ontwikkelende" lande afkomstig is. Die etiese kwessies hierby betrokke is: hoe sal ingeligte goedkeuring beskerm word, veral wanneer proefpersone onopgevoed is en nie die tersaaklike terme verstaan nie? Wat is die kosteeffektiwiteit of voordele van hierdie proefnemings? Watter risiko's is betrokke? Die etiese debat oor die markprys van medisyne, wat heel bekostigbaar vir ryk lande, maar duur vir armer lande is, word ook aangeraak. Hierdie verhandeling dek nie alle relevante kwessies wat betref MIV/VIGS nie. Tog hoop ek dat dit 'n bydrae sal lewer tot mense se bewuswording van die etiese dilemmas wat MIV/VIGS inhou.

Univ., Diss--Bern, 2007.

The purpose of this study is to investigate the right to confidentiality in the context of HIV/AIDS through an interdisciplinary lens. This study indicates that whilst confidentiality is important and should be preserved in order to protect persons living with HIV/AIDS against stigmatisation, discrimination and victimisation, this should be balanced by other equally important interests, such as the protection of public health and individual third parties who may be affected by the intentional or negligent infection of others with HIV. As the consideration of the legal issues relating to confidentiality and privacy cannot be divorced from the social context in which HIV/AIDS plays out in South African communities, the study will examine, amongst others, the victimisation, discrimination and stigmatisation experienced by persons living with HIV/AIDS, followed by a critical exploration of the present legal and ethical framework governing privacy and confidentiality, including medical confidentiality, as well as the duty to disclose a positive HIV-status, in the context of HIV/AIDS. Possible limitations on the right to privacy in this context are also examined, which include, amongst others, a consideration of making HIV/AIDS notifiable diseases in South Africa. The study suggests that it is imperative that legal interventions aimed at curbing the spread of HIV will need to be mindful of the unique social, cultural and economic forces that impact on the duty to disclose a positive HIV-status to partners and other affected third parties. Insights gained from philosophical theories relating to Africanism, individualism, communitarianism and utilitarianism are valuable tools in facilitating a clearer understanding of relevant social and cultural factors that keep South African society locked in the present stalemate with regard to the disclosure of HIV status. / Public, Constitutional, and International law / LLD

Instances of fraudulent acts are often headline news in the popular press in South Africa. Increasingly, these press reports point to the government tender process as being the main enabler used by the perpetrators committing the fraud. The cause of the tender fraud problem is confidentiality breach of information. This is accomplished, in part, by compromising the tender information contained in the government information system. This results in the biased award of a tender. Typically, the information in the tender process should be used to make decisions about a tender’s specifications, solicitation, evaluation and adjudication. The sharing of said information to unauthorised persons can be used to manipulate and corrupt the process. This in turn corrupts the tender process by awarding a tender to an unworthy recipient. This research studies the generic steps in the tender process to understand how information is used to corrupt the tender process. It proposes that conflict of interest, together with a lack of information confidentiality in the information system, paves the way for possible tender fraud. Thereafter, a system of internal controls is examined within the South African government as well as in foreign countries to investigate measures taken to reduce the breach of confidential information in the tender process. By referring to the Common Criteria Security Model, various critical security areas within the tender process are identified. This measure is assisted with the ISO/IEC 27002 (2005) standard which has guiding principles for the management of confidential information. Thereafter, an information security policy,the Chinese Wall Model will be discussed as a means of reducing instances where conflict of interest may occur. Finally, an adapted Chinese Wall Model, which includes elements of the tender process, is presented as a way of reducing fraud in the government tender process. Finally, the research objective of this study is presented in the form of Critical Success Factors that aid in reducing the breach of confidential information in the tender process. As a consequence, tender fraud is reduced. These success factors have a direct and serious impact on the effectiveness of the Chinese Wall Model to secure the confidentiality of tender information. The proposed Critical Success Factors include: the Sanitisation Policy Document, an Electronic Document Management System, the Tender Evaluation Ethics Document, the Audit Trail Log and the Chinese Wall Model Prosecution Register.

This thesis concluded that offering physicians an appropriate Web-based transcription service should be well received and improve their medical record management and patient care.

DCur / Departmet of Public Health / See the attached abstract below

Indiana University-Purdue University Indianapolis (IUPUI) / Derived from the field of art curation, digital provenance is an unforgeable record of a digital object's chain of successive custody and sequence of operations performed on the object. It plays an important role in accessing the trustworthiness of the object, verifying its reliability and conducting audit trails of its lineage. Digital provenance forms an immutable directed acyclic graph (DAG) structure. Since history of an object cannot be changed, once a provenance chain has been created it must be protected in order to guarantee its reliability. Provenance can face attacks against the integrity of records and the confidentiality of user information, making security an important trait required for digital provenance. The digital object and its associated provenance can have different security requirements, and this makes the security of provenance different from that of traditional data. Research on digital provenance has primarily focused on provenance generation, storage and management frameworks in different fields. Security of digital provenance has also gained attention in recent years, particularly as more and more data is migrated in cloud environments which are distributed and are not under the complete control of data owners. However, there still lacks a viable secure digital provenance scheme which can provide comprehensive security for digital provenance, particularly for generic and dynamic ones. In this work, we address two important aspects of secure digital provenance that have not been investigated thoroughly in existing works: 1) capturing the DAG structure of provenance and 2) supporting dynamic information sharing. We propose a scheme that uses signature-based mutual agreements between successive users to clearly delineate the transition of responsibility of the digital object as it is passed along the chain of users. In addition to preserving the properties of confidentiality, immutability and availability for a digital provenance chain, it supports the representation of DAG structures of provenance. Our scheme supports dynamic information sharing scenarios where the sequence of users who have custody of the document is not predetermined. Security analysis and empirical results indicate that our scheme improves the security of the typical secure provenance schemes with comparable performance.

Indiana University-Purdue University Indianapolis (IUPUI) / Reducing medical error remains in the forefront of healthcare reform. The use of health information technology, specifically the electronic health record (EHR) is one attempt to improve patient safety. The implementation of the EHR in the Emergency Department changes physician workflow, which can have negative, unintended consequences for patient safety. Inaccuracies in clinical documentation can contribute, for example, to medical error during transitions of care. In this quasi-experimental comparison study, we sought to determine whether there is a difference in document quality, error rate, error type, cognitive load and time when Emergency Medicine (EM) residents use paper charts versus the EHR to complete physician documentation of clinical encounters. Simulated patient encounters provided a unique and innovative environment to evaluate EM physician documentation. Analysis focused on examining documentation quality and real-time observation of the simulated encounter. Results demonstrate no change in document quality, no change in cognitive load, and no change in error rate between electronic and paper charts. There was a 46% increase in the time required to complete the charting task when using the EHR. Physician workflow changes from partial documentation during the patient encounter with paper charts to complete documentation after the encounter with electronic charts. Documentation quality overall was poor with an average of 36% of required elements missing which did not improve during residency training. The extra time required for the charting task using the EHR potentially increases patient waiting times as well as clinician dissatisfaction and burnout, yet it has little impact on the quality of physician documentation. Better strategies and support for documentation are needed as providers adopt and use EHR systems to change the practice of medicine.

The limited success of HIV-testing facilities in South Africa means that many people are not accessing necessary antiretroviral treatment services. This study investigates the practical implications of HIV exceptionalism inherent in Voluntary Counselling and Testing (VCT). A semi-structured interview schedule was used to survey participants for their perspectives on barriers to HIV-testing uptake as well as the effects of exceptionalist practices at VCT clinics. Responses showed marked perceptions of gender differences in people's willingness to test and several important barriers including problems of access to services. Significantly, exceptionalism displayed in certain clinic procedures was thought to contribute to stigma, and attempts to normalise HIV practice in order to combat the effects of stigma were being informally implemented. Participants' views on routine opt-out testing were explored. The researcher recommended further investigation on how HIV testing and treatment policies can be normalised so as to reduce stigma and increase testing uptake. / Social Work / M.A. Sociology (Social Behaviour Studies in HIV/AIDS)