Suchergebnisse

Cover page -- Halftitle page -- Series page -- Title page -- Copyright page -- Contents -- Acknowledgements -- 1 Introduction -- 2 Entering the World of Medicine - Contexts -- Introduction: learning from a tragedy -- The global context of medicine -- The state of Western medicine -- 3 Why Bioethics Needs a Philosophy (and Th eology) of Medicine -- Introduction -- Euthanasia -- Janet Radcliffe Richards on organ transplantation -- Digging deeper -- Conclusion: why bioethics needs a philosophy (and theology) of medicine -- 4 Perspectives on Philosophy of Medicine -- Health, healing and philosophy of medicine -- Evidence- based medicine, clinical judgement and medical knowing -- Phenomenology and philosophy of medicine -- Conclusion -- 5 Perspectives on Theology of Medicine -- Introduction: theology, medicine and a 'culture of death'? -- Christian theological critiques of the culture of medicine -- Edmund Pellegrino's Christian philosophy of medicine -- 6 Finding the Target: Messer's Theology of Health -- Philosophy of health -- Theology of health -- 7 A Philosophical-Theological Framework for Medicine -- A philosophical framework: practising Christian scholarship -- Epistemology and theories of medicine -- A theological framework: biblical theology and God's story -- 8 Human Vulnerability and the Goods of Medicine -- Medicine as social practice -- Medicine as caring for this frail flesh: human vulnerability and the practice of medicine -- Medicine as an inherently moral practice -- 9 Re-engaging the World of Medicine: Applying Philosophy and Theology of Medicine -- A summary of the argument so far -- Bringing philosophy and theology of medicine to bear on the world of practice -- Majority world medicine, scarcity and medicine as a moral practice -- Concluding pedagogical refl ections -- Bibliography -- Index.

IntroductionHIV‐positive (HIV+) temporary residents living in Australia legally are unable to access government subsidized antiretroviral treatment (ART) which is provided via Medicare to Australian citizens and permanent residents. Currently, there is no information systematically being collected on non‐Medicare eligible HIV+ patients in Australia. The objectives of this study are to describe the population recruited to the Australian HIV Observational Database (AHOD) Temporary Residents Access Study (ATRAS) and to determine the short‐ and long‐term outcomes of receiving (subsidized) optimal ART and the impact on onwards HIV transmission.MethodsATRAS was established in 2011. Eligible patients were recruited via the AHOD network. Key HIV‐related characteristics were recorded at baseline and prospectively. Additional visa‐related information was also recorded at baseline, and updated annually. Descriptive statistics were used to describe the ATRAS cohort in terms of visa status by key demographic characteristics, including sex, region of birth, and HIV disease status. CD4 cell count (mean and SD) and the proportion with undetectable (<50 copies/ml) HIV viral load are reported at baseline, 6 and 12 months of follow‐up. We also estimate the proportion reduction of onward HIV transmission based on the reduction in proportion of people with detectable HIV viral load.ResultsA total of 180 patients were recruited to ATRAS by June 2012, and by July 2013 39 patients no longer required ART via ATRAS, 35 of whom became eligible for Medicare‐funded medication. At enrolment, 63% of ATRAS patients were receiving ART from alternative sources, 47% had an undetectable HIV viral load (<50 copies/ml) and the median CD4 cell count was 343 cells/µl (IQR: 222–479). At 12 months of follow‐up, 85% had an undetectable viral load. We estimated a 75% reduction in the risk of onward HIV transmission with the improved rate of undetectable viral load.ConclusionsThe immunological and virological improvements highlight the importance of supplying optimal ART to this vulnerable population. The increase in proportion with undetectable HIV viral load shows the potentially significant impact on HIV transmission in addition to the personal health benefit for each individual.