Confirmed cases of acquired immunodeficiency syndrome (commonly referred to as AIDS) have been reported in more than 100 countries. It is estimated that five to ten million people worldwide are infected with AIDS virus and therefore are potentially capable of transmitting the disease. All National Medical Associations and all physicians must share their knowledge and expertise to develop strategies to cope with this disease until a cure can be found.

Because AIDS is an incurable disease, and because it is a predominantly sexually transmitted disease (STD) it presents the physician with many complex ethical issues in addition to the scientific and medical issues inherent in the disease. In order to assist physicians and National Medical Associations, the WMA adopts the guidelines presented in this statement. The WMA is also conducting a scientific session devoted to the subject of AIDS at this 39th World Medical Assembly (1987). The WMA will study the advice of the experts at this scientific session as well as the best information that can be obtained from experts around the world, and will report more fully on this important matter at the 40l World Medical Assembly in 1988. Until a more complete report is available, the WMA recommends the following:

1. That National Medical Associations participate fully with the government in developing a national policy to cope with AIDS related problems.
2. That Nation Medical Associations participate fully in the development of public awareness programs to educate the general public as to AIDS, and the problems associated with AIDS, and how these problems will affect society generally.
3. That all physicians be trained to be effective AIDS counsellors. Physicians should counsel their patients to educate them as to effective behaviours to avoid the risk of AIDS for themselves and others. With reference to those patients who are found to be seropositive, physicians must be able to effectively counsel them regarding: (a) responsible behaviour to prevent the spread of the disease; (b) strategies for their own health protection; and (c) the necessity of alerting sexual contacts, past and present, regarding their possible infection by the AIDS virus.
4. That tests for the AIDS virus should be readily available to all who wish to be tested. Mandatory testing for the AIDS virus must be required of donors of blood and blood fraction, organs and other tissues intended for transplantation, and for donors of semen or ova collected or artificial insemination or in vitro fertilization. In addition the national policy may
   provide for mandatory testing for certain other segments of the population, such as military personnel, inmates of penal institutions and immigrants. Voluntary testing, with the patient's informed consent, should be regularly available to the following: (a) All patients seeking treatment for sexually transmitted diseases; (b) all patients seeking treatment for drug abuse; (c) pregnant women in the first trimester of pregnancy; (d) Individuals who are from areas with a high incidence of AIDS or who engage in high risk behaviour seeking family planning services; (e) patients requiring surgical or other invasive procedures. However, if a voluntary policy is not effective, a mandatory requirement should be considered.
5. That each confirmed case of AIDS be reported to a designated authority anonymously or by identifier for epidemic logical purposes. Individuals who are found to be seropositive for the AIDS virus should be reported on an anonymous basis with enough information to be epidemiologically significant.
6. That patients with AIDS and those who test positively for the antibody to the AIDS virus must be provided with appropriate medical care and should not be treated unfairly or suffer from arbitrary or irrational discrimination in their daily lives. Physicians have a long and honoured tradition of tending to patients afflicted with infectious diseases with compassion and courage. That tradition must be continued throughout the AIDS epidemic. Physicians and National Medical Associations must participate actively in the development of a sound framework for carefully balancing the right of the
   patient to be free from irrational acts of prejudice and the rights of others in society to be protected against an unreasonable risk form disease.
7. That access to patient information should be limited to health care personnel who have a legitimate need to have access to the information in order to assist the patient or to protect the health of those closely associated with patient. The identity of AIDS patients and carriers should be protected from disclosure except where the health of the community requires otherwise.

The physician should continue to study even after the completion of the course to be more erudite, confident and skilful.
- Susruta Samhita of Susruta - 28/27

Adopted by the 40th World Medical Assembly
Vienna, Austria, September 1988

The World Medical Association, Inc. has previously adopted guidelines to assist National Medical Associations in developing strategies to cope with a growing AIDS epidemic. This statement provides the individual physician with direction as to his or her professional responsibilities with reference to the treatment of AIDS patients, and also as to the physician's responsibility to his or her patients in the event the physician is seropositive.

The WMA Interim Statement on AIDS, adopted in October 1987, stated in part:
"Patients with AIDS and those who test positively for the antibody to the AIDS virus must be provided with appropriate medical care and should not be treated unfairly or suffer from arbitrary or irrational discrimination in their daily lives. Physicians have a long and honoured tradition of tending to patients afflicted with infectious diseases with compassion and courage. That tradition must be continued throughout the AIDS epidemic."

ADDS patients are entitled to competent medical care with compassion and respect for human dignity. A physician may not ethically refuse to treat a patient whose condition is within the physician's current realm of competence, solely because the patient is seropositive. Medical ethics do not permit categorical discrimination against a patient based solely on his or her seropositivity. A person who is afflicted with AIDS needs competent, compassionate treatment. A physician who is not able to provide the care and services required by persons with AIDS should make an appropriate referral to those physicians or facilities that are equipped to provide such services. Until the referral can be accomplished, the physician must care for the patient to the best of his or her ability.

The rights and interests of those who are infected with the ADDS virus, as well as those who are not, are entitled to protection. A physician who knows that he or she has an infectious disease should not engage in any activity that creates a risk to transmission of the disease to others, hi the context of possible exposure to AIDS, the activity in which the physician wishes to engage will be the controlling factor.

hi the provision of medical care, if a risk of transmission of an infectious disease from a physician to a patient exists, disclosure of that risk to patients is not enough; patients are entitled to expect that their physicians will not increase their exposure to the risk of contracting an infectious disease.

If no risk exists, disclosure of the physician's medical condition to his or her patients will serve no rational purpose; if a risk does exists, the physician should not engage in that activity.

If a patient is fully informed of the physician's condition and the risks that condition presents, and the patient elects to continue care and treatment with the seropositive physician, great care must be exercised to assure that true informed consent is obtained.
The duty of all physicians is to refrain from issuing false certificates even if the intention of such is to help the patients to stay within his regular environment.

The duty of the physician is to comply with and make comply the sanitary and protective rules established for health personnel because they are known, simple and effective.

The duty of all physicians is to participate fully in preventive programs initiated by public authorities to stop the spread of AIDS.