Chen Reis and colleagues’ study in this month’s PLoS Medicine showed that most Nigerian physicians commendably appeared to be providing appropriate care for HIV/AIDS patients [1]. However, 9% refused to care for such patients, 9% admitted they had refused a patient with HIV/AIDS admission to hospital, and 20% felt that many of these patients had behaved immorally and deserved the disease. The authors also noted the adverse impact of limited health care resources upon ethical practice and protection of human rights (this impact is not surprising in a very poor country with a per-capita GDP of US$290 [2], less than 1% of the United States per-capita GDP). They conclude that discriminatory behaviour and breaches of ethical codes could be addressed effectively through education, enforcement of anti-discrimination policies, increasing resources for health care, and attempts to change attitudes and cultural beliefs. Presumably, their motivations for this study were (1) to better understand how well physicians in Nigeria respect human rights and meet universal ethical standards of medical practice in caring for patients with HIV/AIDS, and (2) to make recommendations that could improve professional practice. Their fi ndings would be more convincing if they could compare their data with similar studies done elsewhere in the world, including the US (home to some of the authors of the study). In particular, it would be valuable to have comparative international data on ethics and human rights standards achieved in medical practice, and on health professionals’ attitudes to patients with HIV/AIDS and other stigmatised conditions. However, Reis and colleagues’ study raises several important questions.
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