DIFFICULT DECISIONS: A Tool for Care Workers
Managing Ethical Dilemmas When Caring for Children and Families of Key Populations:

People Living With HIV, People who use Drugs, Sex Workers, Transgender People, Gay Men, and other Men who have Sex with Men

When it comes to HIV care and support, making better decisions matters to all of us.

Ethical decision-making: 

  • It matters to all people with HIV, including key populations and their children; and
  • It matters to care workers who want to make the best possible decision.

If you want to make the best possible decision—or wish that the organization that supports you would improve its decision-making—now there’s a simple tool that can help.


  • Difficult-Decisions” – the comprehensive guidance written in plain language–in PDF format–containing the Four Step Tool, a Code of Ethics, 3 examples of ethical dilemmas resolved using the tool, and a Pocket Guide to Handling Ethical Dilemmas in the Field – printer layout; 

  • Difficult-Decisions” – “booklet” layout (2-pages side by side);

  • A stand-alone, editable MS Word Document containing The Four-Step Tool;
  • Orientation Slides (PowerPoint format) to help you deliver a 3-hour orientation to your colleagues, and to implement the use of the guidance in your organization.

    This slide package is password-protected to prevent changes being made to it. When opening the document, choose “Read-only” when the password window appears. This will allow you to view, re-save, and use the presentation. 

This guidance, available in English, French, Spanish and Russian, was developed by an international working group led by key population networks, and comprising community-based ethicists & care worker organizations. It was tested, improved and validated in four languages and five countries—in Africa, Asia, Eastern Europe and North America—over a rigorous 3-year process.

For more information, contact John Miller of The Coalition for Children Affected by AIDS.