Balancing competing ethical and scientific demands on HIV/AIDS prevention and treatment research

Significant gains have been made in improving the health of populations in developing countries, such as the eradication of smallpox and the reduction in infant mortality in many resource-poor regions, but significant public health challenges remain. For example, HIV/AIDS has had a particularly devastating impact, affecting the poorest and most vulnerable countries and populations. These countries cannot afford the expensive drugs used in many developed countries, and their decaying public health infrastructure makes implementation of large-scale prevention and treatment programs difficult. The lack of effective public health systems in those countries most affected by HIV/AIDS also presents a formidable challenge to research, with transnational trials of new prevention and treatment modalities facing three competing needs: 1) To meet the demands of scientific validity and feasibility in testing new prevention and treatment modalities; 2) To protect the rights, health and safety of study participants; and 3) To develop new prevention and treatment modalities to meet an urgent public health need. This session will explore each of these competing needs in turn, framing them in the context of the basic principles of biomedical research ethics established in the Belmont Report and other international guidance documents.