Consent challenges for minors participation in HIV and related risk research in Thailand

Gay and bisexual youth (GBY) under 18 years are often excluded from HIV and related risk research in the Global South. Reasons for this are many, but the most common is GBY’s reluctance to participate in studies that require guardian permission and IRB and local community standards that oppose waiving the guardian permission requirement.  This study drew on a rights-based, community engaged approach in Bangkok, Thailand to illuminate barriers and potential solutions to this problem through focus groups discussions and individual interviews with 12^th grade GBY and with mothers and fathers of high school students who were and were not aware of their son’s sexual orientation.  Participants were asked to respond to mock informed consent forms for research on a broad range of youth risk behaviors. Youth expressed positive aspects of involving parents in decisions tempered by concerns about harms posed by disclosing same-sex attraction through permission forms and their general disposition for signing their parents’ signatures.  Generally, parents were receptive to granting permission for their children to participate in studies directed at reducing HIV risk and socially sensitive studies including substance use, violence, unwanted teenage pregnancy and gay-oriented studies. However, professional parents were more cautious and not as trusting of academic institutions or researchers than non-professional parents. Fathers, more than mothers, seemed hesitant in granting permission for their sons’ participation in gay-oriented studies. While most parents did not favor the waiver of guardian permission, they responded positively to waivers when cast as a means of ensuring that their children had fair access to research that could improve their health—as long as some adult proxy mechanism was put in place to protect youths’ rights. The study’s findings have potential to influence current IRB practices in Thailand. Parents expressed faith in schools as proxy protectors of their sons suggest that collaborating with schools in Thailand may be an ethical approach to waiver of guardian permission and a means of involving GBY in critical HIV-related prevention research.