Provision of HIV treatment in HIV preventive vaccine trials: a developing country perspective

被引:36
作者
Slack, C
Stobie, M
Milford, C
Lindegger, G
Wassenaar, D
Strode, A
IJsselmuiden, C
机构
[1] Univ KwaZulu Natal, Sch Psychol, HAVEG, ZA-3209 Scottsville, Pietermaritzbur, South Africa
[2] Univ KwaZulu Natal, Sch Human & Social Studies, Unilever Eth Ctr, ZA-3209 Scottsville, Pietermaritzbur, South Africa
[3] Univ KwaZulu Natal, Sch Law, ZA-3209 Scottsville, Pietermaritzbur, South Africa
[4] Univ Pretoria, Fac Med, Sch Hlth Syst & Publ Hlth, ZA-0001 Pretoria, South Africa
[5] Council Hlth Res Dev, COHRED, CH-1201 Geneva, Switzerland
关键词
HIV vaccines; consent; justice; research ethics; standard of care; South Africa;
D O I
10.1016/j.socscimed.2004.06.049
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
HIV treatment for participants who become infected during HIV vaccine trials has been the focus of ethical controversy. The obligations of sponsors to ensure that participants have access to antiretrovirals have been a particular focus of this debate. This paper presents three arguments that have been made in this regard, and some of their limitations, in anticipation of HIV vaccine trials in South Africa. The first argument is that HIV risk behaviour increases in such trials, and HIV infection can be viewed as a research-related injury, justifying sponsor provision of treatment on grounds of compensation for harm. We conclude that risk-behaviour studies to date do not show general increases in risk behaviour that could constitute the basis for a general obligation. Participation may well adversely impact on risk behaviour for some individuals, and conceivably this could be demonstrated. This argument may, therefore, have merit at the individual level; however, it seems a weak platform from which to argue that sponsors should treat all HIV infections acquired during trials. The second argument is that treatment should be provided based on distributive justice. We conclude that traditional concepts of "distributive justice" in research appear limited in justifying obligations of sponsors to ensure access to antiretrovirals. Further, using research initiatives to reduce global health care inequities is controversial, and even proponents may disagree about the fairest use of finite resources. The third argument is that sponsors should ensure antiretroviral access on grounds of beneficence; namely, the maxim that if one can do something beneficial without sacrificing anything of comparable significance, it ought to be done. Thus, sponsors should provide more interventions than those minimally required to conduct the research. However, beneficence may demand levels of altruism that exceeds what is reasonable. While the latter arguments may provide stronger justifications than the first, it is difficult to use these arguments to establish that sponsor provision of antiretrovirals to infected individuals is obligatory. (C) 2004 Elsevier Ltd. All rights reserved.
引用
收藏
页码:1197 / 1208
页数:12
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