HIV prevention clinical trials' community engagement guidelines: inequality, and ethical conflicts.

Q1 Arts and Humanities
Morenike O Folayan, Kristin Peterson
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引用次数: 5

Abstract

In 2004 and 2005, the first clinical trials were launched to investigate the use of tenofovir for HIV prevention in Cambodia,Cameroon, Nigeria and Thailand. Controversies erupted over the ethical integrity of the research protocol. We reflect on the events that ledto the controversies and identified that scientific and ethical concerns raised by members of local communities at each of these sites wereerased by trialists, causing crisis that led to premature shut down the early PrEP trials. In the aftermath of these trials, the World HealthOrganisation, UNAIDS, and AVAC developed ethics guidelines intended to recognize the concerns as authentic, and developed guidelines toimprove researchers' engagement of communities in biomedical HIV prevention trial design and implementation. Our findings suggest thatthe ethics guidelines are limited in its ability to address power inequalities that leads to voice erasures and non-recognition of localcompetencies. Rather the ethical documents enabled trialists to gain a new sense of authority through the interpretations of ethical researchconduct enabling trialists regain power that can further entrench inequality and voice erasures. To address concerns with what seems anintractable problem, we suggested models of engagement for off-shored research may be the option.

艾滋病预防临床试验的社区参与指南:不平等和伦理冲突。
2004年和2005年,在柬埔寨、喀麦隆、尼日利亚和泰国开展了第一批临床试验,以调查替诺福韦用于艾滋病毒预防的使用情况。研究方案的伦理完整性引发了争议。我们反思了导致争议的事件,并发现这些地点的当地社区成员提出的科学和伦理问题被试验人员消除了,造成了导致早期PrEP试验过早关闭的危机。在这些试验之后,世界卫生组织、联合国艾滋病规划署和AVAC制定了伦理准则,旨在承认这些担忧是真实的,并制定了准则,以提高研究人员在社区中参与艾滋病毒生物医学预防试验的设计和实施。我们的研究结果表明,道德准则在解决权力不平等问题上的能力有限,权力不平等导致了声音的抹去和对地方能力的不承认。相反,伦理文件使审判者通过对伦理研究行为的解释获得了一种新的权威感,使审判者重新获得权力,从而进一步巩固不平等和消除声音。为了解决这个看似棘手的问题,我们建议离岸研究的参与模式可能是一个选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Global Bioethics
Global Bioethics Arts and Humanities-Philosophy
CiteScore
5.00
自引率
0.00%
发文量
12
审稿时长
37 weeks
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