Ethics and AIDS vaccine trials: a response

With regard to Professor Sanjay Mehendale’s valuable article on ‘Ethical considerations in AIDS vaccine trials’ (1), could I make afew critical comments? In preventive HIV vaccine trials, any participant who gets infected as a consequence of his or her participation in such a trial deserves the best proven HIV/ AIDS treatments, and not only whatever is locally available. In my view it simply doesn’t make sense to suggest that triple therapy would amount to undue inducement to join such a trial, simply because before these people joined the trial they simply had no need for any treatment. How could providing them with the best proven treatment possibly amount to undue inducement, given that the participant wasn’t in need of any medication before he or she joined the trial?

The claim that providing best proven therapy is not financially sustainable is an empirical claim which, as of yet, has not been substantiated. It is being introduced by various people with an interest in cheap access to research subjects. The recently released latest draft of a UNAIDS document (‘Ethical Considerations in HIV Preventive Vaccine Research’) essentially supports this line of reasoning, but only after conceding that after several years of consultations with treatment access activists and researchers from developing countries, a consensus could not be reached. The UN organisation has taken a regrettable stance on this matter. It allows Western researchers to avoid providing their trial subjects with the best proven therapies in case something goes wrong during the trials they conduct in developing countries.