HIV experts say ethics bottlenecking research
Promising prevention tools may not be accessible
Promising new HIV prevention approaches are within reach, but international AIDS experts say the world is not prepared to make those approaches accessible to populations most at risk.
The Global HIV Prevention Working Group, made up of leading public health experts, clinicians, and researchers, reported to the 16th International AIDS Conference in August that some methods, such as male circumcision and microbicides, could be proved effective within the next one to five years. But the working group says an array of practical and ethical challenges threaten to slow or derail critical research.
"Very soon we could have new, highly effective ways to prevent many of the 4 million new HIV infections that occur each year," said Helene Gayle, MD, MPH, co-chair of the Working Group, president and CEO of CARE USA, and co-chair of the International AIDS Conference, in a statement to the conference. "But these tools will have little impact in the real world unless we take immediate steps to complete current trials, mount new ones, and reach people most in need."
Trials on new HIV prevention nearing completion
The group's report, "New Approaches to HIV Prevention: Accelerating Research and Ensuring Future Access" (available at www.kff.org/hivaids/hiv081506pkg.cfm), surveys the state of research on six promising new HIV prevention approaches — male circumcision; cervical barriers such as diaphragms; daily administration of antiretroviral drugs currently used for HIV treatment; suppression of herpes, which increases HIV risk up to three times; topical microbicides; and HIV vaccines.
The report finds that HIV prevention research faces significant financial, logistical, and ethical obstacles that if not quickly addressed could delay the completion of critical clinical trials. The working group makes three recommendations to avoid bottlenecks in the progress of trials of promising new prevention approaches:
- Clinical trials should see increased capacity, ensuring adequate number of participants, well-equipped study sites, and trained staff. The HIV prevention efficacy trials already underway involve about 80,000 study participants, but many thousands more will be needed for future trials;
- Ethical guidelines for medical research should be streamlined and adapted to sufficiently address key issues that have emerged in HIV prevention clinical trials. For example, there is no formal consensus on which existing prevention services should be provided to all trial participants, or on how to facilitate HIV treatment access for participants who become HIV-infected;
- Improve communication between researchers and local stakeholders that has slowed — and even stopped — some critical prevention studies.
The working group was convened and supported by the Henry J. Kaiser Family Foundation and the Bill & Melinda Gates Foundation.
Promising new HIV prevention approaches are within reach, but international AIDS experts say the world is not prepared to make those approaches accessible to populations most at risk.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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