TY - JOUR
T1 - Addressing ethical challenges in HIV prevention research with people who inject drugs
AU - Dawson, Liza
AU - Strathdee, Steffanie A.
AU - London, Alex John
AU - Lancaster, Kathryn E.
AU - Klitzman, Robert
AU - Hoffman, Irving
AU - Rose, Scott
AU - Sugarman, Jeremy
N1 - Publisher Copyright:
© 2018 Article author(s) (or their employer(s) unless otherwise stated in the text of the article). all rights reserved.
PY - 2018/3
Y1 - 2018/3
N2 - Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs (PWID). Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: (1) Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? (2) Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? (3) When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? (4) Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world.
AB - Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs (PWID). Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: (1) Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? (2) Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? (3) When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? (4) Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world.
KW - HIV Infection and AIDS
KW - Research Ethics
KW - Research on Special Populations
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U2 - 10.1136/medethics-2015-102895
DO - 10.1136/medethics-2015-102895
M3 - Article
C2 - 27114469
AN - SCOPUS:84965062518
SN - 0306-6800
VL - 44
SP - 149
EP - 158
JO - Journal of medical ethics
JF - Journal of medical ethics
IS - 3
ER -