Sunday, February 19, 2012

Ethical considerations in the use of anti-retrovirals for HIV prevention



Call for Papers

Evidence-based approaches to reducing sexual transmission of HIV has remained a major challenge in responding to the HIV pandemic.  The past 18 months has witnessed a substantial shift in this landscape.  Controlled trials have demonstrated that the treatment of individuals with HIV infection reduces the risk of viral transmission to uninfected sexual partners (treatment as prevention).  Additional evidence suggests the possibility of providing anti-retroviral medications to uninfected individuals may reduce the risk of acquiring HIV infection from sexual partners (PrEP— Pre-Exposure Prophylaxis).

In view of scarce resources, there will inevitably be a need to prioritize who will get anti-retroviral drugs; those who are sick, those who can transmit HIV, those at risk for acquiring HIV. Research that focuses on the balance between efficiency and equity will be involved.  Ethical frameworks for guiding decision-making at the clinical level as well as the macro social policy level will be essential.

Among the questions that will need to be discussed are:  

i.                    What rights claims can uninfected persons make for access to ARVs for prophylactic purposes when millions across the globe are dying from AIDS because they cannot access ARV treatment? 
ii.                   What moral claims can justify the provision of ARV therapy to those who do not yet clinically require treatment as a way of reducing the risks of HIV transmission?
iii.                  What normative issues are raised in making the determination that there is sufficient evidence to demonstrate the effectiveness of either PrEP or Treatment for Prevention? 
iv.                 How should the social and biological vulnerability of women to HIV infection inform discussion about the allocations of resources for either PrEP or treatment as prevention? 
v.                  If there is a risk that PrEP will increase the risk of drug resistance and compromise treatment options for those already infected, what ethical questions must be confronted? 
vi.                 What conceptions of procedural fairness and inclusiveness should shape decision making processes about these allocation decisions?
vii.                How should current research findings inform the ethics of trial design?
viii.               Given current evidence what moral issues involving the protection of research subjects should be considered in determining the extent of ancillary services and care that should be provided in prevention trials? 

This issue of Developing World Bioethics will be guest edited by Ronald Bayer (email: rb8@mail.cumc.columbia.edu) and Quarraisha Abdool Karim (email: abdoolq2@ukzn.ac.za), Mailman School of Public Health, Columbia University, New York, NY  10032  USA.

Deadline for submissions: 31 July 2012