Ethics and HIV research in Zimbabwe

A plethora of articles are now being published in both local and international journals on research activities conducted on the human immunodeficiency virus (HIV) in Zimbabwe. Some of the bioethical issues they raise, however, are neither unique to HIV nor unique to developing countries. In this article we discuss several of these issues, including the failure to provide interventions of known efficacy, ethical relevance of study design, informed consent, and exploitation. A challenge raised by much of the research in HIV/AIDS is whether, or under what conditions, it is ethical in research to fail to provide an intervention of known efficacy. The further we diverge from this situation, in which an effective, easy to implement intervention is available, to situations that resemble the controversial international clinical trials to prevent perinatal transmission of HIV the less clear the ethical mandate becomes. In relation to clinical trials the debate has focused on whether the standard of care in the United States--an expensive and complex regimen of Zidovudine--must be provided to all HIV infected pregnant women who join a research study in developing countries. Different scientists and scholars in bioethics have drawn the line differently in terms of what interventions routinely available in the developed world must be provided to research participants in developing countries. At an extreme, no one suggests that the most expensive and complex of Western tertiary care, for example, renal dialysis or coronary bypass, must be provided in research conducted in Zimbabwe. Indeed, public debates about the HIV perinatal transmission trials have not even focused on whether the women in the trials should be provided with HIV combination therapy as they would be in the West or whether they should even have the Zidovudine continued post partum.