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Ethics and pre-exposure prophylaxis for HIV infection
Jeremy Sugarman1, Kenneth H Mayer
1Berman Institute of Bioethics, Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA. jsugarman@jhu.edu
Journal of Acquired Immune Deficiency Syndromes (1999)
|June 15, 2013
Summary
Antiretroviral agents (ARVs) show promise for HIV prevention, but ethical considerations like well-being and justice are crucial for their appropriate use in practice and research.
Area of Science:
- Public Health
- Infectious Disease Prevention
- Bioethics
Background:
- Antiretroviral agents (ARVs) are increasingly recognized for their potential in preventing HIV infection.
- The U.S. Food and Drug Administration (FDA) approved tenofovir-emtricitabine as pre-exposure prophylaxis (PrEP), with guidance issued by regulatory bodies.
- Clinicians, policymakers, and individuals at risk face decisions regarding the use of ARVs for HIV prevention.
Purpose of the Study:
- To identify and analyze the ethical dimensions surrounding the use of ARVs for HIV prevention, specifically pre-exposure prophylaxis (PrEP).
- To explore ethical issues related to well-being (safety, use, risk behaviors, resistance, stigma, diversion) and justice (access, competing priorities) in PrEP implementation.
- To address ethical considerations for incorporating PrEP into future HIV prevention research, including control arm selection and participant prevention packages.
Main Methods:
- Ethical analysis of pre-exposure prophylaxis (PrEP) for HIV prevention.
- Review of current evidence and regulatory guidance on ARV use for prophylaxis.
- Identification of ethical domains: well-being and justice.
Main Results:
- Key ethical considerations for PrEP use include safety, appropriate parameters, risk behaviors, potential for resistance, stigma, and diversion.
- Justice-related ethical issues encompass equitable access to PrEP and the prioritization of resources.
- Ethical challenges in PrEP research involve determining appropriate control groups and the provision of PrEP within prevention packages.
Conclusions:
- Understanding and addressing the ethical issues of well-being and justice is critical for the safe, effective, and appropriate implementation of PrEP.
- Ethical considerations must guide both the clinical application and future research of ARVs as a tool for HIV prevention.
- Proactive ethical evaluation is essential for maximizing the public health impact of PrEP while upholding individual rights and societal values.
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