Bioethics Talk on HIV Pre-exposure Prophylaxis

Gender studies extra credit 9/21/12

The talk I attended was given by Cindy Patton and was entitled, “The Cost of Science: Knowledge and Ethics in HIV Pre-Exposure Prophylaxis Trials”. The respondent was Sharrona Pearl. I chose this talk because it combined my interest in our topic matter and my interest in the sciences. The focus of the talk was on the efficacy and the methodology of attempting to treat HIV before it is contracted. The trials utilized combinations of anti-retroviral agents that were given to homosexual men who were currently HIV-negative. Prior to the last decade or so, preemptive treatment of HIV was not widespread and generally frowned upon by the medical community at large. The flagship trial in 2010 used about 2500 subjects from disparate parts of the globe (10% USA). The researchers claimed to have game-changing results, such as a 43% rate of reduction of contraction, and were hailed by the media as precisely that. However, upon further examination several factors obfuscated the success of the trial. For instance, in many of the communities of subjects, many had never had safe sex counseling prior to starting the trial. Moreover, the majority of subjects admitted to a marked decrease in the number of sexual partners once starting the trial. Furthermore, the 250 American subjects were exclusively from Boston and San Francisco. For a drug whose primary market will almost exclusively be in the US/Canada, why were 90% of the participants from less developed nations? One point I found particularly provocative were the assumptions made by the researchers going into the study. They assumed from the start the homosexual men were inconsistent at best at using condoms. In doing so, it seems that the researchers could avoid a comparison of efficacy between the drugs and condoms, which were apparently not used diligently enough. The reality of the situation, at least according to Patton, is that this assumption is only true in communities where no prior education about safe sex was present. It is unlikely that it would hold true in a developed society. In addition, the researchers assumed that women were not reliable enough to use as subjects. They assumed that women were wary of regularly taking a pill, especially if they did not have sexual contact regularly. Thus, my question going forward is what is it about our society that leads people/researchers to assume that subdivisions of society like at-risk gay men and women would not want to be proactive about their health? Also, referring back to an earlier point, why are researchers so shy about attempting a large-scale, powerful tests of these antiretrovirals in an area where there are established gay communities who have common safe sex practices?

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