The thorny issue of ethics

WYCLIFFE MUGA poses a question: Suppose that a research team of scientists came up with an AIDS vaccine that was 50% effective. What would you recommend that they do with it?

1. Do some more research to try and make it 100% effective?
2. Rush out to make it available to those who need it most?
3. Study its long-term side-effects, bearing in mind that – as was famously the case with Thalidomide – some cures are worse than the disease?
These are questions that AIDS researchers have been grappling with for decades now. And they are also questions that already engage those who are at the centre of the storm, in the global rush to find a cure for Ebola.

A similar dilemma arises when you seek to implement AIDS interventions in an at-risk population which is criminalized in the statute books of the specific country.

Take commercial sex workers, for example: In Germany and The Netherlands, where commercial sex work is perfectly legal, it is relatively easy to come up with programmes directed at this at-risk population. But in many African nations, not only is sex work illegal, but the mere act of carrying a bunch of condoms can get a woman arrested for prostitution. How then can you protect such vulnerable populations, when the cheapest and most effective barrier to infection may be impractical for them?

It is one of the unavoidable issues of AIDS research that an element of choice has to be built into the interventions proposed, as what works for the general population, may not work with the most-at-risk populations.

This has led to a call from some advocates for decriminalizing sex work, as a potent intervention against HIV infection. Also the need for “sex-worker-friendly” health services.