Synergies, tensions and challenges in HIV prevention, treatment and cure research : exploratory conversations with HIV experts in South Africa
Contributor(s)Rossouw, Theresa M.
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AbstractBACKGROUND : The ethical concerns associated with HIV prevention and treatment research have been widely
explored in South Africa over the past 3 decades. However, HIV cure research is relatively new to the region and
significant ethical and social challenges are anticipated. There has been no published empirical enquiry in Africa
into key informant perspectives on HIV cure research. Consequently, this study was conducted to gain preliminary
data from South African HIV clinicians, researchers and activists.
METHODS : In-depth interviews were conducted on a purposive sample of fourteen key informants in South Africa.
Audiotaped interviews were transcribed verbatim with concurrent thematic analysis. The perspectives of HIV clinicians,
researchers and activists were captured. Analyst triangulation occurred as the data were analysed by three
RESULTS : The rapid evolution of HIV cure research agendas was prominent with participants expressing some
concern that the global North was driving the cure agenda. Participants described a symbiotic relationship
between cure, treatment and prevention research necessitating collaboration. Assessing and managing
knowledge and expectations around HIV cure research emerged as a central theme related to challenges to
constructing ‘cure’ - how patients understand the idea of cure is important in explaining the complexity of cure
research especially in the South African context where understanding of science is often challenging. Managing
expectations and avoiding curative misconception will have implications for consent processes. Unique strategies
in cure research could include treatment interruption, which has the potential to create therapeutic and ethical
conflict and will be perceived as a significant risk. Ethical challenges in cure research will impact on informed
consent and community engagement.
CONCLUSIONS : It was encouraging to note the desire for synergy amongst researchers and clinicians working in the
fields of prevention, treatment and cure. Translation of complex HIV cure science into lay language is critical. Moving
forward, RECs must be adequately constituted with scientific expertise and community representation when reviewing
cure protocols. It is hoped that knowledge and resource sharing in the context of collaboration between research
scientists working in cure and those working in treatment and prevention will accelerate progress towards cure.
Support for this work was provided by the Social and Ethical Aspects of
Research on Curing HIV Working Group which is supported by a NIH/NIAID
grant (R01A108366-01: ‘Unintended and Intended Implications of HIV Cure: A
Social and Ethical Analysis’).
Moodley, K, Rossouw, T, Staunton, C & Colvin, CJ 2016, 'Synergies, tensions and challenges in HIV prevention, treatment and cure research : exploratory conversations with HIV experts in South Africa', BMC Medical Ethics, vol. 17, art. no. 26, pp. 1-11.