Comments on: Is CDC’s HIV prevention trial in Thailand ethical?

By: elizabeth

elizabeth — Sun, 08 Aug 2010 16:39:13 +0000

Michael
You’re right to be concerned. Tenofivir, one of the antiretroviral drugs currently being tested for PrEP, is an important first-line therapy for people who are infected. The main problem with developing resistance is when PrEP fails and people become infected but carry on taking the ARVs as a prophylactic. Low or intermittent doses of ARVs designed for prevention may allow the virus to mutate more easily in people who do not yet know they are infected.

On the upside, preliminary safety data released at the recent AIDS conference in Vienna suggest that there is not yet any evidence of such resistance developing in practice. Watch this space.

By: Michael Ozanne

Michael Ozanne — Fri, 06 Aug 2010 22:15:42 +0000

Ms Pisani,
i have a worry about PrEP. As I recall widespead penicillin PrEP practiced by US soldiers on R&R from the Great Asian Vacation (Vietnam War) was what ultimately gave rise to the “holy crap fire just shot out of my dick” strains of anti-biotic resistant syphilis and gonorrhea in the Phillipines and Thailand during the ’70′s.
I have no course of action to advocate, but isn’t there a risk that presenting fresh infections with insufficient overkill may give us a hardier HIV that we could well do without…?

By: Rieza

Rieza — Thu, 04 Mar 2010 21:35:23 +0000

Elizabeth–sorry for repost (if this becomes one). PrEP is one of those things I think belongs in Fluffy La La Land. I do hate to be the Debbie Downer of the party, but: 1. who will fund PrEP, if it ‘proves’ to be efficacious? From my understanding, there are 6 trials running thru 2012 (curiously, only one is focused on MSM), and 2. more importantly (and related to item 1), who qualifies to be on PrEP?

Re: the syringe exchange ethical scandal. The CDC researchers say it’s b/c of ‘local standard of care’, but we know better. I think the real reason is the ban on using federal $$ on needle exchange, which our lovely friend Ronnie Reagan introduced in HIS ‘war on drugs’, and our other friend Bill Clinton didn’t bother to remove during his 8 yrs in office. The Thai trials started in 2005, so @ the height of the Bush administration, and we know HE wasn’t gonna do anything to get rid of it. For many many years, needle exchange programs have had to get $$ from locals/state hlth depts (and we see their efforts have paid off in the decreasing # of new HIV diagnoses due to IDU), so we kind of see the lifting of the ban as too little, too late. However, going back to the Thai trials, if even American (tax-paying?) junkies and the ppl trying to give him safe injection kits couldn’t use fed $$ for clean needles, what’s to say that Thai junkies would be able to get the goodies from the US gov’t?

By: Robert

Robert — Mon, 25 Jan 2010 10:54:02 +0000

Thanks eliza

By: John

John — Sun, 24 Jan 2010 15:46:43 +0000

i never really thought of the process that some of these trials take on but after spending a lot of time in issan where a lot of the former sex workers come home to die you see the aftermath of HIV aids and wonder why more is not being done to help everyone

By: admin

admin — Sun, 24 Jan 2010 12:36:37 +0000

As one of these programme managers who had to deal very recently with an ignorant and dangerous blogger who did a lot of dammage (I’ll tell you more next time we meet), I think it is a bit disingenuous to say that researchers “need quite a few people to get infected”.

Researchers do not “need” people to get infected. People *will* become infected, trial or not. I don’t dispute your argument but the impression given, once more, that those willing participants are used like guinea pigs. Whilst it may have been the case in the past, it is not anymore due to the strengthening and tightening up of ethics and regulatory aspects of conducting a trial.

In this regard, it is also unfair and untrue to suggest that “researchers are reluctant to push the envelope on providing decent prevention to study participants.” Participants in the trial I am familiar with often receive better care than the “standard of care”. The recent change in HPTN 052 is a reflection of this.

The local standard of care is often not “the best that can be done” but rather “the best the government is prepared to do”. It is not for researchers to refuse to compound with government unethical policies, but for the civil society to do so. South Africa did it with TAC and access to treatment. Thailand is failing doing it with IDU because overall Thai people don’t care about IDU as demonstrated by the large support former Prime Minister Taksin and his “war on drug” policy got in 2003.

It is misplaced to blame researchers for the failure of the civil society.

By: Anonymous

Anonymous — Sun, 24 Jan 2010 07:26:52 +0000

From the CDC site:
“Consistent with Thai government policy, sterile syringes are not provided, but are widely available in Thailand without a prescription and at low cost (one sterile syringe and one needle cost about 5 baht, or about $0.15).”
Do we know what motivated the Thai government policy? Was it bound up with the older US governments’ attitude to clean needles?