Division of Medical Ethics and Law
Unintended and Intended Implications of HIV Cure: A Social and Ethical Analysis
Brocher Foundation Workshop, Geneva, Switzerland 7-–9 May 2014
Keymanthri Moodley: Pluralistic Perspectives on Cure in Africa
Africa has a rich and contentious history of HIV cure options that range from mythology, cultural beliefs and religion to alternate and traditional medications. This history is set against a backdrop of political ideology, claims of colonialism, pluralistic understanding of health and disease and distrust of the pharmaceutical industry. The concept of HIV cure holds enormous power that has been strategically harnessed by political leaders in some African countries. A “strong pan-Africanist and anti-Western discourse” has fuelled the return to traditional medicines in Africa. This phenomenon is however, not unique to the African continent. Traditional Chinese Medicine (TCM) and Complementary and Alternative Medicine (CAM) hold major support in Asia and several Western countries. The World Health Organization, in its Beijing Declaration, has supported respect for and development of safe traditional medicines. Consequently, there is a global call for an integrated culturally relevant approach to the treatment of HIV and this must be borne in mind in any conception of research or implementation of cure. At the same time it is critical that harmful, fraudulent and unproven “cures” are strongly sanctioned.
Malcolm de Roubaix: Traditional African Ethics, Western Medicine… Reconcilable?
In contemporary biomedical and philosophical discourse, traditional African culture has been largely usurped by Western colonial influence. Tradional culture, however, still has a significant influence on the thinking and actions of many Africans. The question is if African ideas on the nature of personhood and the causation/treatment of disease can be translated into an organised system of bioethics; even if not, biomedical researchers should be sensitive to the implications of traditional African thinking. In HIV Cure Research in particular, it may be useful to incorporate traditional healers, and integrate relevant aspects of the communitarian ideal (as advised by local community partners) as an essential element of African HIV Cure research. Exactly how, where and to what purpose this should be done, should be the focus of a dedicated research project.
Ciara Staunton: Informed Consent for HIV Cure research in South Africa
Since the days of AIDS denialism in South Africa, there has been great progress made in the provision of treatment to PLHIV as well as improved treatment campaign. South Africa has one of the biggest treatment campaigns in the world and the rate of infections is stabilising, however significant challenges remain. Only 30% of PLHIV are on treatment and the successes in treatment and prevention have been offset somewhat by increasing risk behaviour. South Africa is one country in which there is a clear need for a HIV Cure and is likely to be the focus of many clinical trials for HIV Cure. However, prior to the commencement of any trials in South Africa, there is a need to consider the current informed consent guidelines in South Africa, the known risks associated with Cure research and whether there is a need for additional protection for HIV Cure research participants.
Johanna Crane & Theresa Rossouw: The Social Context of Curing HIV Among Infants: From Mississippi to South Africa and Back
In March 2013 a group of physician-researchers made the startling announcement that a baby born in Mississippi had been functionally cured of HIV (Persaud et al. 2013). Since then, this case has been both widely reported and widely scrutinized. Much of the scrutiny has focused on scientific and technical aspects of the case, such as whether the baby was truly infected with HIV at birth and thus whether the term “cure” is accurate. By contrast, the social context of the case—and its implications for pediatric HIV cure more globally--has gone largely unexamined.
This paper describes the social context of the “Mississippi baby” case and a parallel case of an HIV-infected infant in South Africa, where proof-of-concept studies of the approach used in Mississippi are in the planning stages. The similarities in these cases highlight the role played by social inequalities and inadequate PMTCT systems in allowing this research. We argue that an ethical program of research into infant cure also needs to address the gaps in care that allow antenatal HIV transmission to occur, and recommend that proof-of-concept studies include a rigorous social science component aimed at identifying barriers to care for HIV-positive pregnant women.