Ethical considerations of human investigation in developing countries: the AIDS dilemma

N Engl J Med. 1988 Oct 20;319(16):1083-6. doi: 10.1056/NEJM198810203191609.


PIP: In the efforts to develop a vaccine for human immunodeficiency virus (HIV), attention has focused on sub-Saharan Africa, where large populations at risk for HIV infection could be studied easily. Cross cultural bioethics must be examined to address the ethical implications and cultural obstacles of such research. Autonomy and informed consent are difficult to achieve in cultures with limited personal choice. In some cultures, individual personhood is secondary to social relationships in the tribe or village. Language barriers, illiteracy, and the lack of knowledge about modern science all make it difficult to adequately inform participants. While the Helsinki Declaration emphasizes that a subject's well-being takes precedence over the interests of science and society, health policy decisions in nonautonomous populations often place state interests over the individual. Political sensitivities have been aroused by attempts to attribute the origin of AIDS to western or central Africa, leading political controversy and discrimination against Africans. Foreign researchers often exclude African participation once they have obtained the body fluid samples for study. Without joint collaboration and education, human research in developing countries can easily become exploitative. Justice dictates that research subjects be chosen for scientific reasons, not due to easy availability or ability to be manipulated. In vaccine development, Africans should not experience a disproportionate amount of risk without an equal share in the benefits. Furthermore, malnutrition, malaria, tuberculosis, and many other diseases present more urgent health problems to the developing world than AIDS. The health care priorities of the developing nations must be considered.

MeSH terms

  • Acquired Immunodeficiency Syndrome*
  • Cultural Characteristics*
  • Culture*
  • Developing Countries*
  • Ethics, Medical*
  • Helsinki Declaration
  • Humans
  • International Cooperation
  • Research
  • United States