Science and ethics of human immunodeficiency virus/acquired immunodeficiency syndrome controversies in Africa
Science and ethics of human immunodeficiency virus/acquired immunodeficiency syndrome controversies in Africa
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DOI：
10.1111/j.1440-1754.2011.02179.x
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发表时间：
2011-09-01
影响因子：
1.7
通讯作者：
Brewster, David
中科院分区：
文献类型：
--
作者：
Brewster, David
人类免疫机能丧失病毒/获得性免疫机能丧失综合症(艾滋病毒/艾滋病)在非洲的流行给研究人员和临床医生提出了重要的伦理问题。最臭名昭著的争议与20世纪90年代末在非洲进行的齐多夫定(AZT)试验有关，在试验中，对照组被给予安慰剂，而不是有效的药物来防止垂直传播。这引起了赞助国对主题的剥削、不公正以及捐助国和资源贫乏环境之间的道德双重标准的关切。然而，真正的双重标准是在西方国家和非洲国家的临床实践标准之间，这必须作为国家之间和国家内部日益严重的全球财富不平等的一部分加以解决。没有背景的伦理推理，伦理宣言、原则和指导方针本身就有重要的局限性。艾滋病毒流行对研究伦理的关注导致了对临床实践中伦理问题的相对忽视。虽然自1990年代以来，艾滋病毒/艾滋病方面的科学进步改变了伦理问题，但在地方委员会的伦理审查能力以及非洲临床医生和研究人员接触伦理问题方面，艾滋病毒/艾滋病的生物伦理也取得了进展。然而，对官僚机构对研究的过度监管仍令人严重关切，这可能会阻碍非洲特别是非洲卫生问题的研究。非洲学术机构和研究人员还需要在研究资助者和捐助机构的协助下逐步提高其研究能力。
The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic in Africa has raised important ethical issues for both researchers and clinicians. The most notorious controversy has been related to the zidovudine (AZT) trials in Africa in the late 1990s, in which the control groups were given a placebo rather than an effective drug to prevent vertical transmission. This raised concerns in the sponsoring country about exploitation of subjects, injustice and an ethical double standard between donor countries and resource-poor settings. However, the real double standard is between clinical practice standards in Western versus African countries, which must be addressed as part of the increasing global inequity of wealth both between countries and also within countries. There are important limitations to ethical declarations, principles and guidelines on their own without contextual ethical reasoning. The focus on research ethics with the HIV epidemic has led to a relative neglect of ethical issues in clinical practice. Although the scientific advances in HIV/AIDS have changed the ethical issues since the 1990s, there has also been progress in the bioethics of HIV/AIDS in terms of ethical review capability by local committees as well as in exposure to ethical issues by clinicians and researchers in Africa. However, serious concerns remain about the overregulation of research by bureaucratic agencies which could discourage African research on specifically African health issues. There is also a need for African academic institutions and researchers to progressively improve their research capacity with the assistance of research funders and donor agencies.