J Med Ethics 31:39-47 doi:10.1136/jme.2004.008102
  • Research ethics

HIV prevention research and global inequality: steps towards improved standards of care*

  1. K Shapiro1,
  2. S R Benatar2
  1. 1Family Health International, PO Box 13951, Research Triangle Park, NC, USA
  2. 2Department of Medicine and Bioethics Centre, University of Cape Town Observatory, 7925, Cape, South Africa
  1. Correspondence to:
 S R Benatar
 Department of Medicine & Bioethics Centre, University of Cape Town Observatory, 7925, Cape, South Africa;
  • Received 22 January 2004
  • Accepted 24 June 2004
  • Revised 20 May 2004


Intensification of poverty and degradation of health infrastructure over recent decades in countries most affected by HIV/AIDS present formidable challenges to clinical research. This paper addresses the overall standard of health care (SOC) that should be provided to research participants in developing countries, rather than the narrow definition of SOC that has characterised the international debate on standards of health care. It argues that contributing to sustainable improvements in health by progressively ratcheting the standard of care upwards for research participants and their communities is an ethical obligation of those in resource-rich countries who sponsor and implement research in poorer ones.


  • * This article was developed in conjunction with the Ethics Working Group of the HIV Prevention Trials Network Ethics.

  • The HIV Prevention Network and Family Health International funded our work.

  • Members of the HIV Prevention Trials Network Ethics Working Group: Q A Karim (Chair), R Bayer, S R Benatar, M Chigwanda, D Dixon, D Donnell, L Guay, S Kirkendale, B Lo, K MacQueen, S M Monico, V Muthuswamy, K Shapiro, R Strauss, S Wakefield, and C Woodsong.