Participants
| Risk to health—iatrogenic | Improved healthcare access |
| Stigma and social harms | Improved health status |
| Time lost to visits | Increased knowledge about health |
| Risk of exploitation | Feeling of altruism |
| Increase in risk behaviour if mistaken belief that study is | Benefits of positive results if available |
| protective | |
Community
| Poor overall access to care in the presence of increased resources for research | Improved access to care if resources shared |
| Dual SOC with access only to the lesser standard by non-participants | Increased knowledge about health |
| Stigma of identification with HIV infection | Benefits of positive results if available |
Healthcare system
| Diversion of scarce health resources to research: | New resources for health |
| • health workers | Training for health workers |
| • clinic and hospital space | New clinic and hospital space |
| • materials | |
| Dual standards of care | |
| Increasing fragmentation of services | |
| Research priorities may dominate services | |
Researchers from sponsoring country
| High costs | Career advancement |
Operational complexities | Good salaries |
| Regulatory restrictions | Travel to interesting places |
| Cultural and social gaps in understanding population | Right livelihood, altruism |
Researchers from host country
| Sponsoring country researcher may set research agenda | Career advancement |
Cultural and social gaps in understanding | Altruism |
| Racism Divided loyalties between local and sponsoring institutions | Increased resources for research directed to local problems |
| | Higher salary than if locally funded |
Sponsors
| Failure to recover costs | High profit potential in drug research |
| Potential for external problems stalling project | Less stringent ethical oversight |
| Operational complexities | Lower operating costs |
| Regulatory complexities | Improved public profile of company or organisation |