Table 2

The burdens and benefits of international research

	Burdens	Benefits
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
Researchers from sponsoring country	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
Researchers from host country	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