Table 2

 The burdens and benefits of international research

Participants Risk to health—iatrogenicImproved healthcare access
Stigma and social harmsImproved health status
Time lost to visitsIncreased knowledge about health
Risk of exploitationFeeling of altruism
Increase in risk behaviour if mistaken belief that study is Benefits of positive results if available
Community Poor overall access to care in the presence of increased resources for researchImproved access to care if resources shared
Dual SOC with access only to the lesser standard by non-participantsIncreased knowledge about health
Stigma of identification with HIV infectionBenefits of positive results if available
Healthcare system Diversion of scarce health resources to research:New resources for health
 • health workersTraining for health workers
 • clinic and hospital spaceNew clinic and hospital space
 • materials
Dual standards of care
Increasing fragmentation of services
Research priorities may dominate services
Researchers from sponsoring country High costsCareer advancement
Operational complexitiesGood salaries
Regulatory restrictionsTravel to interesting places
Cultural and social gaps in understanding populationRight livelihood, altruism
Researchers from host country Sponsoring country researcher may set research agendaCareer advancement
Cultural and social gaps in understandingAltruism
Racism Divided loyalties between local and sponsoring institutionsIncreased resources for research directed to local problems
Higher salary than if locally funded
Sponsors Failure to recover costsHigh profit potential in drug research
Potential for external problems stalling projectLess stringent ethical oversight
Operational complexitiesLower operating costs
Regulatory complexitiesImproved public profile of company or organisation