Ethics and the standards of prevention in HIV prevention trials
Taking a hard look at successes and failures in HIV prevention research is essential. Accordingly, the excellent comprehensive review of randomized trials of interventions aimed at protecting from the sexual transmission of HIV that Padian et al. [1] recently reported in AIDS is a most welcomed addition to the literature. As pointed out in their review, although it is critical to applaud thesmall numerator of successful trials, it is also important to evaluate carefully the much larger denominator of trials that were ‘flat’.
On the basis of their review, the authors conclude that flat trials ‘are attributable, at least in part, to issues related to trial design, implementation, or both’ ([1], p. 631). The authors pay particular attention to the selection of the control arm. Although this issue is of profound importance from the perspective of trial design, it also raises fundamental ethical considerations, among others, related to both the need for equipoise among the arms of the trial as well as designing trials which promise to be informative. Such considerations should be useful in taking the lessons learned from this recent review forward into the HIV prevention arena. ...
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