Dr Thomas C Quinn8217;s experiments in developing countries raise ethical questions

Funded by the World Bank, Rockefeller Foundation and National Institute of Child Health and Human Development, the Quinn project was carried out to delineate the risk factors associated with heterosexual transmission of HIV-1. It has been published in the New England Journal of Medicine, along with a ethical critique of the issue.

The researchers observed several hundred people with HIV infection but did not treat them. The investigators also left it to the HIV positive partner to decide whether the HIV negative partner should be informed about the infection, even though both were regularly examined by the investigators. Many people found to have other sexually transmitted diseases were also not treated.

Quinn subsequently identified 415 couples where one partner was initially HIV-1-positive and the other HIV-1-negative. At the end of 30 months, 90 of the initially HIV-1-negative partners 21.7 per cent tested positive.

Such a study could not have taken place in the US, where Quinn would have been forced to treat patients with HIV and other sexually transmitted diseases. He would also have been expected to inform HIV-negative partners of their special risk.

Already, intense international debate is on whether research conducted in developing countries should be held to different standards from those applied in the developed world. Many people believe that different standards are justified and should be applied not only by the local economic conditions, but also by the special relevance of the studies to the regions in which they are conducted.

8220;True, Quinn found that the risk of heterosexual transmission correlated with viral load, but as often the case, the results will probably find their greatest application in the developed world,8221; says Joe Thomas, a Melbourne-based principal investigator of a Deakin University research project on AIDS-related Human Rights violations in seven Asian countries, including India.

Agrees Marcia Angell, the editor of The New England Journal of Medicine. In a strongly-worded editorial, she notes that ethical standards should not depend on where the research is performed. She holds that investigators are expected to assume broad responsibility for the welfare of the subjects they enrol in their studies, which means treating illnesses even if they are not directly caused by the research.

She further argues that the nature of investigators8217; responsibility for the welfare of their subjects should not be influenced by the politico-economic condition of the region. This would easily lead to researchers from the developed world conducting studies in developing countries that could not be performed in their own countries.

8220;Such a study would never have been allowed in a hospital set-up, where doctors cannot turn away people with HIV without treating them,8221; said an ICMR scientist, on reading the report. 8220;The very hypothesis of using antibiotics to reduce load is suspect as it has been known since the 1980s that antibiotic therapy has no effect on HIV infection.8221;

Antiretroviral therapy AZT works, but is currently too expensive and the regimen too complex for routine use in developing countries. HIV burden can be, however, reduced with the treatment of some systemic infections or genital tract infections.