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Why were the HIV prevention trials in commercial sex workers abandoned?

One promising approach to help stem the global HIV epidemic is to give commercial sex workers an HIV medication (such as the drug tenofovir) before they have high risk sex in the hope of reducing their chances of becoming infected, an approach called "pre-exposure prophylaxis" (PREP). But activist groups, including Act Up-Paris have "halted the progress of at least two important clinical trials of tenofovir as PREP and brought negative attention to tenofovir, somewhat similar to that visited on thalidomide more than four decades ago," say two researchers in an essay in the open access global health journal PLoS Medicine.

The dramatic protest at the XV International AIDS Conference in Bangkok, Thailand last year against a PREP trial of tenofovir among Cambodian commercial sex workers caught the world's media attention. But Jerome Singh, of the Centre for the AIDS Programme of Research in South Africa, University of KwaZulu–Natal, and Edward Mills of the Department of Clinical Epidemiology and Biostatistics, McMaster University, Canada, argue that "if tenofovir is someday proven to be clinically efficacious as a PREP, today's irresponsible reporting and activism surrounding tenofovir could cause those in need to snub the drug if, or when, it becomes licensed for use as a PREP."

In a commentary on the essay, Joep Lange, who was the President of the International AIDS Society at the time of the Bangkok conference, criticizes the protestors who derailed the PREP trials.

In the absence of an effective HIV vaccine, which is felt to be the only tool that can definitively break the epidemic, Lange says that there is a pressing need to develop female-controlled prevention technologies that do not require the male partner's consent, and the protestors are getting in the way of such development. "Activist groups have now managed to derail several PREP trials, arguably the most important studies for those at high risk of acquiring HIV infection around the globe."

Lange is highly critical of the tactics used by those who have managed to shut down the PREP trials. "The methods of these specific activist groups," he says, "are uninformed demagogy, intimidation, and 'AIDS Exceptionalism', the last in the sense that they exploit their HIV-positive status to get away with behavior that would not be accepted from others."

"Those who will suffer the most from the misguided ethical imperialism that derailed the PREP trials do not live in Paris, but as usual in Nairobi, Johannesburg, Phnom Penh, and Calcutta."


Citation: Singh JA, Mills EJ (2005) The abandoned trials of pre-exposure prophylaxis for HIV: What went wrong? PLoS Med 2(9): e234.

Related article:

Citation: Lange JMA (2005) We must not let protestors derail trials of pre-exposure prophylaxis for HIV. PLoS Med 2(9): e248.



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