Sociopolitical issues

1
Sociopolitical issues

• Carlos del Rio, MD
• Emory University CFAR

2
Objectives

• To address the special social and political
  issues associated with conducting human subjects
  research in resource poor countries including
  awareness of individual, cultural, and
  institutional attitudes towards and beliefs about
  HIV and research.

3
"Medicine is a social science, and politics is
nothing but medicine on a large scale."

• Rudolph Virchow, a German Pathologist of the XIX
  Century and a pioneer of the public health
  movement, identified socio-economic factors such
  as poverty as key elements impacting disease,
  disability, and premature death.

4

• Public health programs, by their very nature, are
  extensions of the state, and have to often
  participated in the perpetuation of the social
  conditions that contribute to poor health.

5

• Societal factors such as religious beliefs,
  gender inequalities, income distribution, lack of
  empowerment of minorities and discrimination of
  stigmatized groups have contributed to the spread
  of HIV and must be taken into consideration in
  the design and implementation of a research
  project.

6

• The existing policies and cultural norms in a
  given country may also be a facilitator for the
  spread of HIV.
• Machismo in Latin America
• Policies in existence in the US about needle
  exchange

7

• Ethics and social policy often lag behind
  advances in medical technology.
• Scientists need to overcome a legacy of mistrust
  concerning the governments role in human
  experimentation.

8

• Maginalization and disadvantage of those
  communities severely burdened with HIV has
  characterized the AIDS epidemic.
• The lack of access to healthcare for most persons
  living with HIV worldwide has increasingly been
  an ethical dilemma confronting HIV research.
• The design of a study that amends some of these
  deficits raises troubling concerns of undue
  incentives to participate and of serious costs
  and complexity for trial sponsors.

9

• Partnership among participants, their
  communities, investigators and trial sponsors are
  required to confront many of the sociopolitical
  challenges confronting HIV research.
• When conducting a research project domestically
  or overseas it is convenient to have a community
  advisory board (CAB) that can help address the
  sociopolitical issues.