Sex Workers, Activists and Scientists Wrangle Over Testing A Pill That May Stop HIV
“Always be prepared,” the Boy Scout motto, may someday serve as the sex
worker’s mantra if PREP, or pre-exposure prophylaxis, proves
effective. A daily HIV med taken by high-risk neggies, it holds
hope as a cheap and easy virus blocker. But right now, politics is
trumping science: Long-awaited tests have been hampered by protests
over research methods, shutting down trials of the leading PREP
contender, Gilead’s nuke, Viread. If it works, Viread could be used by
millions unable to negotiate condoms. With so much at stake, feuding
activists, funders, scientists and officials met in Seattle in May to
try to hammer out their differences. “It didn’t make sense to be
shouting at each other,” says Gregg Gonsalves, director of treatment
and prevention advocacy at Gay Men’s Health Crisis, which helped plan
the meeting.
Researchers have long theorized that if an HIV
med given within days of exposure could prevent infection, taking it
before exposure might work, too. But there’s a conflict of interest in
running prevention tests: Ethics dictate that subjects get the best
counseling and care available, but in order to determine that the drug
stops HIV, some subjects must risk exposure. “You only know if
prevention technologies work if you have infections,” says Mitchell
Warren, head of the AIDS Vaccine Advocacy Coalition. Stuck on these
scientific and moral hooks, PREP trials took until 2004 to launch.
And
the trouble only mounted. No sooner were sex workers in Cambodia
enrolled than they began organizing against what they said was a lack
of informed consent, hinting that participants were mere guinea pigs of
researchers interested in better trial data. Activists jumped on the
bandwagon, too, blasting funders for failing to offer lifelong meds to
subjects who got infected.
In a Cameroon trial, ACT UP Paris
raised its own red flags. “The screening and consent forms were in
English,” says ACT UP Paris’ Fabrice Pilorgé (some Cameroonians speak
French). “Another problem was that they wouldn’t provide the female
condom.” In the Thai trial, drug-using participants were denied free
needles. Well-organized protests at Bangkok’s 2004 global AIDS confab
grabbed headlines, causing Cambodia to pull out and Cameroon to suspend
tests. “I was furious,” says Gonsalves. “Is that a victory—to shut down
research?”
But in Seattle, some common ground was reportedly
reached. “It’s safe to say nobody left that meeting against the
research itself,” says Warren. Gonsalves agrees. “Research is
important,” he says. “But it’s also important that it’s done
ethically.” Meanwhile, trials proceed in San Francisco, Atlanta and six
foreign countries, while UNAIDS plans its own talks on the ethics of
prevention studies. As for Cambodian prostitutes, they take their risks
as they come, PREP-lessly.
