MacQueen Kathleen M, Karim Quarraisha Abdool
Family Health International, Research Triangle Park, NC, USA.
J Assoc Nurses AIDS Care. 2007 Mar-Apr;18(2):78-82. doi: 10.1016/j.jana.2007.01.002.
One quarter of HIV infections globally occur among young people 15 to 24 years of age, and more than half of all new infections are in people younger than 25 years. Clearly, there is a need to identify and implement effective HIV prevention strategies among at-risk teens. Some of the most effective options for slowing the epidemic are biomedical, and several promising methods are in development, including microbicides, vaccines, and preexposure prophylaxis (PREP, or the daily use of antiretrovirals to prevent the acquisition of HIV). There is widespread reluctance to enroll minors in such biomedical prevention trials because of concerns about vulnerability related to physical maturity, experiential maturity, and diminished autonomy as well as legal and social challenges that vary across and within nations. However, excluding minors from trials misses an important opportunity to evaluate the effectiveness, acceptability, and safety of innovative interventions under the best conditions for identifying and resolving potential problems. The challenges of including minors in HIV prevention trials are highlighted through the example of one rural South African community that has been particularly devastated by the HIV epidemic.
全球四分之一的艾滋病毒感染发生在15至24岁的年轻人中，所有新感染病例的一半以上是25岁以下的人群。显然，有必要在高危青少年中确定并实施有效的艾滋病毒预防策略。减缓这一流行病的一些最有效方法是生物医学方法，目前有几种很有前景的方法正在研发中，包括杀菌剂、疫苗和暴露前预防（PrEP，即每日服用抗逆转录病毒药物以预防感染艾滋病毒）。由于担心与身体成熟度、经验成熟度和自主性降低相关的脆弱性，以及各国之间和各国国内不同的法律和社会挑战，人们普遍不愿意让未成年人参与此类生物医学预防试验。然而，将未成年人排除在试验之外错过了一个在识别和解决潜在问题的最佳条件下评估创新干预措施有效性、可接受性和安全性的重要机会。通过南非一个农村社区的例子突出了将未成年人纳入艾滋病毒预防试验所面临的挑战，该社区尤其受到艾滋病毒疫情的重创。
