Behavioral and Social Sciences, FHI360, 2224 ENC Hwy 54, Durham, NC 27713, USA.
J Int AIDS Soc. 2011 Sep 27;14 Suppl 2(Suppl 2):S3. doi: 10.1186/1758-2652-14-S2-S3.
Biomedical research is critical to identifying effective and safe interventions, such as vaccines, microbicides, male circumcision and antiretrovirals, for prevention. Funding for clinical prevention trials is highly competitive and the benchmarks of success ultimately reduce to quickly enrolling a select group of people at risk, keeping them enrolled, and inducing them to be compliant with trial requirements - all at the lowest cost possible. Juxtaposed with this reality is the fact that HIV is situated with poverty, exploitation, assaults on human dignity, and human rights abuses. The result is a complex web of ethical challenges that are socially constructed along lines of wealth and power. While social science research methods are commonly employed to examine such topics, they have played a marginal role in biomedical HIV prevention research. Why? To answer this question, a core set of persistent interlocking social, behavioural and ethical challenges to biomedical HIV prevention research are described. A critique is offered on how the social has been framed relative to the behavioural, ethical and biomedical components. Examples of how this framing has devalued social knowledge are provided, including the conflation of qualitative research with anecdotal reporting, a bias toward brevity and accuracy over external validity, and difficulties in distinguishing between a moral understanding of social norms and achieving a moral outcome when confronted with ethical challenges in research. Lastly, opportunities are identified for enhancing the success of biomedical HIV prevention research through development of a coherent programme of social science research. Recommendations are offered for reframing the social as a valid domain of scientific inquiry in this highly applied and interdisciplinary context.
生物医学研究对于确定有效的和安全的干预措施至关重要，例如疫苗、杀微生物剂、男性包皮环切术和抗逆转录病毒药物等预防措施。临床预防试验的资金竞争非常激烈，成功的基准最终归结为迅速招募一批有风险的特定人群，让他们继续参与，并促使他们遵守试验要求——所有这些都要尽可能地降低成本。与这一现实形成鲜明对比的是，艾滋病毒存在于贫困、剥削、侵犯人类尊严和侵犯人权的环境中。其结果是一个复杂的伦理挑战网络，这些挑战是按照财富和权力的标准构建的。虽然社会科学研究方法通常被用于研究此类主题，但它们在生物医学艾滋病毒预防研究中只发挥了边缘作用。为什么？为了回答这个问题，描述了生物医学艾滋病毒预防研究中一些持久的、相互关联的社会、行为和伦理挑战。本文对社会是如何相对于行为、伦理和生物医学因素来构建的进行了批判。提供了一些例子来说明这种构建方式是如何贬低社会知识的，包括将定性研究与轶事报告混为一谈，偏向于简洁和准确性而不是外部有效性，以及在面对研究中的伦理挑战时，难以区分对社会规范的道德理解和实现道德结果。最后，确定了通过制定连贯的社会科学研究计划来提高生物医学艾滋病毒预防研究成功的机会。本文提出了一些建议，即重新将社会作为这一高度应用和跨学科背景下科学探究的有效领域。
