Peterson Kristin, Folayan Morenike Oluwatoyin, Chigwedere Edward, Nthete Evaristo
a Anthropology Department , University of California , 3151 Social Sciences Plaza, Irvine , CA , USA.
b Institute of Public Health , Obafemi Awolowo University , Ile-Ife , Nigeria.
Anthropol Med. 2015 Dec;22(3):278-94. doi: 10.1080/13648470.2015.1081377. Epub 2015 Sep 30.
Between 2004 and 2005, the first multi-sited clinical trial tested whether an existing, marketed antiretroviral drug, Tenofovir (TDF), could prevent HIV transmission. Referred to as pre-exposure prophylaxis (PrEP), most of these trial sites prematurely closed down. Two sites located in Cambodia and Cameroon received international media attention. But little attention was drawn to sites in Malawi and Nigeria, where university ethicists and research scientists extensively debated PrEP. This article focuses on events that took place in Malawi where there was a prolonged dispute over the scientific rationales of PrEP and not trial specific ethics referred to as 'bioethics'. Specifically, the article discusses debates pertaining to three PrEP trial protocols that were refused ethics approval in Malawi between 2004 and 2009. It is argued that HIV science debates in Malawi are embedded in postcolonial politics--geopolitical histories and state and household economic dispossessions that have created the structural possibilities for Malawi to become an offshore destination for HIV clinical research. As such, ethics in this case does not pertain to trial or bioethical 'failures'. Rather, ethics is located at the scale of imperial relations that give rise to multiple, often invisible, research concerns and constraints.
2004年至2005年期间，首个多中心临床试验对一种已上市的抗逆转录病毒药物替诺福韦（TDF）能否预防艾滋病毒传播进行了测试。这种方法被称为暴露前预防（PrEP），大多数试验地点都提前关闭了。位于柬埔寨和喀麦隆的两个试验地点受到了国际媒体的关注。但马拉维和尼日利亚的试验地点却很少受到关注，在那里，大学伦理学家和研究科学家对暴露前预防进行了广泛辩论。本文重点关注在马拉维发生的事件，那里围绕暴露前预防的科学原理存在长期争议，而非被称为“生物伦理学”的具体试验伦理。具体而言，本文讨论了2004年至2009年期间在马拉维被拒绝伦理批准的三项暴露前预防试验方案的相关辩论。有人认为，马拉维的艾滋病毒科学辩论植根于后殖民政治——地缘政治历史以及国家和家庭经济被剥夺的状况，这些状况为马拉维成为艾滋病毒临床研究的海外目的地创造了结构上的可能性。因此，在这种情况下，伦理并非涉及试验或生物伦理的“失败”。相反，伦理存在于帝国关系的层面，这种关系引发了诸多往往不为人所见的研究问题和限制。
