Ethical, behavioral, and social aspects of HIV vaccine trials in developing countries.

ISSUE: Several investigators are preparing to conduct efficacy trials of human immunodeficiency virus (HIV) vaccines in the developing world. Failure to adequately address the unique ethical, behavioral, and social issues that surround vaccine testing in that setting will jeopardize the success of these trials and future acquired immunodeficiency syndrome (AIDS) research in the host nation. DESCRIPTION OF THE PROJECT: Twelve investigators from Africa, Asia, North America, and South America reviewed previous experience with HIV trials in developing countries and explored potential solutions to these issues. CONCLUSIONS: Host country scientists, government officials, and media must be actively involved in all aspects of the trials. Minimum prerequisites for conducting the trial include the following: (1) researching vaccines active against developing world HIV isolates; (2) establishing and maintaining an adequate technological infrastructure; (3) assessing the feasibility of recruitment in countries where the existence of HIV may be denied; (4) designing methods to obtain informed consent from each individual subject, rather than exclusively from family members or community elders; (5) creating locally appropriate instruments to measure risk behavior; (6) identifying a behavioral intervention for placebo and treatment groups; (7) making available laboratory methods to distinguish between natural HIV infection and vaccine-induced seropositivity; and (8) guaranteeing that an effective vaccine is available free of charge to the placebo group and at affordable prices to other host country residents.

Promoting traditional medicine in Ethiopia: a brief historical review of government policy.

Past and current official policy toward Ethiopian traditional medicine is reviewed. To facilitate the objective assessment of official policy, the nature and historical origins of Ethiopian traditional medicine is examined briefly. It is noted that there is no single system of traditional medicine in Ethiopia, even though themes that are common to the many cultural groups constituting the society have been evolving. Common to most systems of Ethiopian traditional medicine are the interdigitation of 'mystical' and 'natural' explanations of ill-health and other misfortune and the holistic approach employed in dealing with illness and other personal misfortune. It is also noted that since the 1974 change of government in Ethiopia, official attitude toward the promotion and development of traditional medicine appears to have become more positive, especially, after the adoption of the Primary Health Care strategy in 1978. While this is true as far as official statements are concerned, in actual practice there continues to be considerable uncertainty about the interpretation and implementation of Government policy. It is suggested that misconceptions regarding the nature and role of traditional medicine in Ethiopian society will have to be corrected if appropriate plans and strategies are to be formulated.

Attitudes of modern and traditional medical practitioners toward cooperation.

Between 1985 and 1987 a total of 103 modern and 91 traditional medical practitioners were interviewed in seven towns in northwestern and central Ethiopia. The main aim was to assess their attitudes toward the legitimacy of each other's medical system and, especially, toward the question of cooperation or integration between modern and traditional medicine. It was found that the majority of the two groups of health workers believed that cooperation between the two systems of medicine would be useful and that they themselves would be willing to participate in such cooperative efforts. Those willing to cooperate suggested that traditional healers be (1) brought into the existing, official health-care settings, (2) given regular government wages for their services, and (3) guided and supervised by their modern counterparts.