In this article Fitzgerald and M-T Behets outline four incidents that arose while conducting HIV clinical research with women in African and Caribbean countries to illustrate the "massive ethical challenges for researchers in HIV prevention trials". The cases include an HIV-positive husband refusing to use condoms with his HIV-negative spouse, cervical cancer being identified within a country which did not have the facilities to treat it, and the fatal consequences of one participant seeking an illegal abortion and another delaying surgical removal of a dead foetus on the advice of a traditional attendant and a lack of funds for treatment.

The authors note that much HIV research will involve women of reproductive age, particularly that focussed on preventing mother-to-child transmission of HIV. The four cases discussed outline the issues that can arise when research is being conducted among vulnerable women without access to basic medical services, where physical and sexual violence against women is relatively common and social injustice is widespread. In such circumstances the authors ask what responsibilities researchers have to participants who have built up a trusting relationship with them over time. They conclude that meaningful discussion between researchers and relevant communities is required, leading to a participatory research model in which potential participants and community members are involved in study design and implementation.

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