ABSTRACT
The global AIDS epidemic has prompted some critical rethinking of the ethical obligations of the research community and sponsoring industry to human participants in medical research. Developing countries are facing a humanitarian crisis of catastrophic proportions caused by the AIDS epidemic. Over 40 million people throughout the world are currently infected with HIV/AIDS.1 The overwhelming majority (95%) live in developing countries. The World Health Organisation (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimate that at least 6 million of these have advanced stage HIV and are in urgent need of antiretroviral (ARV) treatment now. Four million live in subSaharan Africa but in 2002 fewer than 50,000 (under 2%) of HIV positive people in Africa received antiretroviral therapy, whilst 95% had no access to testing and remained unaware of their HIV status.2 And yet, where available, highly active antiretroviral therapy (HAART) has reduced mortality by 90% and dramatically improved quality of life.3 In November 2003, the WHO and UNAIDS declared the AIDS epidemic a public health emergency and launched the 3 x 5 Initiative to treat 3 million sufferers by 2005.4 The unprecedented scale of the international effort required from ‘resource-rich’ countries to meet these targets may be gleaned from the lack of progress on the targets set in the 2001 Declaration of Commitment by UNAIDS.5 At the launch of the 3 x 5 Initiative, Peter Biot, Executive Director of UNAIDS, talked about the need to overcome the ‘formidable barrier of creating sufficient operational capacity to expand access to HIV treatment’.6 Lee Jong Wook, Director-General of the WHO, said that this massive challenge could only be met if ‘we change the way we think and change the way we act’.7 The 3 x 5 Initiative aims to ‘advance the UN goals of promoting human rights as codified in the UN Declaration of Human Rights, as expressed in the WHO Constitution in
1 Epidemic Update, December 2003, UNAIDS, www.unaids.org. 2 Mukherjee, Farmer, Niyizonkiza, McCorkle, Vanderwarker, Teixeira and Kim, 2003. 3 Ibid, at p 1105. 4 WHO and UNAIDS, 2003. 5 Two years later, Kofi Annan, Secretary General of the UN, warned that: ‘we have the
commitment. Our resources are increasing. But the action is still far short of what is needed … By 2005, we should have cut by a quarter the number of young people infected with HIV in the worst affected countries; we should have halved the rate at which infants become infected; and we should have comprehensive care programmes in place everywhere. At the current rate, we will not achieve any of those targets by 2005.’ Press Release SG/SM/9014 AIDS/65 OBV/393.
