Social Justice and HIV Vaccine Research in the Age of Pre-Exposure Prophylaxis and Treatment as Prevention
Theodore C. Bailey and Jeremy Sugarman
Affiliation: Johns Hopkins Berman Institute of Bioethics and Division of Infectious Diseases, 1809 Ashland Avenue, Baltimore, MD, 21205, USA.
Keywords: AIDS, ethics, HIV, justice, pre-exposure prophylaxis, prevention, treatment as prevention, vaccine research.
The advent of pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) as means of HIV
prevention raises issues of justice concerning how most fairly and equitably to apportion resources in support of the
burgeoning variety of established HIV treatment and prevention measures and further HIV research, including HIV
vaccine research. We apply contemporary approaches to social justice to assess the ethical justification for allocating
resources in support of HIV vaccine research given competing priorities to support broad implementation of HIV
treatment and prevention measures, including TasP and PrEP. We argue that there is prima facie reason to believe that a
safe and effective preventive HIV vaccine would offer a distinct set of ethically significant benefits not provided by
current HIV treatment or prevention methods. It is thereby possible to justify continued support for HIV vaccine research
despite tension with priorities for treatment, prevention, and other research. We then consider a counter-argument to such
a justification based on the uncertainty of successfully developing a safe and effective preventive HIV vaccine. Finally,
we discuss how HIV vaccine research might now be ethically designed and conducted given the new preventive options
of TasP and PrEP, focusing on the ethically appropriate standard of prevention for HIV vaccine trials.
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