This scenario mostly makes me question the ethicality of conducting a trial in a country where national regulations prevent the implementation of evidenced based strategies for HIV prevention (in this scenario, clean needles). On one hand, clean needles wouldn’t be available in absence of the trial anyway, but I’m not sure that affects the moral obligation of the research team to provide HIV prevention tools to participants.
While this particular issue may have been intractable, it seems the research group could have addressed some of the other concerns of civil society such as standard of care for seroconverters and screened out HIV-positive individuals, stakeholder involvement in protocol design and development, etc. Proactively addressing these items may have helped to smooth over tensions related to the needle issue, which the research team has less ability to influence. Additionally, acknowledging stakeholder concerns as part of results dissemination may have helped to prevent the rift between civil society and the research enterprise from growing.
