The Needed Revision of the Belmont Report An HIV Cure Research Case Study

Abstract

The use of human subjects in research gives rise to a myriad of ethical concerns, which are primarily addressed in the Belmont Report. This set of guidelines for researchers focuses on protecting vulnerable individuals from being taken advantaged of in medical studies. Until recently, its breadth has been adequate guidance for contemporary concerns, but these guidelines are now failing to address novel biomedical issues. The structure of the Report creates an inadequate foundation to navigate ethical concerns not explicitly addressed in the paper, exemplified through a case study of HIV cure research. While the HIV crisis is centered in sub-Saharan Africa and largely affecting women and adolescents, cure research is happening almost exclusively in high income countries using white male subjects. This introduces an ethical dilemma, as studies have shown that population and environmental differences could lead to an HIV cure developed on one demographic to be less effective on another. Low-income countries in most need of the cure have inadequate infrastructure to pursue one on their own, leaving large populations excluded from research with no ethical guidelines to protect them. I argue that the Belmont Report must make more explicit the ethical principles that are implied in their report, calling for a distributive justice that makes clear our moral obligation to include vulnerable populations in research studies.