Unintended and Intended Implications of HIV Cure: A Social and Ethical Analysis

Introduction :

Thirty years ago, HIV was a death sentence with no vaccine, no treatment, and no cure. Its high morbidity and association with stigmatized sexual and drug-use behaviors led to the rise of HIV exceptionalism, the tendency to treat HIV differently from other diseases. Over time, a culture of HIV exceptionalism has profoundly shaped public perceptions, law, policy, advocacy, funding priorities, and the structure of health service delivery. A potential HIV cure signals a new chapter in this complex global story. The history of HIV shows that the social meaning of a disease – including how it is represented and policies surrounding its treatment and control – changes dramatically when it transitions from an untreatable disease to a treatable chronic condition. A further transformation of HIV from a treatable chronic condition to a curable disease will not only potentially decrease morbidity and mortality and contribute to epidemic control, but also alter how HIV is experienced, perceived and approached. Curing HIV is a strategic priority of the International AIDS Society and the US National Institutes of Health, and in the past two years, there have been well-publicized cases of formerly HIV-positive persons apparently being functionally cured by innovative medical interventions. Although HIV cure research is at an early stage, this is a critical time to explore the ethical and social implications of HIV cure research and future implementation of potential cures. What is meant by an HIV cure? What risks are acceptable for those who enroll in early phase HIV cure research? What challenges will the prospect of a cure for HIV pose for the process of informed consent among research participants who are HIV positive? How will the curability of HIV likely affect the social stigma traditionally surrounding the virus, and how will curability affect current HIV prevention and treatment efforts? Will the cure for HIV be ‘owned’ by scientific institutions, and how can equitable access to future cures by vulnerable communities be assured? In the past, some HIV control strategies such as male circumcision have been implemented with minimal discussion of their likely social and ethical implications, resulting in suboptimal uptake and missed public health opportunities. Anticipating the implications of HIV cure requires input from a diverse group of stakeholders who have the capacity to better understand unintended implications in order to prevent negative implications and expand positive ones. Building on strong links to ongoing cure research, social science/ethics research expertise, and global stakeholder links, we propose a Brocher workshop focused on the ethical and social implications of curing HIV infection.

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