title: Saying 'No' to PrEP research in Malawi: what constitutes 'failure' in offshored HIV prevention research?
abstract: Between 2004 and 2005, the first multi-sited clinical trial tested whether an existing, marketed antiretroviral drug, Tenofovir (TDF), could prevent HIV transmission. Referred to as pre-exposure prophylaxis (PrEP), most of these trial sites prematurely closed down. Two sites located in Cambodia and Cameroon received international media attention. But little attention was drawn to sites in Malawi and Nigeria, where university ethicists and research scientists extensively debated PrEP. This article focuses on events that took place in Malawi where there was a prolonged dispute over the scientific rationales of PrEP and not trial specific ethics referred to as 'bioethics'. Specifically, the article discusses debates pertaining to three PrEP trial protocols that were refused ethics approval in Malawi between 2004 and 2009. It is argued that HIV science debates in Malawi are embedded in postcolonial politics--geopolitical histories and state and household economic dispossessions that have created the structural possibilities for Malawi to become an offshore destination for HIV clinical research. As such, ethics in this case does not pertain to trial or bioethical 'failures'. Rather, ethics is located at the scale of imperial relations that give rise to multiple, often invisible, research concerns and constraints.
authors.affiliation: a Anthropology Department , University of California , 3151 Social Sciences Plaza, Irvine , CA , USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Peterson
authors.affiliation: b Institute of Public Health , Obafemi Awolowo University , Ile-Ife , Nigeria.
authors.forename: Morenike Oluwatoyin
authors.initials: MO
authors.lastname: Folayan
authors.affiliation: c V&E Consultants , PO Box 31400, Lilongwe 3 , Malawi.
authors.forename: Edward
authors.initials: E
authors.lastname: Chigwedere
authors.affiliation: d Malawi College of Health Sciences (Lilongwe Campus) , P.O. Box 30368, Lilongwe 3 , Malawi.
authors.forename: Evaristo
authors.initials: E
authors.lastname: Nthete
mesh_terms: D060432:Anthropology, Medical; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic / Q000941:ethics*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000208:ethnology / Q000517:prevention & control; D006801:Humans; D008295:Malawi; D065129:Pre-Exposure Prophylaxis; D017211:Treatment Failure
chemical_list: D019380:Anti-HIV Agents
keywords: AIDS Clinical trials; Malawi and Africa; PrEP; ethics; failure; imperialism