Yes, we have condoms. But what else works to prevent HIV? This question drives research into pre-exposure prophylaxis (PrEP, when HIV-negative people take HIV meds to keep from contracting the virus), microbicides (gels and other products applied to the vagina or rectum that contain meds to prevent infection), vaccines and other HIV prevention strategies.
While we place a lot of focus—and hope—on these new prevention strategies, it is time to reconsider how we test these tools to see if they work. Is it possible that the trials, themselves, are creating roadblocks to prevention breakthroughs? For example, trial participants receive condoms and condom counselling because, ethically, researchers have to do everything they can to reduce participants’ risk of acquiring HIV. It is the right thing to do. But these new prevention tools are needed most by people who do not use condoms regularly. So isn’t there some ethical way to test the products under conditions that are more like real life?
Researchers and advocates have been asking these questions—and raising the related ethical concerns—as they explore ways to improve the testing process. But before delving into the details and the future of prevention trails, the need for this discussion must be reiterated: We can no longer ignore the fact many people don’t use or don’t like condoms. If they did, the number of new HIV infections in the United States every year would have decreased as condom promotion increased. It hasn’t.
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