Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...) be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...) be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

In crafting our paper on addressing the ethical challenges in HIV prevention research with people who inject drugs,1 we had hoped to stimulate further discussion and deliberation about the topic. We are pleased that three commentaries on our paper have begun this process.2 3 4 The commentaries rightly bring up important issues relating to community engagement and problems in translating research into practice in the fraught environments in which PWID face multiple risks. These risks include acquisition of HIV as well (...) as criminalisation, stigma and lack of access to needed healthcare, prevention and social services. We take this opportunity to respond to the excellent points raised by the commentators. All of the commentaries support our emphasis on robust community engagement with PWID and other stakeholders in designing and conducting HIV prevention research, but urge us to go farther. Wolfe highlights the difficulty of even engaging with community members in oppressive settings, where authorities severely restrict civil liberties of PWID so that even discussing issues related to drug use and enforcement may place individuals at risk. To overcome such limitations, he appropriately suggests interviewing confidentially those who have previously been detained in closed settings as part of the community engagement process. Similarly, Wolfe observes that critical issues can be overlooked with a narrow focus on study procedures if contextual factors before, during or after a study are ignored. For example, he cites the risk of overdose for study participants who have been abstinent during a study and subsequently resume injecting when the study concludes. These kinds of risks may not be obvious …. (shrink)

In crafting our paper on addressing the ethical challenges in HIV prevention research with people who inject drugs, 1 we had hoped to stimulate further discussion and deliberation about the topic. We are pleased that three commentaries on our paper have begun this process. 2 3 4 The commentaries rightly bring up important issues relating to community engagement and problems in translating research into practice in the fraught environments in which PWID face multiple risks. These risks include acquisition of HIV (...) as well as criminalisation, stigma and lack of access to needed healthcare, prevention and social services. We take this opportunity to respond to the excellent points raised by the commentators. All of the commentaries support our emphasis on robust community engagement with PWID and other stakeholders in designing and conducting HIV prevention research, but urge us to go farther. Wolfe highlights the... (shrink)

Over the past two decades, Cuba has become a recognized global leader in sustainable agriculture. This paper explores how this process of agricultural transition has taken place, and argues that it has largely been led by research institutes, non-state organizations and the Cuban government, which have all contributed to the institutionalization of agroecology in both policy and practice. This process has been highly effective in terms of the numbers of people using agroecological techniques. However, although these techniques have been widely (...) adopted by farmers across the country, this paper suggests that many still perceive maximizing production to be a higher priority than maintaining a commitment to agroecological ideals. For these farmers, agroecological farming is viewed primarily as a pragmatic decision rather than an ideological or moral one, and they may thus be susceptible to shifting back to conventional production if this option became politically and economically feasible. (shrink)

Amid the many food safety scandals that have erupted in recent years, Chinese food activists and consumers are turning to the creation of alternative food networks to ensure better control over their food. These Chinese AFNs have not been documented in the growing literature on food studies. Based on in-depth interviews and case studies, this paper documents and develops a typology of AFNs in China, including community supported agriculture, farmers’ markets, buying clubs, and recreational garden plot rentals. We unpacked the (...) four standard dimensions of alternativeness of AFNs into eight elements and used these to examine the alternativeness of AFNs in China. We argue first that the landscape of alternativeness varies among different networks but the healthfulness of food is the most prominent element. Second, there is an inconsistency in values between AFN initiators and customers, which contributes to the uneven alternativeness of Chinese AFNs. Third, Chinese AFNs are strongly consumer driven, a factor that constrains their alternativeness at present. The inclusion of “real” peasants in the construction of AFNs in China is minimal. This paper adds to the existing literature on AFNs with an analysis of recent initiatives in China that have not been well documented before. By unpacking the dimensions of alternativeness into specific elements, this paper also provides an analytical framework for examining the alternativeness of AFNs especially nascent ones that have not developed a full spectrum of alternativeness. (shrink)