HIV This Week

Singh JA, Abdool Karim SS, et al. Enrolling adolescents in research on HIV and other sensitive issues: Lessons from South Africa. PLoS Med 2006;3:e180. http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030180

In much of sub-Saharan Africa, the HIV epidemic is growing fastest among teenagers. The rapid spread of HIV among adolescents in South Africa has been described as “explosive”. For example in 2005, HIV incidence among South African youth aged 15–24 years was estimated at 3.3%. Hence, any future prevention strategy in this setting will, of necessity, have to target young adolescents prior to sexual debut. Singh and colleagues discuss challenges that face South African researchers in enroling adolescent participants in HIV studies. They believe these challenges are common to most of sub-Saharan Africa, where future HIV prevention research will need to be conducted if we are to fast track efforts to develop novel prevention strategies to reduce the spread of HIV in this important population. The authors conclude that the need to protect adolescents from harm in research needs to be carefully balanced with the need to undertake research in this population to find solutions to the HIV epidemic. To this end, rigid legislation and/or ethical guidelines that pertain to adolescent participation in research and their uncritical application are counterproductive. Those concerned need to be cognizant of this inherent conflict and create an enabling ethical-legal framework to avoid inadvertently doing more harm than good to the intended study population.