Nashville, TN
June 23-24, 2003

Sponsored by:
National Institute on Drug Abuse

Meeting Summary

The Center on AIDS and Other Medical Consequences of Drug Abuse (CAMCODA) and Meharry Medical College co-sponsored and presented a meeting entitled: “Issues, Ethics, and You: A Community Discussion of HIV/AIDS and Substance Abuse, Research and Treatment”, Nashville, June 23-24, 2003. The objectives of the meeting were to discuss issues surrounding bioethics in HIV/AIDS among drug addicts with emphasis on minorities and underserved populations. Health care providers, scientists, clinicians, and field workers discussed a number of practical problems faced by the field workers. A field trip was organized by Meharry for bench scientists and other health scientists to see how community field workers [some were volunteers] in real world settings provide intervention/prevention messages to HIV-infected drug abusing poor people on the streets of Nashville. See below for a more detailed summary of the meeting.

Meharry Medical College Staff:
Linda D. Sander, Ph.D., Thomas Mether, Ph.D., Carolyn Szetela, Ph.D. and Susan DeRiemer, Ph.D.

Center on AIDS and Other Medical Consequences of Drug Abuse (CAMCODA), National Institute on Drug Abuse (NIDA)/NIH/DHHS Staff:
Henry Francis, M.D., Jag H. Khalsa, Ph.D., Thomas Kresina, Ph.D.

Hosted by:
The Program in Clinical and Research Ethics at Meharry Medical College
Academy for Educational Development, Alcohol and Drug Council of Middle Tennessee, First Response Wellness Center, IMANI Coalition, Metropolitan Health Department, Nashville CARES, National Minority AIDS Education and Training Center, Project COPE, Street Works, Vanderbilt University Medical Center HIV Vaccine Trials Unit, W.O.M.E.N.

The hosts (Meharry) and sponsor (CAMCODA/NIDA) developed and presented a highly interactive two-day colloquium addressing current ethical challenges and controversies in developing and maintaining government, academic, clinical, and community-based organization partnerships for addressing HIV/AIDS and substance abuse treatment and research. Minority community representatives, researchers, and government representatives, speakers and audience members confronted some of the ethical questions and regulatory issues that arise in the contemporary conduct of clinical research and treatment of HIV/AIDS and substance abuse.

The objectives of the conference were: 1) identify ethical challenges in developing and maintaining partnerships among government, academic, clinical and community-based organizations working on various aspects of HIV/AIDS and substance abuse; 2) identify ethical complexities facing a collaborative effort to address the issues of HIV/AIDS and substance abuse research and treatment; and 3) recognize regulatory and practical issues in the inclusion of minorities and underserved populations in HIV/AIDS and substance abuse research.

The approximately 150 participants included clinical researchers and members of clinical research teams, patient and human subjects advocates and community advisory board (CAB) members, clinicians not involved in research, mental health professionals, HIV/AIDS counselors, alcohol and drug abuse counselors, bioethicists, medical and graduate students, government officials (state and federal, public health and NIH), and staff and volunteers associated with community- and faith-based health service organizations.

The program included didactic presentations on rapid HIV testing kits, HIV vaccine trials, use of buprenorphine in a primary care setting and techniques for developing and maintaining working partnerships among seemingly unequal groups, i.e. community based organizations (CBOs), academic organizations and government funding bodies. These presentations formed the bases for interactive audience and panel discussions of case studies highlighting ethical issues related to rapid HIV testing in community settings and recruitment of minority participants for HIV vaccine trials and addiction studies. A roundtable discussion led by representatives of CAMCODA emphasized opportunities for research collaborations between community groups and NIDA. Additionally, participants were given the opportunity to accompany HIV outreach workers to provide a chance to compare real world conditions with those discussed in the conference sessions.

Invited speakers and conference participants highlighted the importance of:

• Establishing relationships of trust between a community and academic research center before a community is approached for research participation;
  
• Engaging the community of interest in all facets of research from protocol development to analyses of outcome rather than limiting their involvement to client recruitment, thus insuring informed consent by the community in addition to the individual;
  
• Recognizing, rather than underestimating or minimizing, the distance from and, in some instances, hostility to medical research activities common in many minority communities;
  
• Recognizing and developing means to deal with the conflicts within communities over ethical and stigma issues surrounding HIV/AIDS and substance abuse;
  
• Recognizing the differences between the priorities of client-centered CBOs and the priorities of public health (whether Public Health Departments and/or CDC) on the relative importance of counseling in relation to some proposed rapid test protocols;
  
• Acknowledging the significance of research findings on the ability of CBOs to serve their client populations successfully;
  
• Developing and maintaining community, academic research centers, and government partnerships;
  
• Recognizing when and how different groups may end up speaking at cross-purposes when trying to enter into dialogue with each other.
  
• Understanding that the most important ethical component is not principles and case studies to guide decision-making and conduct of individuals in their separate walks of life but in the very creation and sustaining of community, researcher, and government partnerships and bonds of trust.