From subjects to relations: Bioethics and the articulation of postcolonial politics in the Cambodia Pre-Exposure Prophylaxis trial

• Published in: Social studies of science Vol. 46; no. 2; pp. 236 - 258
• Main Author: Grant, Jenna M
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.04.2016; Sage Publications Ltd
• Subjects: Acquired immune deficiency syndrome; Activism; AIDS; Bioethics; Biomedical research; Cambodia; Clinical trials; Colonialism; Decolonization; Ethical standards; Ethics; Exposure; History, 21st Century; HIV; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Medical research; Noncitizens; Nongovernmental organizations; Participation; Politics; Postcolonialism; Pre-Exposure Prophylaxis - ethics; Pre-Exposure Prophylaxis - history; Pre-Exposure Prophylaxis - methods; Prevention; Prophylaxis; Public participation; Randomized Controlled Trials as Topic - ethics; Randomized Controlled Trials as Topic - history; Randomized Controlled Trials as Topic - methods; Randomized Controlled Trials as Topic - psychology; Research ethics; Research methodology; Researcher subject relations; Sex workers; Social ethics; Tenofovir; Transportation safety; Vulnerability; Cambodia; postcolonial bioethics; HIV prevention trials; Cambodia; controversy; activism
• ISSN: 0306-3127; 1460-3659
• DOI: 10.1177/0306312716632617

Controversies about global clinical trials, particularly HIV trials, tend to be framed in terms of ethics. In this article, I explore debates about ethics in the Cambodia Pre-Exposure Prophylaxis trial, which was designed to test the safety and efficacy of tenofovir as a prevention for HIV infection. Bringing together studies of public participation in science with studies of bioethics, I show how activists around the Cambodian Pre-Exposure Prophylaxis trial circulated and provoked debates about standards of research ethics, as opposed to research methodology. This postcolonial bioethics was configured through the circulation of and debate about ethics guidelines, and historically and culturally specific relations of vulnerability and responsibility between foreigners and Cambodians and between Cambodian leaders and Cambodian subjects. I argue that this shift in the object of ethical concern, from the experimental human subject to the relation between subjects and researchers, illustrates how a postcolonial field of articulation reformulates classical bioethics.