AIDS continues to be an epidemic killer in Africa. The antiviral drugs available today can extend the lives of people infected with HIV, but they are not a cure and they all have serious side effects. There is a great need for further research. New drugs and combinations of drugs are being tested around the world, including areas where the people are not familiar with Western traditions of medical research.
The use of placebos presents an ethical challenge even in the United States. If an established treatment is available for whatever disease is being researched, then it is ethically questionable to use placebos. The new treatment should be tested against the established treatment. When we see new drugs advertised in the United States, we tend to assume they're better than the older drugs. This is not necessarily true, since placebo testing is widely used for conditions that are not life-threatening.
When the disease is life-threatening, there are drugs that offer some benefit, and the research subjects have difficulty understanding what placebos are, then most of us would consider placebos unethical. But in some places, people with AIDS have no access to treatment other than joining a clinical trial. If the trial offers everyone a drug that is expected to benefit them, then the purpose of the trial becomes treatment rather than research for patients who have no other choice. Informed consent is supposed to be based on agreement with the research goals of the trial.
Informed consent is considered essential to ethical research in Western culture. In parts of Africa where large numbers of people are infected with HIV, it may be difficult to for researchers to provide adequate information. Some languages do not even have words for “research” or “science”, as distinct from medicine.
Signing a consent form is standard in Western culture. In some other cultures, signing papers is a tradition reserved for major events such as marriage. Another ethical challenge is illiteracy. When a test subject signs a form that he or she cannot read, it is difficult to know how much informed consent is being honored.