Next SectionIntensification of poverty and degradation of health infrastructure over recent decades in countries most affected by HIV/AIDS present formidable challenges to clinical research. This paper addresses the overall standard of health care (SOC) that should be provided to research participants in developing countries, rather than the narrow definition of SOC that has characterised the international debate on standards of health care. It argues that contributing to sustainable improvements in health by progressively ratcheting the standard of care upwards for research (...) participants and their communities is an ethical obligation of those in resource-rich countries who sponsor and implement research in poorer ones. (shrink)

The present study of the psychology of animal rights activists utilizes a qualitative analytic method based on two forms of data: a set of questionnaire protocols completed by grassroots activists and of autobiographical accounts by movement leaders. The resultant account keys on the following descriptives: an attitude of caring, suffering as an habitual object of perception, and the aggressive and skillful uncovering and investigation of instances of suffering. In a final section, the investigator discusses tensions and conflicts arising from these (...) three themes and various ways of attempting to resolve them. (shrink)

BackgroundHIV prevention research in resource-limited countries is associated with a variety of ethical dilemmas. Key amongst these is the question of what constitutes an appropriate standard of health care (SoC) for participants in HIV prevention trials. This paper describes a community-focused approach to develop a locally-appropriate SoC in the context of a phase III vaginal microbicide trial in Mwanza City, northwest Tanzania.MethodsA mobile community-based sexual and reproductive health service for women working as informal food vendors or in traditional and modern (...) bars, restaurants, hotels and guesthouses has been established in 10 city wards. Wards were divided into geographical clusters and community representatives elected at cluster and ward level. A city-level Community Advisory Committee (CAC) with representatives from each ward has been established. Workshops and community meetings at ward and city-level have explored project-related concerns using tools adapted from participatory learning and action techniques e.g. chapati diagrams, pair-wise ranking. Secondary stakeholders representing local public-sector and non-governmental health and social care providers have formed a trial Stakeholders' Advisory Group (SAG), which includes two CAC representatives.ResultsKey recommendations from participatory community workshops, CAC and SAG meetings conducted in the first year of the trial relate to the quality and range of clinic services provided at study clinics as well as broader standard of care issues. Recommendations have included streamlining clinic services to reduce waiting times, expanding services to include the children and spouses of participants and providing care for common local conditions such as malaria. Participants, community representatives and stakeholders felt there was an ethical obligation to ensure effective access to antiretroviral drugs and to provide supportive community-based care for women identified as HIV positive during the trial. This obligation includes ensuring sustainable, post-trial access to these services. Post-trial access to an effective vaginal microbicide was also felt to be a moral imperative.ConclusionParticipatory methodologies enabled effective partnerships between researchers, participant representatives and community stakeholders to be developed and facilitated local dialogue and consensus on what constitutes a locally-appropriate standard of care in the context of a vaginal microbicide trial in this setting.Trial registrationCurrent Controlled Trials ISRCTN64716212. (shrink)

The number of women living with HIV/AIDS is increasing worldwide, and there is an urgent public health need to develop new user-initiated HIV prevention methods, including microbicides. Although funding for microbicide development has increased since 2000, financial support is provided predominantly by governmental agencies and private foundations. Many donors, including the US Agency for International Development (USAID) and the US National Institutes of Health (NIH), have policies that restrict how research funds may be used. Among these are the now-rescinded Mexico (...) City Policy, elements of the US Foreign Assistance Act, and restrictions on non-study-related care. The effect of these restrictions on the design and conduct of clinical research is poorly understood. As part of a recent mapping exercise conducted by the Global Campaign for Microbicides, we reviewed the impact of donor restrictions on seven HIV prevention trials. We found considerable confusion within the HIV prevention field as to whether and how Mexico City and other policies affect the use of research funds. We also found that these donor-imposed policies limited the level of care provided to trial participants and the types of capacity building projects undertaken. (shrink)

The number of women living with HIV/AIDS is increasing worldwide, and there is an urgent public health need to develop new user-initiated HIV prevention methods, including microbicides. Although funding for microbicide development has increased since 2000, financial support is provided predominantly by governmental agencies and private foundations. Many donors, including the US Agency for International Development and the US National Institutes of Health, have policies that restrict how research funds may be used. Among these are the now-rescinded Mexico City Policy, (...) elements of the US Foreign Assistance Act, and restrictions on non-study-related care. The effect of these restrictions on the design and conduct of clinical research is poorly understood. As part of a recent mapping exercise conducted by the Global Campaign for Microbicides, we reviewed the impact of donor restrictions on seven HIV prevention trials. We found considerable confusion within the HIV prevention field as to whether and how Mexico City and other policies affect the use of research funds. We also found that these donor-imposed policies limited the level of care provided to trial participants and the types of capacity building projects undertaken. (shrink)

For many tribes of Plains Indians whose bison-hunting culture flourished during the 18th and 19th centuries, the sun dance was the major communal religious ceremony. Generally held in late spring or early summer, the rite celebrates renewal-the spiritual rebirth of participants and their relatives as well as the regeneration of the living earth with all its components. The sun dance reflects relationships with nature that are characteristic of the Plains ethos, and includes symbolic representations of various animal species, particularly the (...) eagle and the buffalo, that once played vital roles in the lives of the people and are still endowed with sacredness and special powers. The ritual, involving sacrifice and supplication to insure harmony between all living beings, continues to be practiced by many contemporary native Americans. (shrink)

This essay takes the performance artworks of Tehching Hsieh as instructive allegories for a global ethics as theorized by a variety of left academics who ground universalism in a singularity that escapes the predicates of identity. Hsieh's projects, I argue, also place universal estrangement in the service of liberation for particular marginalized groups whose lives confound our fantasies of recognition. At the same time, they illustrate some of the challenges facing attempts to treat particular struggles as embodiments of universal conflicts.

In lieu of an abstract, here is a brief excerpt of the content:Politics Is a Mushroom: Worldly Sources of Rule and Exception in Carl Schmitt and Walter BenjaminKam Shapiro (bio)Life is not a mushroom growing out of death.—Carl Schmitt, The Visibility of the ChurchTo isolate death from life, not leaving the one intimately woven in the other, and each one entering into the other’s midst—this is what one must never do.—Jean-Luc Nancy, L’intrus1Carl Schmitt’s theory of the exception was bound up (...) with a thoroughgoing critique of philosophies of immanence, materialism, and “atheism,” which he treated as interchangeable. In his early writings, he adopted the Christian perspective according to which postlapsarian nature cannot by itself yield a juridical order, or in his poetic phrase, “life is not a mushroom growing out of death.” Yet—in accord with Catholic doctrine—he also found sources of life, or law, in this world. While he repudiated theories of collective self-legislation, he embraced a popular sovereign empowered to impose form on a chaotic society. In Political Theology (1922), he compared the form-giving power of the sovereign to an act of divine intervention. Law, he argued, can only function in a lawful or “normal” situation that precedes formalization, and the sovereign “produces and guarantees the situation in its totality” [13]. In The Crisis of Parliamentary Democracy (1923) Schmitt retained his theological terms: “A scientific study of democracy must begin with a particular aspect that I have called political theology” [32]. In the modern age, democratic constituent power (pouvoir constituant) replaces the will of God as the transcendent source of a substantial order, namely democratic homogeneity. Democratic will-formation thereby becomes an act prior to its subject, or as Schmitt wrote, “[...] only political power, which should come from the people’s will, can form the people’s will in the first place” [Crisis 28]. A variety of democratic theorists dwell on the paradoxical character of democratic sovereignty, sometimes tracing it back to Rousseau’s well-known formulations [see esp. Connolly and Honig]. They highlight the gap between a transcendent (ideal or fictive) will in whose name political power acts, and the bounded, material consensus it forms, ostensibly rendering the latter vulnerable to challenge. As I argue, however, a closer look at Rousseau’s discussion of democratic founding in On the Social Contract reveals instead a dynamic relay between dispersed substantial or immanent sources of affiliation, on the one hand, and various agents and techniques of political power that draw on and combine them in a collective will, on the other, or what I call the virtual and the virtuosic.2 After briefly exploring this dynamic in Rousseau’s [End Page 121] On the Social Contract, I will highlight similar dynamics at work in Schmitt’s Weimar writings, examining three instances: the complexio oppositorum (1923), national myth (1923), and the polemical opposition of friend and enemy (1927), focusing especially on the first. Contrary to familiar readings of Schmitt’s metaphysical “exceptionalism,” I argue that for Schmitt, as for Rousseau, political power does not create a normative order from a vacuum, and the apparent transcendence of sovereign authority has a variety of worldly sources.3 Finally, I consider what I call “democratic virtuosity,” or virtuosity from below, focusing on Walter Benjamin’s repudiation of sovereign acts of lawmaking or law preserving in favor of ongoing collective habit-formation. As I argue, Benjamin returns spiritual force to the material world not only to shatter human authorities, but also to democratize creation.Rousseau—Anticipating the PeopleIn the Social Contract, Rousseau formulated the paradox of democratic founding to which so many, including Schmitt, would return. “In order for an emerging people to appreciate the healthy maxims of politics, and follow the fundamental rules of statecraft, the effect would have to become the cause; the social spirit, which should be the result of the institution, would have to preside over the founding of the institution itself; and men would have to be prior to laws what they ought to become by means of laws” [Rousseau 69]. As Rousseau argues, a constitution can form a general will only if it commands the loyalty of the people, that is, if there is... (shrink)