In their criticism, Winter et al.  imply that, for the purpose of our previous study , highly-active antiretroviral therapy (HAART) was withheld, even though it was obtainable in Europe at the time. They stated that it is the duty of researchers to offer the best treatment to their patients; they believe ‘there is only one world’ and this principle should be applied to all research patients in all countries.
Like all researchers in resource limited countries, we battle with this dilemma. Like many, we strive to provide better than the best locally available treatment, but do not of necessity shun research if optimal therapy is unavailable. This proved to be the case at the time of our study in The Gambia and of other longitudinal studies of HIV in Africa . Despite repeated efforts, we could not obtain funds for HAART because research agencies were unwilling, and the Government unable, to commit to the long-term provision of drugs that were very expensive. The situation changed in 2004 when the Gambian Government and Medical Research Council obtained a grant from the Global Fund to provide antiretroviral treatment for HIV infection. At no time was this, or any other proven treatment, denied to our research patients when it was available.
Our stance may be subject to criticism and misinterpretation, but we argue, along with many others, that medical research in poor countries is a necessity and may be envisaged even if the treatment on offer does not meet the best international standards [4,5]. Thus, studies of hepatocellular carcinoma, which is very common in The Gambia, continue despite a lack of resources for the treatment of chronic hepatitis B or C carriers or facilities for liver transplantation. However, our research patients benefit from better care and treatment and all studies are subject to rigorous scientific scrutiny before approval both by local and international ethics committees.
1. Winter C, Auperin I, Allaoui C. There is only one world
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3. Jaffar S, Grant AD, Whitworth J, Smith PG, Whittle H. The natural history of HIV-1 and HIV-2 infections in adults in Africa: a literature review. Bull World Health Organ 2004; 82:462–469.
4. Gambia Government/Medical Research Council Joint Ethical Committee. Ethical issues facing medical research in developing countries. Lancet 1998; 351: 286–287.
5. Lie RK, Emanuel E, Grady C, Wendler D. The standard of care debate: the Declaration of Helsinki versus the international consensus opinion. J Med Ethics 2004; 30:190–193.