It's not like HIV is the easiest virus to test a vaccine against. A clinical trial against COVID is pretty ethically sound: provided the vaccine is harmless, the novel virus which most people still survive is survivable.
With HIV, if the vaccine is harmless, you're still left with the fact that failure means a bunch of people get an incurable, fatal disease.
HIV vaccine trials are costly and lengthy: you take a statistically at-risk population, vaccinate half, and then tell them to not assume the vaccine works, but a decent number of them are likely to (1) assume it does and (2) engage or be victimized by risky activity which leads to some of them getting HIV.
At the end of that, you then tally up your groups and see if you see a substantial difference in who is now HIV positive.
I can't imagine how much it sucks to be involved in the planning of those experiments. Someone, somewhere, talks to every single one of the people involved knowing full well what might happen.
My post and the GP were about HSV (herpes simplex virus), not HIV. HSV is extremely prevalent, so a simple randomized controlled trial in children should do the trick. (And there isn’t even any substantial ethical issue with participants potentially taking addition risks — kids don’t do anything to avoid HSV in the first place.)
But the specific discussion is about a potential cure. Finding a few hundred HSV patients who don’t take any antivirals when they don’t have any lesions should be very, very easy as trials go — something like half the population is seropositive, many of those have occasional symptoms, and very few of those are taking antivirals to prevent symptoms.
While it's fatal if untreated, life expectancy for people who get HIV and are diagnosed early and put on a treatment regime is now believed to be similar to the general population (though they do tend to develop other health issues earlier), so while it's still problematic to accidentally induce risky behaviours, it's at least nowhere near as bad as it used to be.
> Someone, somewhere, talks to every single one of the people involved knowing full well what might happen.
I've known people who were involved in HIV vaccine studies, both as participants and as investigators. Everybody involved understands that side of the risk assessment ("this might not work, and you might get a placebo") from the very beginning, but the threat of HIV/AIDs is grave enough that people in the at-risk populations are happy to be involved.
It is not a fatal disease anymore though. I would rather have HIV than diabetes, all I have to do is take a pill every day. That’s much better than what diabetics go through.
With HIV, if the vaccine is harmless, you're still left with the fact that failure means a bunch of people get an incurable, fatal disease.
HIV vaccine trials are costly and lengthy: you take a statistically at-risk population, vaccinate half, and then tell them to not assume the vaccine works, but a decent number of them are likely to (1) assume it does and (2) engage or be victimized by risky activity which leads to some of them getting HIV.
At the end of that, you then tally up your groups and see if you see a substantial difference in who is now HIV positive.
I can't imagine how much it sucks to be involved in the planning of those experiments. Someone, somewhere, talks to every single one of the people involved knowing full well what might happen.