Chemical weapons: safe until 2004?

Policy Forum C ivil society organizations (CSOs) are nonprofi t organizations that aim to further the interests of the communities they serve. Driven to protect and empower the vulnerable, CSOs work in areas such as community development, service provision, advocacy, activism, and research. Sanders and colleagues argue that CSOs are at the forefront of supporting innovations aimed at tackling today's global public health challenges and that working with them plays a crucial role in making research relevant to communities [1]. While several publications have addressed the role of CSOs in social science research in health [2–4], their role in biomedical research has not been widely discussed. The recent termination of tenofovir-based HIV prevention trials in Cambodia, Cameroon, and Nigeria, primarily as a result of pressure from CSOs, underscores the signifi cant impact CSOs can have on biomedical research [5]. In Cambodia, in particular, intense pressure from CSOs infl uenced the Prime Minister's decision to suspend a trial of tenofovir (an antiretroviral medication used to treat HIV) among commercial sex workers [5]. Similar outcomes have occurred in other countries hosting tenofovir prevention studies, and have complicated potentially promising research on this drug [6,7]. The termination of these trials has reinforced the importance of engaging with communities and CSOs, and being sensitive to their respective needs and perceptions. In October 2005 the Bill & Melinda Gates Foundation announced an approximately US$450 million sponsorship of 44 innovative projects under the auspices of its Grand Challenges in Global Health (GCGH) initiative. As described in the opening article in this series, we serve as an advisory service on ethical, social, and cultural (ESC) issues for these projects [8]. We are exploring a range of ESC issues identifi ed by the GCGH investigators and independently by developing world key informants in a study published as the second paper in this series [9]. The investigators and key informants placed particular emphasis on the importance of engaging with CSOs in research, and therefore we prepared a conceptual paper on this topic, which we distributed as a working paper to GCGH investigators and program staff at the 2nd Annual GCGH Meeting held in Washington, D. C. in October 2006. This work represents the fi nal version of our analysis. Our article aims to delineate different types of CSOs, their role in biomedical research, and the advantages and challenges of working with them. We stress that despite the challenges, it …