15 years of records related to the Haiti couples re- search shows that it has received scant scrutiny from Government officials in Washington. And the Government's rules barely address the moral ambiguities of AIDS research in indigent countries.... Dr. Warren D. Johnson, the chief of interna- tional medicine and infectious diseases at Cornell, called the couples study "a very high priority," though he said it had been temporarily suspended while the university concentrated on other research in Haiti. “This is the critical group in the world- couples-that's where the war is to be fought," he said. At least 97 couples have been enrolled in the blood study since 1991, records show, but Dr. Johnson said only 30 couples are still being followed. The study will be expanded to new couples early next year, he said, and coordinated with AIDS vaccine trials, which are expected to start in Haiti this fall using similar couples as subjects. Cornell's clinic in Haiti offers strong induce- ments to subjects. It is the only center in the country providing free screening and treatment for H.I.V., venereal disease, and tuberculosis, a common com- plication of AIDS. The thousands who flock to it are too poor to buy food, let alone the simple medicines and vitamins that serve as "a powerful incentive for study participation," in the words of one Cornell grant report. The head of the clinic, Dr. Jean William Pape, is a Haiti native and Cornell professor who has studied AIDS in Haiti for two decades. Dr. Pape, who trained at Cornell, defended the treatment of research subjects in the couples study, saying they benefited from the same counseling and free condoms available to everyone who visits the clinic. Dr. Pape said that offering the life-saving drugs to the handful of research subjects would be an unethical lure to participate. Treating all H.I.V.- infected citizens, he said, would cost 10 times Haiti's health budget. If the research on couples succeeds, he said, it could help lead to a vaccine against AIDS. "You have to take into account people who mean well for their country and not impose on them things that you feel are good for Western ideas," he said.... The Haitians were valuable for another reason. Unlike AIDS patients in the United States and Europe, they were not receiving the anti-retroviral drugs that proved effective in halting the disease's progress. The lack of those drugs "may allow identification of novel findings not easily studied in the U.S.A.," Dr. John L. Ho, a Cornell immunologist, wrote in an application for Federal funds. In 1995, the Federal Government awarded Cornell an extra $60,000 to expand this part of the Haitian couples study.... Ethical standards for Federally financed studies require that patients be told why researchers want to study them. But the written consent form ap- proved at Cornell and read aloud in Creole to each potential subject does not mention that the study focuses on couples in which one sexual partner has tested positive for H.I.V. The form tells subjects their blood is being tested because "you live in an area where AIDS may be common." It promises all patients that H.I.V. test results will be kept confidential... After reviewing clinic materials, Marie Saint Cyr, a native of Haiti who now directs an AIDS pro- gram for women in Harlem, said there was a "clear conflict of interest" between the desire to collect in- formation from research subjects and the obligation to effectively warn patients at risk. "If you know somebody is positive and is having sex with a partner who is negative, you have a life and death situation in front of you," she said. "You have to do individualized counseling to really tap into what those people value in life, to confront them with the reality of H.I.V. and AIDS. This in no way addresses those serious things.”* Is the Cornell research ethical? Should subjects in the study get the same AIDS treatment available to people in the United States? Should the researchers provide stronger warnings to subjects about the dan- gers of not using condoms? Is the informed consent process morally acceptable? Explain your answers. *Nina Bernstein, "Strings Attached: For Subjects in Haiti Study, Free AIDS Care Has a Price," New York Times, 6 June 1999, http://www.nytimes.com/pages/health (6 March 2008).