Is HIV Vaccine Research a site of progress, or power?
I sat down with Jarissa Greenard of Vanderbilt University’s HIV Vaccine Program to discuss the implications of cultural humility and communication in the research and development contexts. We discussed how the values of diversity, equity, and inclusion are entangled with the success of clinical trial outcomes; and how anthropological theory can be a framework for building equitable research designs.
Check out the conversation here: https://lnkd.in/egz4uFfU
What what unsaid, was the mountain of thoughts and feelings I have about research on human subjects, the role of power and Capital, the critical question of "access" to knowledge created from the study, and the systems of meaning (science and society) that reduce people to data points, without regard for the subjective experiences of participants.
The link above is my public opinion, but read on for the rest of what I think.
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Here is a Deeper Dive into How HIV Vaccine Clinical Trials are a Site of Power, Not Just Progress….
Although I support the aims of HIV vaccine research and the public health urgency behind this work, it would be intellectually dishonest, and ethically insufficient, for me not to share the whole of my thinking; especially when it comes to the role of diversity initiatives and community engagement in clinical trials. We must remain critically alert to the passive revolutions in science that use co-opt the language of justice (e.g., “cultural humility,” “health equity”) while maintaining centralized control over what counts as valid or ethical science.
In the context of HIV vaccine clinical trials, inclusion is not synonymous with justice. The diversification of study populations does not automatically equate to the redistribution of power, nor does it challenge the ownership and production of biomedical knowledge. Rather, it often extends the reach of institutional control while leaving the underlying logics of pharmaceutical capitalism intact
These trials, while framed as scientific progress, are also technologies of governance. They produce data that shape public health policy, drug approval, and global funding priorities. But they also exercise disciplinary power over the bodies they study. Participants are often enrolled not simply as volunteers, but as subjects inscribed with norms of risk, efficiency, and utility—rendered as data points rather than complex, social beings. Their participation frequently reflects structural inequalities—lack of access to care, hope for treatment—an abstract notion of “informed consent.”
The medical gaze is alive in this process overseeing the research and development context as the locus of surveillance.
Clinical trials isolate participants from their social, cultural, and historical contexts. They transform people into variables to be measured, abstracted from their lived realities. Inclusion, in this sense, becomes not emancipatory but extractive—serving institutional interests rather than community autonomy.
So I must ask: Who defines health? Who determines evidence? Whose ethics shape the process?
The structure of the clinical trial itself—its inclusion/exclusion criteria, protocols of randomization, and definitions of success—reflects a system of discursive power that normalizes some bodies and behaviors while marginalizing others. This is not neutral.
There is no “view from nowhere” in science. What we call objectivity is often just the perspective of the dominant made invisible.
From a cultural humility standpoint, this calls for more than demographic representation. It demands epistemic transformation. True humility requires researchers—and the institutions that fund and approve clinical trials—to critically examine the assumptions that govern their work. It insists that we not only include marginalized populations, but center their knowledge, leadership, and critiques in the very design and governance of research.
Without that transformation, diversity becomes a liberal alibi for structural exploitation. Investigative instruments and data collection tools that fail to account for the heterogeneity and subjectivity of participants do more than overlook nuance—they perpetuate epistemic violence, sustaining the illusion that science is neutral while it reproduces hierarchy.
Drawing from poststructuralist, anthropological, and Marxist theory, we must understand that scientific inquiry is never conducted in a vacuum. It is shaped by the cultural, economic, and ideological forces in which it is embedded. Clinical trials are embedded in a global capitalist system that commodifies health, instrumentalizes bodies, and privileges particular ways of knowing while rendering others illegible. Race, gender, class, ability, and geopolitical location all shape how participants are recruited, treated, and written into the narrative of science.
Bias in this context is not a minor methodological flaw—it is a structural feature of an unequal epistemic system. “Diversity, equity, and inclusion” may be the language of progress, but unless we ask who benefits from the knowledge being produced, who is erased in the process, and whose suffering is rendered legible only when it aligns with pharmaceutical profitability, we are reproducing harm.
Scientific objectivity must be reframed—not as detachment, but as rigorous reflexivity. Cultural humility, then, becomes a critical counter-practice—one that resists the dehumanization of research participants and seeks instead to co-construct knowledge through relationships of accountability, mutual respect, and shared power.
To do HIV research in a truly transformative way is not simply to develop vaccines—it is to ask what kind of world we are building through our science. If we are not working toward justice, we are only refining the technologies of control.
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