Financial compensation and HIV/HCV testing elicited trust and motivated an addicted population to participate in research, according to the authors of a recent report1 examining the ethical issues that can arise when intravenous drug addicts are paid for their research participation.

“As trust in research developed with participants’ continuous involvement, participants came to perceive compensation as part of a reciprocal exchange in which they assisted researchers by providing a trustful account and researchers reciprocated with financial support,” they noted.

Research participants, rather than viewing payment as undue inducement, saw it as a fair exchange for their expertise.

“But if trust in the study is absent, financial compensation can lead participants to reassert themselves by deceiving researchers they feel are not fulfilling their obligations, thus compromising the validity of the study,” the authors warned.

The researchers assessed how people who inject drugs perceive payments for participating in HIV epidemiological studies. While carrying the inherent risk of overdose, injection drug use and shared needles can transmit HIV and HCV transmission. The researchers intervened and interviewed drug users in rural Puerto Rico.

“Findings suggest that financial compensation was the main motivation for initially enrolling in the parent study,” they reported. “Then, as trust in the researchers developed, participants came to perceive compensation as part of a reciprocal exchange in which they assisted researchers by providing a trustful account of their experiences and researchers reciprocated with financial support.”

Citing some concern and criticism of paying vulnerable populations like addicts, the researchers said the study underscores that “marginalized research participants might be vulnerable, but they are not without power.” Addicted participants can lie and undermine studies by researchers they do not trust.

“Participants in our study perceive trust as a process in which reciprocity plays a critical role,” they stated. “Financial compensation is perceived as an aspect of a relationship in which researchers support participants, not only financially but also by providing testing or other things that participants value.”

Once this trust was gained, participants aligned with the goals of the study and credibly shared personal experiences. In one of several quotes in the study, a research participant said, “If you help me, you’re curing me, well, then, I give you the information you need and then we both helped each other.”

REFERENCE

1. Abadie R, Brown B, Fisher CB. “Money Helps:” People who inject drugs and their perceptions of financial compensation and its ethical implications. Ethics & Behavior 2018; DOI: 10.1080/10508422.2018.1535976.