Kasoka Kasoka

Only 2% of the world’s Artificial Intelligence (AI) training data originates from Africa, while the continent bears more than 20% of the global disease burden – a historic disparity representing a form of epistemic injustice. Health AI is improving screening, diagnostics, data analysis, telemedicine, surgical support, administrative automation, drug development, and other applications globally. Yet Africa is falling behind due to data scarcity – a disparity mirroring the inequities seen during the COVID-19 pandemic. To rectify this epistemic injustice and alleviate the region’s disproportionate disease burden, I argue that cautiously adopting synthetic data as an immediate, practical short-term solution to bridge the current data gap is not only pragmatic but also an ethical imperative. This should be paired with foundational and consolidated AI governance frameworks reflecting diverse African ontologies, ongoing investment in physical and digital infrastructure, and developing interoperable data systems. Synthetic data is no longer novel; it is already a standard practice in health, medical and life sciences fields. Studies show that synthetic data can closely mimic real-world data to the extent that even domain experts may struggle to distinguish between the two, and some forecasts predict it will overshadow real data in AI models by 2030. Thus, the technology offers a viable, immediately deployable resource that can accelerate equitable healthcare delivery across Africa if adopted with appropriate ethical safeguards. Moreover, its deployment can help ensure that AI development aligns with context-specific lived realities, reflects African ethical frameworks, and respects diverse knowledge systems – provided it is designed with local input.

International bioethical principles place considerable weight on individual rights and autonomy. They require informed consent for both treatment and diagnostic testing. Although individual rights are widely valued, in some non-Western contexts, they receive relatively less weight than other moral values. In particular, the communitarian African philosophy of Ubuntu places a greater emphasis on the collective good of the community than it does on individual rights. In this paper, we explore differences between an Ubuntu-based bioethics and international bioethical principles through the lens of Zambia’s Universal Routine HIV Testing Services Policy. We find that both the written form of the testing policy and its practical implementation violate standard international bioethical principles of informed consent. However, we show that the policy and its implementation are compatible with an Ubuntu-based bioethics. We conclude with a suggestion that Ubuntu-based bioethics also better capture actual clinical practice in Western contexts than standard bioethical principles based on autonomy and individual rights.

In recent times, informed consent has been adopted worldwide as a cornerstone to ensure autonomy during HIV testing. However, there are still ongoing debates on whether the edifice on which informed consent requirements are grounded, that is, personal autonomy, is philosophically, morally, and practically sound, especially in countries where HIV is an epidemic and/or may have a different ontological perspective or lived reality. This study explores the views of participants from Zambia. In-depth and focus group discussions were conducted at various locations in Lusaka and Chongwe, Zambia. Participants came from various demographics, including people living with HIV, healthcare professionals and workers, policymakers, pregnant women, churchgoers, teachers, rural-based persons, and police officers. Data were manually analysed by conducting inductive and deductive thematic analyses. Results show that participants were not in favour of HIV policies that promote personal autonomy at the expense of pursuit of the common good. Participants viewed interdependence, not autonomy, as an essential characteristic of being human. The participants’ views have a realistic potential to provide a contextual and appropriate ethical, respectful, and realistic foundation for HIV testing policies.

The author reviews various conceptions of autonomy to show that humans are actually not autonomous, strictly speaking. He argues for a need to rethink the personal autonomy approaches to HIV testing in sub-Saharan Africa (SSA) countries. HIV/AIDS has remained a leading cause of disease burden in SSA. It is important to bring this disease burden under control, especially given the availability of current effective antiretroviral regimens in low- and middle-income countries. In most SSA countries the ethic or value of personal autonomy or self-determination is promoted as primary in HIV testing decision-making. SSA policymakers have an ontological and moral duty to adopt HIV testing policies that reflect human and medical realities, relationships, local contexts, and respect human rights for both individuals and others who are affected by HIV in society. Without rethinking the value of autonomy in HIV testing decision-making, the article cautions that attainment of the Sustainable Development Goal (SDG) 3 and the UNAIDS fast-track strategy that explicitly call to end the epidemic by 2030 will not be feasible for SSA.