•  5
    Stakeholders’ experiences of ethical challenges in cluster randomized trials in a limited resource setting: a qualitative analysis
    with Tiwonge K. Mtande, Carl Lombard, and Gonasagrie Nair
    Research Ethics 20 (1): 64-78. 2024.
    Although the use of the cluster randomized trial (CRT) design to evaluate vaccines, public health interventions or health systems is increasing, the ethical issues posed by the design are not adequately addressed, especially in low- and middle-income country settings (LMICs). To help reveal ethical challenges, qualitative interviews were conducted with key stakeholders experienced in designing and conducting two selected CRTs in Malawi. The 18 interviewed stakeholders included investigators, cli…Read more
  •  24
    Male circumcision and HIV prevention: ethical, medical and public health tradeoffs in low-income countries
    with A. S. Muula and D. Westreich
    Journal of Medical Ethics 33 (6): 357-361. 2007.
    Ethical challenges surrounding the implementation of male circumcision as an HIV prevention strategyResearchers have been exploring the possibility of a correlation between male circumcision and lowered risk of HIV infection almost since the beginning of the HIV/AIDS epidemic.1 Results from a randomised controlled trial in South Africa in 2005 indicate that male circumcision protects men against the acquisition of HIV through heterosexual intercourse,2 confirming the findings from 20 years of ob…Read more
  •  24
    Objectives: This study aimed to determine attitudinal and self reported behavioural variations between medical students in different years to scenarios involving academic misconduct.Design: A cross-sectional study where students were given an anonymous questionnaire that asked about their attitudes to 14 scenarios describing a fictitious student engaging in acts of academic misconduct and asked them to report their own potential behaviour.Setting: Dundee Medical School.Participants: Undergraduat…Read more
  •  13
    Strengthening Howick's Argument Against The Alleged Superiority of Placebo-Controlled Trials
    with Til Stürmer
    American Journal of Bioethics 9 (9): 62-64. 2009.
    No abstract
  •  35
    Healing Without Waging War: Beyond Military Metaphors in Medicine and HIV Cure Research
    with Jing-Bao Nie, Adam Gilbertson, Malcolm de Roubaix, Ciara Staunton, Anton van Niekerk, and Joseph D. Tucker
    American Journal of Bioethics 16 (10): 3-11. 2016.
    Military metaphors are pervasive in biomedicine, including HIV research. Rooted in the mind set that regards pathogens as enemies to be defeated, terms such as “shock and kill” have become widely accepted idioms within HIV cure research. Such language and symbolism must be critically examined as they may be especially problematic when used to express scientific ideas within emerging health-related fields. In this article, philosophical analysis and an interdisciplinary literature review utilizin…Read more
  •  20
    BackgroundThe COVID-19 pandemic presents significant challenges to research ethics committees (RECs) in balancing urgency of review of COVID-19 research with careful consideration of risks and benefits. In the African context, RECs are further challenged by historical mistrust of research and potential impacts on COVID-19 related research participation, as well as the need to facilitate equitable access to effective treatments or vaccines for COVID-19. In South Africa, an absent National Health …Read more
  •  9
    Stakeholder views on informed consent models for future use of biological samples in Malawi and South Africa
    with Walter Jaoko and Francis Masiye
    BMC Medical Ethics 24 (1): 1-10. 2023.
    BackgroundCurrent advances in biomedical research have introduced new ethical challenges in obtaining informed consent in low and middle-income settings. For example, there are controversies about the use of broad consent in the collection of biological samples for use in future biomedical research. However, few studies have explored preferred informed consent models for future use of biological samples in Malawi and South Africa. Therefore, we conducted an empirical study to understand preferre…Read more
  •  20
    Advancing a Data Justice Framework for Public Health Surveillance
    with Mara Buchbinder, Eric Juengst, Colleen Blue, and David L. Rosen
    AJOB Empirical Bioethics 13 (3): 205-213. 2022.
    Background Bioethical debates about privacy, big data, and public health surveillance have not sufficiently engaged the perspectives of those being surveilled. The data justice framework suggests that big data applications have the potential to create disproportionate harm for socially marginalized groups. Using examples from our research on HIV surveillance for individuals incarcerated in jails, we analyze ethical issues in deploying big data in public health surveillance. Methods We conducted …Read more
  •  2
    Ethical considerations for HIV remission clinical research involving participants diagnosed during acute HIV infection
    with Maartje Dijkstra, Karine Dubé, Joseph D. Tucker, and Adam Gilbertson
    BMC Medical Ethics 22 (1): 1-12. 2021.
    HIV remission clinical researchers are increasingly seeking study participants who are diagnosed and treated during acute HIV infection—the brief period between infection and the point when the body creates detectable HIV antibodies. This earliest stage of infection is often marked by flu-like illness and may be an especially tumultuous period of confusion, guilt, anger, and uncertainty. Such experiences may present added ethical challenges for HIV research recruitment, participation, and retent…Read more
  •  5
    The Ethics of Stigma in Medical Male Circumcision Initiatives Involving Adolescents in Sub-Saharan Africa
    with Adam Gilbertson, Denise Hallfors, and Winnie K. Luseno
    Public Health Ethics 14 (1): 79-89. 2021.
    Ongoing global efforts to circumcise adolescent and adult males to reduce their risk of acquiring HIV constitute the largest public health prevention initiative, using surgical means, in human history. Voluntary medical male circumcision (VMMC) programs in Africa have significantly altered social norms related to male circumcision among previously non-circumcising groups and groups that have practiced traditional (non-medical) circumcision. One consequence of this change is the stigmatization of…Read more
  •  15
    HIV prevention research and COVID-19: putting ethics guidance to the test
    with Jeremy Sugarman, Steven Wakefield, Brandon Brown, Ernest Moseki, Robert Klitzman, Florencia Luna, Leah A. Schrumpf, and Wairimu Chege
    BMC Medical Ethics 22 (1): 1-10. 2021.
    BackgroundCritical public health measures implemented to mitigate the spread of the novel coronavirus disease (COVID-19) pandemic have disrupted health research worldwide, including HIV prevention research. While general guidance has been issued for the responsible conduct of research in these challenging circumstances, the contours of the dueling COVID-19 and HIV/aids pandemics raise some critical ethical issues for HIV prevention research. In this paper, we use the recently updated HIV Prevent…Read more
  •  1
    Corrigendum: Scraping the Web for Public Health Gains: Ethical Considerations from a ‘Big Data’ Research Project on HIV and Incarceration
    with Mara Buchbinder, Eric Juengst, Lauren Brinkley-Rubinstein, and Colleen Blue and David L. Rosen
    Public Health Ethics 13 (3): 314-314. 2020.
  •  5
    Ethics of pursuing targets in public health: the case of voluntary medical male circumcision for HIV-prevention programs in Kenya
    with Adam Gilbertson, Denise Hallfors, and Winnie K. Luseno
    Journal of Medical Ethics 47 (12). 2021.
    The use of targets to direct public health programmes, particularly in global initiatives, has become widely accepted and commonplace. This paper is an ethical analysis of the utilisation of targets in global public health using our fieldwork on and experiences with voluntary medical male circumcision initiatives in Kenya. Among the many countries involved in VMMC for HIV prevention, Kenya is considered a success story, its programmes having medically circumcised nearly 2 million men since 2007.…Read more
  •  9
    HIV Molecular Epidemiology: Tool of Oppression or Empowerment?
    with Kristen Sullivan and Ann Dennis
    American Journal of Bioethics 20 (10): 44-47. 2020.
    Volume 20, Issue 10, October 2020, Page 44-47.
  •  21
    Allocation of scarce resources in Africa during COVID‐19: Utility and justice for the bottom of the pyramid?
    with Keymanthri Moodley, Frieda Behets, Adetayo Emmanuel Obasa, Robert Yemesi, Laurent Ravez, Patrick Kayembe, Darius Makindu, Alwyn Mwinga, and Walter Jaoko
    Developing World Bioethics 21 (1): 36-43. 2020.
    The COVID‐19 pandemic has raised important universal public health challenges. Conceiving ethical responses to these challenges is a public health imperative but must take context into account. This is particularly important in sub‐Saharan Africa (SSA). In this paper, we examine how some of the ethical recommendations offered so far in high‐income countries might appear from a SSA perspective. We also reflect on some of the key ethical challenges raised by the COVID‐19 pandemic in low‐income cou…Read more
  •  12
    What Could “Fair Allocation” during the Covid‐19 Crisis Possibly Mean in Sub‐Saharan Africa?
    with Keymanthri Moodley, Laurent Ravez, Adetayo Emmanuel Obasa, Alwyn Mwinga, Walter Jaoko, Darius Makindu, and Frieda Behets
    Hastings Center Report 50 (3): 33-35. 2020.
    The Covid‐19 pandemic has sparked rapid and voluminous production of bioethics commentary in popular media and academic publications. Many of the discussions are new twists on an old theme: how to fairly allocate scarce medical resources, such as ventilators and intensive care unit beds. In this essay, we do not add another allocation scheme to the growing pile, partly out of appreciation that such schemes should be products of inclusive and transparent community engagement and partly out of rec…Read more
  •  6
    Corrigendum: Scraping the Web for Public Health Gains: Ethical Considerations from a ‘Big Data’ Research Project on HIV and Incarceration
    with Mara Buchbinder, Eric Juengst, Lauren Brinkley-Rubinstein, and Colleen Blue and David L. Rosen
    Public Health Ethics 13 (3): 314-314. 2020.
  •  10
    Scraping the Web for Public Health Gains: Ethical Considerations from a ‘Big Data’ Research Project on HIV and Incarceration
    with Mara Buchbinder, Eric Juengst, Lauren Brinkley-Rubinstein, Colleen Blue, and David L. Rosen
    Public Health Ethics 13 (1): 111-121. 2020.
    Web scraping involves using computer programs for automated extraction and organization of data from the Web for the purpose of further data analysis and use. It is frequently used by commercial companies, but also has become a valuable tool in epidemiological research and public health planning. In this paper, we explore ethical issues in a project that “scrapes” public websites of U.S. county jails as part of an effort to develop a comprehensive database to enhance HIV surveillance and improve…Read more
  •  6
    Enhancing ethics review of social and behavioral research: developing a review template in Ethiopia
    with Liya Wassie, Senkenesh Gebre-Mariam, and Geremew Tarekegne
    Research Ethics 15 (3-4): 1-23. 2019.
    Background:Africa is increasingly becoming an important region for health research, mainly due to its heavy burden of disease, socioeconomic challenges, and inadequate health facilities. Regulatory...
  •  16
    Delineating the role of penile transplantation when traditional male circumcisions go wrong in South Africa
    with Keymanthri Moodley
    Journal of Medical Ethics 47 (3): 192-193. 2021.
    Back in 2017, Moodley and Rennie published a paper in the Journal of Medical Ethics entitled ‘Penile transplantation as an appropriate response to botched traditional circumcisions in South Africa: an argument against.’1 As the title suggests, we took a critical view towards penile transplantation as a way of responding to the problem of young men in South Africa experiencing genital mutilation and amputation as a result of traditional circumcision practices. Our main conclusion was that prevent…Read more
  •  4
    Engaging with research ethics in central Francophone Africa: reflections on a workshop about ancillary care
    with Tshikala Tomi, Mupenda Bavon, Dimany Pierre, Malonga Aime, and Ilunga Vicky
    Philosophy, Ethics, and Humanities in Medicine 7 (1): 10. 2012.
    Research ethics is predominantly taught and practiced in Anglophone countries, particularly those in North America and Western Europe. Initiatives to build research ethics capacity in developing countries must attempt to avoid imposing foreign frameworks and engage with ethical issues in research that are locally relevant. This article describes the process and outcomes of a capacity-building workshop that took place in Kinshasa, Democratic Republic of Congo in the summer of 2011. Although the w…Read more
  •  2
    Appropriateness of no-fault compensation for research-related injuries from an African perspective: an appeal for action by African countries: Table 1
    with Patrick Dongosolo Kamalo and Lucinda Manda-Taylor
    Journal of Medical Ethics 42 (8): 528-533. 2016.
    Compensation for research-related injuries (RRIs) remains a challenge in the current environment of global collaborative biomedical research as exemplified by the continued reluctance of the US government, a major player in international biomedical research, to enact regulation for mandatory compensation for RRIs. This stance is in stark contrast to the mandatory compensation policies adopted by other democracies like the European Union (EU) countries. These positions taken by the USA and the EU…Read more
  •  46
    Engaging with research ethics in central Francophone Africa: reflections on a workshop about ancillary care
    with Tomi Tshikala, Bavon Mupenda, Pierre Dimany, Aime Malonga, and Vicki Ilunga
    Philosophy, Ethics, and Humanities in Medicine 7 10. 2012.
    Research ethics is predominantly taught and practiced in Anglophone countries, particularly those in North America and Western Europe. Initiatives to build research ethics capacity in developing countries must attempt to avoid imposing foreign frameworks and engage with ethical issues in research that are locally relevant. This article describes the process and outcomes of a capacity-building workshop that took place in Kinshasa, Democratic Republic of Congo in the summer of 2011. Although the w…Read more
  •  18
    The Paywall as Metaphor and Symptom
    with Keymanthri Moodley
    American Journal of Bioethics 17 (10): 17-18. 2017.
  •  9
    Traditional male circumcision is a deeply entrenched cultural practice in South Africa. In recent times, there have been increasing numbers of botched circumcisions by untrained and unscrupulous practitioners, leading to genital mutilation and often, the need for penile amputation. Hailed as a world’s first, a team of surgeons conducted the first successful penile transplant in Cape Town, South Africa in 2015. Despite the euphoria of this surgical victory, concerns about the use of this costly i…Read more
  •  25
    Is It Ethical to Study What Ought Not to Happen? 1
    Developing World Bioethics 6 (2): 71-77. 2006.
    In the Democratic Republic of Congo, only an estimated 2% of all AIDS patients have access to treatment. As AIDS treatment access is scaled‐up in the coming years, difficult rationing decisions will have to be made concerning who will come to gain access to this scarce medical resource. This article focuses on the position, expressed by representatives of Médecins sans Frontières (MSF), that the practice of AIDS treatment access rationing is fundamentally unethical because it conflicts with the …Read more
  •  39
    Ethics of treatment interruption trials in HIV cure research: addressing the conundrum of risk/benefit assessment
    with Gail E. Henderson, Holly L. Peay, Eugene Kroon, Rosemary Jean Cadigan, Karen Meagher, Thidarat Jupimai, Adam Gilbertson, Jill Fisher, Nuchanart Q. Ormsby, Nitiya Chomchey, Nittaya Phanuphak, and Jintanat Ananworanich
    Journal of Medical Ethics. 2017.
    Though antiretroviral therapy is the standard of care for people living with HIV, its treatment limitations, burdens, stigma and costs lead to continued interest in HIV cure research. Early-phase cure trials, particularly those that include analytic treatment interruption, involve uncertain and potentially high risk, with minimal chance of clinical benefit. Some question whether such trials should be offered, given the risk/benefit imbalance, and whether those who choose to participate are actin…Read more
  •  30
    Ethics of mandatory premarital hiv testing in Africa: The case of goma, democratic republic of congo
    with Bavon Mupenda
    Developing World Bioethics 8 (2): 126-137. 2007.
    Despite decades of prevention efforts, millions of persons worldwide continue to become infected by the human immunodeficiency virus (HIV) every year. This urgent problem of global epidemic control has recently lead to significant changes in HIV testing policies. Provider-initiated approaches to HIV testing have been embraced by the Centers for Disease Control and Prevention and the World Health Organization, such as those that routinely inform persons that they will be tested for HIV unless the…Read more
  •  25
    White (Coat) Lies: Bending the Truth to Stay Faithful to Patients
    with Christopher Bennett and Alex Finch
    American Journal of Bioethics 16 (9): 15-17. 2016.
  •  10
    The FDA and Helsinki
    Hastings Center Report 39 (3): 3-3. 2009.