Suchergebnisse

It is a sine qua non that research and health care provided in international settings raise profound ethical questions when different cultural and political values are implicated. Yet ironically, as international health research expands and as research on ethical issues in international health research broadens and deepens, we appear to have moved away from discussing the moral foundations of these activities. For international health research to thrive and lead to the kind of benefits it is capable of, it is helpful to occasionally revisit the foundational premises that justify the enterprise as a whole. We draw on the experience of the Indiana University–Moi University Academic Research Ethics Partnership, an innovative bioethics training program co-located in Indianapolis and Eldoret, Kenya to highlight the changing nature of ethical issues in international health research and the ongoing practical challenges.

AbstractIntroductionStreet‐connected young people (SCY) experience structural and social barriers to engaging in the HIV prevention‐care continuum. We sought to elicit recommendations for interventions that may improve SCY's engagement along the HIV prevention‐care continuum from healthcare providers, policymakers, community members and SCY in Kenya.MethodsThis qualitative study was conducted in Uasin Gishu, Trans Nzoia, Bungoma, Nakuru and Kitale counties in Kenya between May 2017 and September 2018 to explore and describe the public perceptions of, and proposed and existing responses to, the phenomenon of SCY. This secondary analysis focuses on a subset of data interviews that investigated SCY's healthcare needs in relation to HIV prevention and care. We conducted 41 in‐depth interviews and seven focus group discussions with 100 participants, of which 43 were SCY. In total, 48 participants were women and 52 men.ResultsOur analysis resulted in four major themes corresponding to stages in the HIV prevention‐care continuum for key populations. We identified the need for an array of strategies to engage SCY in HIV prevention and testing services that are patient‐centred and responsive to the diversity of their circumstances. The use of pre‐exposure prophylaxis was a biomedical prevention strategy that SCY and healthcare providers alike stressed the need to raise awareness around and access to for SCY. Several healthcare providers suggested peer‐based approaches for engaging SCY throughout the continuum. However, SCY heavily debated the appropriateness of using peer‐based methods. Structural interventions, such as the provision of food and housing, were suggested as strategies to improve antiretroviral therapy adherence.ConclusionsThis study identified contextually relevant interventions that should be adapted and piloted for use with SCY. Education and sensitization of SCY and healthcare providers alike were identified as possible strategies, along with affordable housing and anti‐poverty strategies as cash transfers and provision of food. Peer‐based interventions are a clear option but require SCY‐specific adaptation to be implemented effectively.

Most of the street-based children are not educated beyond primary school and their living conditions are based on begging and doing odd jobs in the market and streets. Forty-six percent of the on-the-street children live with one parent, and 97 percent of the of-the-street children have lost contact with their parents. The on-the-street children have a higher percentage of family sector networks than the of-the-street children and the shelter or institutionalized children. Generally, school children still have strong family ties.

Research has uncovered substantial gender, social, and health disparities among children and youth in street situations (CYSS) in Eldoret, Kenya. From 2013-2014 we engaged CYSS aged 11-24 years in a qualitative study to explore the sexual language and practices used in the street subculture in Eldoret, Kenya. We engaged 65 CYSS in 25 in-depth interviews and 5 focus group discussions. This work uncovered stark gender inequities, which result in girls and young women in street situations experiencing profound levels of sexual and gender-based violence and harmful sexual and reproductive health outcomes. To comprehend the underlying drivers of these inequities and to appropriately and adequately intervene, we sought to comprehend how CYSS's social identities intersect with systems of oppression and privilege to produce and maintain these inequities. We therefore sought to reanalyze the original data from this study using intersectionality as a theoretical framework to explore how systems of oppression in Kenya have shaped the street subculture, construct CYSS's street and resistance social identities, and how these social identities and the street subculture intersect with macro-level structural factors to produce health and gender inequities. Our analysis identified three distinct social identities that are given to CYSS in Eldoret: Chokoraa (garbage pickers), Mshefa (hustlers), and Mboga ya jeshi (vegetables for soldiers). Our findings revealed how these identities and the street subculture intersect with the Patriarchy, the political-economic context, and social cultural forces in Kenya, resulting in hegemonic masculinity and detrimental gender roles and norms for young men and women. Our findings show that CYSS are a product of the oppressive systems that construct their circumstances and shape their social identities. This population urgently requires policies and programs that intervene at multiple levels to halt the harmful practices within street subculture and associated with street-involvement.

Involving vulnerable pediatric populations in international research requires culturally appropriate ethical protections. We sought to use mabaraza, traditional East African community assemblies, to understand how a community in western Kenya viewed participation of children in health research and informed consent and assent processes. Results from 108 participants revealed generally positive attitudes towards involving vulnerable children in research, largely because they assumed children would directly benefit. Consent from parents or guardians was understood as necessary for participation while gaining child assent was not. They felt other caregivers, community leaders, and even community assemblies could participate in the consent process. Community members believed research involving orphans and street children could benefit these vulnerable populations, but would require special processes for consent.