Douglas Wassenaar

Homicide-Suicide in Durban, South Africa

This study investigated homicide-suicide in Durban, South Africa, for the years 2000 to 2001. The incidence was 0.89 per 100,000, higher than the international average. A majority of perpetrators (91%) and victims (87%) were Black African, proportional to their representation in the population. Perpetrators were typically men (in 95% of cases), older than, and intimate partners (in 75% of cases) of the female victims (in 100% of cases). Average ages of perpetrators and victims were 32 and 27, respectively. The security sector was overrepresented as an employment category for perpetrators. A firearm was used in 87% of the homicides and 80% of the suicides. The individuals involved in homicide-suicides in Durban are similar to homicide-suicide perpetrators and victims in industrialized countries. The fact that homicide-suicides in South Africa, as in most countries, involve almost exclusively men killing female intimates confirms the importance of examining and challenging social norms enabling male violence against women.

MAPPING AFRICAN ETHICAL REVIEW COMMITTEE ACTIVITY ONTO CAPACITY NEEDS: THE MARC INITIATIVE AND HRWEB'S INTERACTIVE DATABASE OF RECS IN AFRICA

Health research initiatives worldwide are growing in scope and complexity, particularly as they move into the developing world. Expanding health research activity in low- and middle-income countries has resulted in a commensurate rise in the need for sound ethical review structures and functions in the form of Research Ethics Committees (RECs). Yet these seem to be lagging behind as a result of the enormous challenges facing these countries, including poor resource availability and lack of capacity. There is thus an urgent need for ongoing capacity and resource development in these regions in general, and in Africa in particular. Similarly, there is a need for research and initiatives that can identify existing capacity and funding and indicate the areas where this needs to be developed. This discussion paper argues that the Mapping African Research Ethics Capacity (MARC) project is a timely initiative aimed at identifying existing capacity. MARC provides a platform and tool on the Council on Health Research for Developments (COHRED) Health Research website (HRWeb), which can be used by RECs and key stakeholders in health research in Africa to identify capacity, constraints and development needs. MARC intends to provide the first comprehensive interactive database of RECs in Africa, which will allow for the identification of key relationships and analyses of capacity. The potential of MARC lies in the mapping of current ethical review activity onto capacity needs. This paper serves as a starting point by providing a descriptive illustration of the current state of RECs in Africa.

Family Dynamics, Hopelessness and Psychiatric Disturbance in Parasuicidal Adolescents

Objective: Adolescent parasuicide has often been associated with family disturbance, hopelessness and psychiatric disturbance, but little empirical work has been done to verify these clinical impressions. Method: The present study compares matched groups of hospitalised parasuicidal adolescents, non-psychiatric medically hospitalised adolescents and a control group on measures of family disturbance, hopelessness and psychopathology. Results: The findings reveal significantly higher levels of family disturbance, hopelessness and depressive symptoms in the parasuicidal group. Conclusions: The results suggest that prevention and treatment of adolescent parasuicide should focus on both individual and family dynamics.

Acculturation and eating disorder symptomatology in Black men and women

Objective: We assessed the prevalence of eating disorder symptoms in Black South African men and also explored their possible links with acculturation. Method: The Eating Disorders Inventory (EDI) and the South African Acculturation Scale (SAAS) were administered to a sample of undergraduate students consisting of 50 Black women, 50 Black men and 50 White men. Results: The Black men had significantly higher scores than the White men on the psychological subscales of the EDI, and higher than cut-off scores on perfectionism, interpersonal distrust and maturity fears subscales. There were marginal racial differences in the average acculturation scores, whereas gender appeared to have a variable effect on acculturation attitudes. Specific acculturation strategies were found to be differentially associated with the EDI subscales. The association between acculturation and eating disorder symptoms in Black men was significantly higher than that in White men. Discussion: Our results indicate that there is a higher prevalence of eating disorder pathology in Black men than in White men. This lends support to the possible association between acculturation and eating disorders, and challenges the assumption that non-Western individuals — and Black men in particular — are protected from body image disturbances and disordered eating patterns.

Researching Family Therapy

The field of family therapy has enjoyed a rapid increase in popularity over the last decade, particularly amongst practically orientated clinical psychologists who are possibly more concerned with pragmatic though poorly defined outcomes than with rigorous and systematically defined outcome criteria. The present article stresses the importance of rigorous evaluation in family therapy process research and explores some of the limitations of applying conventional quantitative methods and criteria to such research. A review of research projects suggests that there is an impasse in the development of research which is simultaneously of use to the systems-orientated practitioner and satisfies criteria of methodological and theoretical rigor. Clinicians and researchers in the field are urged to promote the development of innovative research approaches in an attempt to resolve the impasse.

Improving understanding of clinical trial procedures among low literacy populations: an intervention within a microbicide trial in Malawi.

BackgroundThe intervention reported in this paper was a follow up to an empirical study conducted in Malawi with the aim of assessing trial participants’ understanding of randomisation, double-blinding and placebo use. In the empirical study, the majority of respondents (61.1%; n= 124) obtained low scores (lower than 75%) on understanding of all three concepts under study. Based on these findings, an intervention based on a narrative which included all three concepts and their personal implications was designed. The narrative used daily examples from the field of Agriculture because Malawi has an agro-based economy.MethodsThe intervention was tested using a sample of 36 women who had been identified as low scorers during the empirical study. The 36 low scorers were randomly assigned to control (n=18) and intervention arms (n=18). The control arm went through a session in which they were provided with standard informed consent information for the microbicide trial. The intervention arm went through a session in which they were provided with a narrative in ChiChewa, the local language, with the assistance of a power point presentation which included pictures as well as discussions on justification and personal implications of the concepts under study.ResultsThe findings on the efficacy of the intervention suggest that the 3 scientific concepts and their personal implications can be understood by low literacy populations using simple language and everyday local examples. The findings also suggest that the intervention positively impacted on understanding of trial procedures under study, as 13 of the 18 women in the intervention arm, obtained high scores (above 75%) during the post intervention assessment and none of the 18 in the control arm obtained a high score. Using Fischer’s exact test, it was confirmed that the effect of the intervention on understanding of the three procedures was statistically significant (p=0.0001).ConclusionsPotential trial participants can be assisted to understand key clinical trial procedures, their justification and personal implications by using innovative tailored local narratives.

Ethical Dilemmas of South African Clinical Psychologists

This study asked a sample of 487 South African clinical psychologists to describe situations that they identified as ethically troubling. Forty-nine psychologists described 51 incidents that were categorized according to Pope and Vetters (1992) system. Psychologists most often described dilemmas involving confidentiality, followed by dual relationship dilemmas. These ethical concerns are presented and discussed in the light of current South African ethical codes and relevant professional literature. The results are compared with six similar international studies. Results suggest that the concerns voiced by South African psychologists resemble those raised by their international colleagues. Similarities with findings from the United States and Finland may be the most marked. These results are discussed in the light of current professional trends. Implications for the development of specific ethical guidelines and professional education are also discussed.

Developing Ethical Practices for Public Health Research Data Sharing in South Africa The Views and Experiences From a Diverse Sample of Research Stakeholders

The abundance of South African clinical and public health research data has the potential to unlock important and valuable future advances in biomedical science. Amid increasing calls for more effective sharing of individual-level data, commitment to promote access to research data is evident within South Africa’s public research sector, but national guidance and regulation are absent. This qualitative study examined the perceptions, experiences and concerns of 32 research stakeholders about data-sharing practices. There was consensus about the utility of data sharing in publicly funded health research. However, disparate views emerged about the possible harms and benefits of sharing data and how these should be weighed. The relative dearth of policies governing data-sharing practices needs to be addressed and a framework of support developed that incentivizes data-sharing practices for researchers that are both ethical and effective.

COMMENTARY: ETHICAL CONSIDERATIONS IN INTERNATIONAL RESEARCH COLLABORATION: THE BUCHAREST EARLY INTERVENTION PROJECT

Ethical issues in international collaborative research are multiple and complex, and the applicable ethical guidance is diverse and sometimes contradictory Council for International Organizations of Medical Sciences CIOMS, 2002; Nuffield Council on Bioethics, 2002; World Medical Association, 2004. Research with children is similarly fraught with ethical conundrums, competing guidelines, and legislation. An intervention study, which is both international and involving children, is thus bound to be riddled with ethical issues. The authors of the Bucharest study BEIPZeanah, Koga, Simion, Stanescu, Tabacaru, Fox, & Nelson, this issue are thus to be commended for publishing some ethical reflections on their study to supplement the basic research findings. Such ethical reflections are rare in the research literature. A useful and comprehensive framework for conceptualizing ethical issues in international collaborative research was published by Emanuel, Wendler, Killen, and Grady 2004. This framework attempts to embody the central ethical principles applicable to international health research in a format that is accessible to researchers rather than just to bioethicists. The authors Zeanah et al., this issue of the BEIP refer to this framework in their paper and cite it as an appendix, but regrettably do not apply it in structuring their discussion of their ethical issues. This could be seen as a shortcoming of the paper itself, as the application of the framework to this Commentary will hopefully illustrate. Each of the headings below represents one of the major categories of ethical discussion contained in the Emanuel et al. framework.

Convergent ethical issues in HIV/AIDS, tuberculosis and malaria vaccine trials in Africa: Report from the WHO/UNAIDS African AIDS Vaccine Programme's Ethics, Law and Human Rights Collaborating Centre consultation, 10-11 February 2009, Durban, South Africa

BackgroundAfrica continues to bear a disproportionate share of the global HIV/AIDS, tuberculosis (TB) and malaria burden. The development and distribution of safe, effective and affordable vaccines is critical to reduce these epidemics. However, conducting HIV/AIDS, TB, and/or malaria vaccine trials simultaneously in developing countries, or in populations affected by all three diseases, is likely to result in numerous ethical challenges.MethodsIn order to explore convergent ethical issues in HIV/AIDS, TB and malaria vaccine trials in Africa, the Ethics, Law and Human Rights Collaborating Centre of the WHO/UNAIDS African AIDS Vaccine Programme hosted a consultation on the Convergent Ethical Issues in HIV/AIDS, TB and Malaria Vaccine Trials in Africa in Durban, South Africa on the 10-11 February 2009.ResultsKey cross cutting ethical issues were prioritized during the consultation as community engagement; ancillary care obligations; care and treatment; informed consent; and resource sharing.ConclusionThe consultation revealed that while there have been few attempts to find convergence on ethical issues between HIV/AIDS, TB and malaria vaccine trial fields to date, there is much common ground and scope for convergence work between stakeholders in the three fields.