Sunita Vs Bandewar

Aligning Community Engagement With Traditional Authority Structures in Global Health Research: A Case Study From Northern Ghana

Despite the recognition of its importance, guidance on community engagement practices for researchers remains underdeveloped, and there is little empirical evidence of what makes community engagement effective in biomedical research. We chose to study the Navrongo Health Research Centre in northern Ghana because of its well-established community engagement practices and because of the opportunity it afforded to examine community engagement in a traditional African setting. Our findings suggest that specific preexisting features of the community have greatly facilitated community engagement and that using traditional community engagement mechanisms limits the social disruption associated with research conducted by outsiders. Finally, even in seemingly ideal, small, and homogeneous communities, cultural issues exist, such as gender inequities, that may not be effectively addressed by traditional practices alone.

Abortion needs of women in India: A case study of rural Maharashtra

Abstract The Indian Medical Termination of Pregnancy (MTP) Act came into force in 1972, in response to the high mortality and morbidity associated with illegal abortion. However, 25 years on, both restrictions in the law and the way it is implemented through service delivery have failed to meet the abortion needs of large numbers of women. Using data from a larger qualitative study in rural Maharashtra, this paper explores womens perceptions of their rights and needs in relation to abortion. The women were ambivalent about abortion, based on their roles and identity as mothers, but they saw the necessity for abortion and supported each other to have abortions. They had conflicting feelings with regard to abortion on grounds of fetal sex, and problematic issues of sexuality, especially for single women in relation to abortion, also arose. Provided with the details of Indias abortion legislation, which they knew little about the women had suggestions for making the law more women-sensitive. Their experiences make it clear that vast improvements in abortion policy and service delivery are needed in India.

Consent and community engagement in diverse research contexts: reviewing and developing research and practice

Consent and community engagement (CE) in health research are two aspects of a single concern—that research is carried out in a respectful manner where social value is maximized. There are important overlaps and interdependencies between consent and CE; for example, CE can provide insights into how best to tailor consent to context and can be an important component of consent processes. Engaging communities can also have intrinsic and instrumental value beyond consent; for example, as a means of showing respect and identifying appropriate ways of working respectfully. In this paper we critically examine how CE and consent processes are characterized, conducted, and evaluated in diverse health research contexts, and propose a preliminary research agenda to support future learning in these critical areas.Consent and community engagement (CE) in health research are two aspects of a single concern-that research is carried out in a respectful manner where social value is maximized. There are important overlaps and interdependencies between consent and CE; for example, CE can provide insights into how best to tailor consent to context and can be an important component of consent processes. Engaging communities can also have intrinsic and instrumental value beyond consent; for example, as a means of showing respect and identifying appropriate ways of working respectfully. In this paper we critically examine how CE and consent processes are characterized, conducted, and evaluated in diverse health research contexts, and propose a preliminary research agenda to support future learning in these critical areas.

Addressing Ethical, Social, and Cultural Issues in Global Health Research

Summary The purpose of this paper is to encourage reflection among the global health research community and the research ethics community about how a wide range of ethical, social, and cultural (ESC) influences on the conduct, success, and impact of global health research can best be addressed by consultation services in research ethics (CSRE). We draw on lessons we have learned during our experiences with the ESC Program of the Grand Challenges in Global Health initiative to propose key features of CSRE that may prove useful for those designing or implementing similar programs.

Is Scale-Up of Community Mobilisation among Sex Workers Really Possible in Complex Urban Environments? The Case of Mumbai, India.

Background In the last decade, community mobilisation (CM) interventions targeting female sex workers (FSWs) have been scaled-up in India’s national response to the HIV epidemic. This included the Bill and Melinda Gates Foundation’s Avahan programme which adopted a business approach to plan and manage implementation at scale. With the focus of evaluation efforts on measuring effectiveness and health impacts there has been little analysis thus far of the interaction of the CM interventions with the sex work industry in complex urban environments. Methods and Findings Between March and July 2012 semi-structured, in-depth interviews and focus group discussions were conducted with 63 HIV intervention implementers, to explore challenges of HIV prevention among FSWs in Mumbai. A thematic analysis identified contextual factors that impact CM implementation. Large-scale interventions are not only impacted by, but were shown to shape the dynamic social context. Registration practices and programme monitoring were experienced as stigmatising, reflected in shifting client preferences towards women not disclosing as ‘sex workers’. This combined with urban redevelopment and gentrification of traditional red light areas, forcing dispersal and more ‘hidden’ ways of solicitation, further challenging outreach and collectivisation. Participants reported that brothel owners and ‘pimps’ continued to restrict access to sex workers and the heterogeneous ‘community’ of FSWs remains fragmented with high levels of mobility. Stakeholder engagement was poor and mobilising around HIV prevention not compelling. Interventions largely failed to respond to community needs as strong target-orientation skewed activities towards those most easily measured and reported. Conclusion Large-scale interventions have been impacted by and contributed to an increasingly complex sex work environment in Mumbai, challenging outreach and mobilisation efforts. Sex workers remain a vulnerable and disempowered group needing continued support and more comprehensive services.

Sex, gender, and health biotechnology: points to consider

BackgroundReproductive technologies have been extensively debated in the literature. As well, feminist economists, environmentalists, and agriculturalists have generated substantial debate and literature on gender. However, the implications for women of health biotechnologies have received relatively less attention. Surprisingly, while gender based frameworks have been proposed in the context of public health policy, practice, health research, and epidemiological research, we could identify no systematic framework for gender analysis of health biotechnology in the developing world.DiscussionWe propose sex and gender considerations at five critical stages of health biotechnology research and development: priority setting; technology design; clinical trials; commercialization, and health services delivery.SummaryApplying a systematic sex and gender framework to five key process stages of health biotechnology research and development could be a first step towards unlocking the opportunities of this promising science for women in the developing world.

Considering risk contexts in explaining the paradoxical HIV increase among female sex workers in Mumbai and Thane, India

BackgroundThe period 2006–2009 saw intensive scale-up of HIV prevention efforts and an increase in reported safer sex among brothel and street-based sex workers in Mumbai and Thane (Maharashtra, India). Yet during the same period, the prevalence of HIV increased in these groups. A better understanding of sex workers’ risk environment is needed to explain this paradox.MethodsIn this qualitative study we conducted 36 individual interviews, 9 joint interviews, and 10 focus group discussions with people associated with HIV interventions between March and May 2012.ResultsDramatic changes in Mumbai’s urban landscape dominated participants’ accounts, with dwindling sex worker numbers in traditional brothel areas attributed to urban restructuring. Gentrification and anti-trafficking efforts explained an escalation in police raids. This contributed to dispersal of sex work with the sex-trade management adapting by becoming more hidden and mobile, leading to increased vulnerability. Affordable mobile phone technology enabled independent sex workers to trade in more hidden ways and there was an increased dependence on lovers for support. The risk context has become ever more challenging, with animosity against sex work amplified since the scale up of targeted interventions. Focus on condom use with sex workers inadvertently contributed to the diversification of the sex trade as clients seek out women who are less visible. Sex workers and other marginalised women who sell sex all strictly prioritise anonymity. Power structures in the sex trade continue to pose insurmountable barriers to reaching young and new sex workers. Economic vulnerability shaped women’s decisions to compromise on condom use. Surveys monitoring HIV prevalence among ‘visible’ street and brothel-bases sex workers are increasingly un-representative of all women selling sex and self-reported condom use is no longer a valid measure of risk reduction.ConclusionsTargeted harm reduction programmes with sex workers fail when implemented in complex urban environments that favour abolition. Increased stigmatisation and dispersal of risk can no longer be considered as unexpected. Reaching the increasing proportion of sex workers who intentionally avoid HIV prevention programmes has become the main challenge. Future evaluations need to incorporate building ‘dark logic’ models to predict potential harms.

Access to controlled medicines for palliative care in India: gains and challenges.

It was in the early 1990s that an appeal was made, both in India and globally, for access to palliative care to be treated as a human rights issue. Over the past few years, India has witnessed robust advocacy efforts which push for the consideration of palliative care and pain management as a human right. Central to this paper is Indias Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985: its genesis, its critique, and the amendments aimed at enhancing access to the NDPS for medical care and research. I refer to the advocacy efforts in India, particularly the most recent ones, which led to the amendments to the NDPS Act, 1985 in February 2014; and the contribution of the global and local human rights discourse on palliative care to these efforts. This I situate in the overall status of palliative care in India. Towards the end, I briefly set out the agenda that should be pursued in the coming years to enhance access to controlled medicines for pain management and palliative care.

SEARCH's HBNC trial: towards a broader debate on the ethics of social intervention research.

The SEARCH home-based neonatal care (HBNC) trial generated a heated debate amongst health activists, researchers and demographers in India upon its publication in the Lancet in 1999. More than a decade after the Lancet article, a new debate has been sparked, this time on the ethics of the study. Against this backdrop, we identify three key questions which require in-depth discussion. First, was the choice of the study design (cluster nonrandomised control trial), appropriate given the circumstances relating both to the study site and the locale? Second, was it ethical not to offer any intervention to the control units given that a known treatment existed? Third, do contemporary research ethics guidelines satisfactorily address all the ethical issues related to the study design? This paper examines the first question. We draw three main conclusions from this critical appraisal of the HBNC trial. First, the study design of the trial is motivated by the paradigm of evidence-based programmes and policy formulation. Second, generally speaking, the HBNC study design passes the internal and external validity tests but raises important ethical questions. Third, these questions transcend the HBNC trial to apply to many other social and health interventions studies; as such, the HBNC trial should be studied as a paradigmatic case.

Medical Council of India's Amended Qualifications for Indian Medical Teachers: Well Intended, yet half-hearted

SUNITA VS BANDEWAR1, AMITA AGGARWAL2, RAJEEV KUMAR3, RAKESH AGGARWAL4, PEUSH SAHNI5 AND SANJAY A PAI6 1Independent Senior Research Professional and Consultant in Global Health and Bioethics, Pune; Departments of 2Clinical Immunology and 4Gastroenterology, SGPGI, Lucknow; Departments of 3Urology and 5GI Surgery, AIIMS, New Delhi; and 6Department of Pathology, Columbia Asia Referral Hospital, Bengaluru; India. Correspondence to: Sunita VS Bandewar (sunita.bandewar@utoronto.ca) and Sanjay A Pai, (sanjayapai@gmail.com)