58 research outputs found
Intersectionality and Community Engagement : Can Solidarity Alone Solve Power Differences in Global Health Research?
Non peer reviewe
A critical examination of research narratives ârumoursâ and passive community resistance in medical research
Several studies in Africa have reported effects of 'rumours, misconceptions or misinformation' on medical research participation and uptake of health interventions. As such, community engagement has sometimes been used for instrumental purposes to enhance acceptability of research or interventions and prevent 'rumours'. This paper seeks to highlight the value of ongoing engagement with communities to understand research narratives 'rumours' reproduced in medical research. We demonstrate that 'rumours' are a form of divergent communication or local interpretation of medical research that needs critical attention, and we question the ethics of dismissing such divergent communication. This paper draws on experiences from ethnographical research, which aimed to understand community engagement in medical research projects conducted in Malawi. We observed that even though community meetings were held to improve participation, 'rumours' about research influenced decision making. 'Rumours' presented local critiques of medical research, legitimate concerns informed by historical experiences and local conceptualisation of health. Structural inequalities, negative outcomes or absence of visible benefits following research participation informed unmet expectations, discontent with research and consequently passive resistance. The sociocultural context where participating research communities often rely on social networks for information nurtured propagation of these divergent perspectives to inform lay discourse around medical research. We conclude that ongoing engagement, critical self-reflection and attempts to decode deeper meaning of 'rumours' throughout research implementation is necessary, to show respect and address community concerns expressed through 'rumours', enhance informed participation and adoption of future health interventions.Peer reviewe
Research as Development
In Research as Development, Salla Sariola and Bob Simpson show how international collaboration operates in a setting that is typically portrayed as "resource-poor" and "scientifically lagging." Based on their long-term fieldwork in Sri Lanka, Sariola and Simpson bring into clear ethnographic focus the ways international scientific collaborations feature prominently in the pursuit of global health in which research operates "as" development and not merely "for" it. The authors follow the design, inception, and practice of two clinical trials: one a global health charity funded trial and the other a pharmaceutical industry-sponsored trial. Research as Development situates these two trials within their historical, political and cultural contexts and thus counters the idea that local actors are merely passive recipients of new technical and scientific rationalities. While social studies of clinical trials are beginning to be an established niche in academic writing, Research as Development helps fill important gaps in the literature through its examination of clinical research situated in cultures in low-income settings. Research as Development is noteworthy for the way it highlights the critical and creative role that local researchers play in establishing international collaborations and making them work into locally viable forms. The volume shows how these clinical and research interactions bring about changes in culture, technologies and expertise in Sri Lanka, contexts that have not previously been written about in any detail
Toward a Symbiotic Perspective on Public Health: Recognizing the Ambivalence of Microbes in the Anthropocene
Microbes evolve in complex environments that are often fashioned, in part, by human desires. In a global perspective, public health has played major roles in structuring how microbes are perceived, cultivated, and destroyed. The germ theory of disease cast microbes as enemies of the body and the body politic. Antibiotics have altered microbial development by providing stringent natural selection on bacterial species, and this has led to the formation of antibiotic-resistant bacterial strains. Public health perspectives such as âPrecision Public Healthâ and âOne Healthâ have recently been proposed to further manage microbial populations. However, neither of these take into account the symbiotic relationships that exist between bacterial species and between bacteria, viruses, and their eukaryotic hosts. We propose a perspective on public health that recognizes microbial evolution through symbiotic associations (the hologenome theory) and through lateral gene transfer. This perspective has the advantage of including both the pathogenic and beneficial interactions of humans with bacteria, as well as combining the outlook of the âOne Healthâ model with the genomic methodologies utilized in the âPrecision Public Healthâ model. In the Anthropocene, the conditions for microbial evolution have been altered by human interventions, and public health initiatives must recognize both the beneficial (indeed, necessary) interactions of microbes with their hosts as well as their pathogenic interactions
Sex workers in Chennai, India: negotiating gender and sexuality in the time of AIDS
Risk of HIV and illness are the dominant context in which sex work is discussed in India and there is a lacuna of social scientific analysis of sex workersâ lives. HIV interventions negotiated between global actors such as UNAIDS, World Bank, USAID etc, the Indian government, state level AIDS prevention bodies, and the local NGOs, have constructed âsex workâ as an epidemiological category rather than treating it as a social concept. Based on fieldwork in HIV prevention NGOs, and participant observation and interviews with sex workers in Chennai, Tamil Nadu, in August 2004-August 2005 to understand the realities of the sex workers lives, this thesis proposes research on sex workers, with specific reference to gender and sexuality. Theoretically the research seeks to answer the question: how to understand agency of vulnerable populations and how do sex workers use agency in oppressive environments? This thesis also engages with the feminist debate of selling sex as profession or as oppression of womenâs rights. I argue that sex workers actively negotiate sex work and their lives with the means at their disposal. This is done not only in the context of negotiating the risks of sex work but also in the broader context of other needs, for example money, love and sexual desire. While sexuality is a taboo in India, the analysis contributes to the understanding of discourses of womenâs sexuality and the sexual behaviour of sex workers in Chennai. While the womenâs experiences are closely knit into the global nexus of the HIV industry, sex work comes across as a complicated knot of poverty, desire, womenâs oppression, love, cooption, and motherhood
How Civil Society Organisations Changed the Regulation of Clinical Trials in India
In 2005 India changed its pharmaceutical and innovation policy that facilitated a dramatic increase in international clinical trials involving study sites in India. This policy shift was surrounded by controversies; civil society organisations (CSOs) criticised the Indian government for promoting the commercialisation of pharmaceutical research and development. Health social movements in India fought for social justice through collective action, and engaged in normative reasoning of the benefits, burdens and equality of research. They lobbied to protect trial participants from structural violence that occurred especially in the first 5â6 years of the new policy. CSOs played a major role in the introduction of new regulations in 2013, which accelerated a decline in the number of global trials carried out in India. This activism applied interpretations of global social justice as key ideas in mobilisation, eventually helping to institutionalise stricter ethical regulation on a national level. Like government and industry, activists believed in randomised controlled trials and comparison as key methods for scientific knowledge production. However, they had significant concerns about the global hierarchies of commercial pharmaceutical research, and their impact on the rights of participants and on benefits for India overall. Pointing to ethical malpractices and lobbying for stricter ethical regulations, they aimed to ensure justice for research participants, and developed effective strategies to increase controls over the business side of clinical research
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