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Kearsley Stewart
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 Visiting
Assistant Professor
Northwestern University
Department of Anthropology
Finding a Common Language: Bioethics and HIV/AIDS Research
in Uganda
United States
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Kearsley Alison Stewart (USA) is Visiting Assistant
Professor of Anthropology at Northwestern University in
Evanston, Illinois where she is developing courses on Medical
Anthropology, Gender and Health, HIV/AIDS, and Anthropology
in Africa. She also consults as a Medical Anthropologist
for the Division of HIV/AIDS Prevention at the Centers for
Disease Control and Prevention in Atlanta. As a member of
the CDC interdisciplinary team, she is conducting ethnographic
research for a clinic-based intervention in Atlanta to improve
adherence to antiretroviral therapies.
Dr. Kearsley recently completed a year-long study of adolescent
HIV/AIDS in Uganda using a variety of data collection methods
including ethnographic interviewing, population-based surveys,
biological markers, and videography. In conjunction with
that study, she also implemented the first voluntary HIV
testing and counseling clinic in a rural area in Uganda.
Its success led to a change of national policy regarding
the feasibility of voluntary testing and counseling in rural
areas in Uganda. The research was supported by NIMH and
NSF.
Dr. Kearsley's on-going research includes a small observational
study of needle-exchange sites in Chicago, in conjunction
with the NIDA-funded COIP study in the Department of Biostatistics
and Epidemiology at the University of Illinois at Chicago.
In addition, she is developing a study of low birth weight
babies of African-born women in collaboration with the Division
of Neonatology at Chicago's Cook Country Children's Hospital.
Selected Publications:
· Stewart, K.A. (2000) Towards a Historical Perspective
on Sexuality in Uganda: The Reproductive Lifeline Technique
for Grandmothers and their Daughters. Africa Today
47, 3/4:122-148.
· Stewart, K.A. and Renne, E.P. (eds) (2000) Sexuality
and Generational Identities in Sub-Saharan Africa. Special
double issue of Africa Today, 47, 3/4 (vii-176).
· Koenig, L., Ellerbrock, T., Pratt-Palmore, M.,
Stratford, D., Malatino, E., Todd-Turner, M., Bush, T.,
Stewart, K., and Schnell, C. (2000) Predictors of Early
Failure of Highly Active Antiretroviral Therapy (HAART).
Poster presented at the XIII International AIDS Conference,
Durban, South Africa, 9-14 July.
· Stewart, K.A. (1999) Confronting Stereotypes about
HIV/AIDS and Africans. In Misty L. Bastian and Jane L. Parpart
(eds.) Great Ideas for Teaching about Africa (Lynne
Rienner Publishers: Boulder.
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The proposed research aims to make a contribution to innovation
in global health governance by producing internationally
compatible language to reshape the ethical conduct of U.S.-funded
health research in resource-poor countries. Specifically,
the research project will analyze local definitions of western-derived
concepts of bioethics, such as autonomy, beneficence, and
risk as described in the 1978 U.S.-authored Belmont Report,
in the context of HIV/AIDS research in Uganda. Although
Ugandan experience with international HIV/AIDS research
dates to 1985, relatively few papers on research ethics
in Uganda-or even Africa-have appeared in print, with most
publications focusing on procedural, not substantive, aspects
of bioethics in international clinical trials. A major recommendation
of the U.S. President's National Bioethics Advisory Commission
calls for U.S.-based Institutional Review Boards to become
more familiar with the local realities of developing countries,
especially as those conditions affect the ability of researchers
to conduct ethical biomedical research. Despite these findings
and recommendations, no authoritative framework for the
ethical conduct of HIV/AIDS research in Africa has emerged
from an interdisciplinary international group of American
and African scholars. 
In close collaboration with colleagues at the Faculty of
Medicine at Makerere University in Kampala, Uganda, this
project will pursue four broad questions: (1) How can we
translate the Euro-American concepts of autonomy, beneficence,
and risk into everyday language and practice in Africa?
(2) How can we resolve conflicting interests of researcher,
local community, and participant and achieve a truly representative
group of research participants? (3) How do we shift from
the procedural focus on obtaining the informed consent document
to the substantive issue of transforming informed consent
into an educational process? (4) What are the ethical responsibilities
of researchers to the participant community before, during,
and after research?
The project will analyze a wide variety of opinions and
experiences of both professionals and laypersons in Uganda
in an attempt to demonstrate how consideration of bioethics
in the context of HIV/AIDS research in Uganda can offer
insight to the conduct of biomedical and social scientific
research within and beyond the African continent. Further,
the study of bioethics in this international context can
serve as a model for truly cooperative research while pursuing
the goal of building the capacity of local-level health
professionals to independently evaluate the ethical content
of all research within their own community. By working closely
with Ugandan biomedical scholars as well as community leaders
and former research participants themselves, the broadest
goal of this research is to contribute to efforts to improve
the conceptual, ethical, and procedural methods for defining
HIV/AIDS research in Africa, and indeed globally, in the
21st century.
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| NCS Scholars, Midterm Meeting, Mexico. |
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NCS Scholars Lori Leonard and Seggane Musisi during first Global Health Summer Course Meeting.
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