Bioethics program prepares Africans to work in HIV care

AU.S.-based bioethics training program has been helping African professionals develop skills that they've taken back to their native countries to work on the behalf of HIV care, prevention, treatment, and other causes.

One of the first bioethics training programs to receive funding from the Fogarty International Center of the National Institutes of Health is the Johns Hopkins Fogarty African Research Ethics Training Program of Baltimore, MD. Through the summer of 2007, the program has trained nearly two dozen African professionals, including some who returned to the African continent to work in the field of HIV prevention and research.

"What we look for is not only someone who is talented, but someone who is committed to making a difference in improving an area of Africa," says Nancy E. Kass, ScD, the Phoebe R. Berman professor of bioethics and public health at the Johns Hopkins Berman Institute of Bioethics, Johns Hopkins Bloomberg School of Public Health in Baltimore.

"There have been controversies over the last 10 years, in particular about international research collaborations around HIV," Kass says. "There have been controversies around other conditions, as well, with some people saying studies are exploiting people in poor countries, where other studies are advancing public health."

For instance, once public debate involved how perinatal HIV transmission trials should be designed in developing countries.

One issue is that there have been too few Africans involved in the debate, so the Johns Hopkins bioethics program's goal is to train a cadre of African professionals in ethics, so they'll know how to decide which studies are right for their countries and how to fill existing research needs, Kass explains.

The program finished its seventh year in April 2007, and has been so successful with building enthusiasm among its African students that 19 of the 23 training graduates returned to Baltimore for a reunion.

The reunion included a public health community discussion, following a viewing of the controversial film, "The Constant Gardener," which depicted HIV research as corrupt and dangerous for Africans.

A panel of experts, including the training graduates, discussed the film's accuracy and ethical perspective, Kass says.

The Johns Hopkins bioethics program trains three to five African health care professionals and students each year. It provides them with an intensive first six months of studying ethics in graduate-level courses, plus three seminar series and regular meetings with an advisor as they develop a 40-page practicum protocol for a big project they'll do in their home country, Kass says.

The seminar series varies according to the interests of the students. For instance, one course involves having experts talk about the ethics of conducting HIV protocols in Africa, Kass notes.

Before the students return home for the last six months of their training, they are given a seed grant to fund their work in ethics upon returning home, Kass says.

The money pays for their planned project, which might include research, working in the field of HIV/AIDS, establishing an IRB, or pursuing other interests.

Some of the students continued their education after completing the program, and others began to work in their new fields.

For example, one trainee from South Africa works with a South African group called the HIV Vaccine Ethics Group, Kass says.

The group drafts ethics guidelines for vaccine studies, and the bioethics trainee did an independent research project for the Johns Hopkins program in which she looks at whether people in vaccine studies feel they should get treatment if they seroconvert while in the vaccine studies, Kass says.

Another training graduate is a pediatrician who now consults with orphanages in South Africa, where most of the children are orphaned because of AIDS, Kass says.

"She works at an enormous hospital in South Africa where many poor people go," Kass says. "She also does research to see if research is helpful or fair to orphans, as opposed to exploitive of orphans."

The pediatrician's research project has the goal of understanding how research works and how decisions are made about whether a study will be done in an orphanage and what are the appropriate ways to ensure orphans are protected, Kass adds.

"We have one trainee who is working on a huge HIV field trial in Uganda, studying a variety of methods to prevent HIV transmission, and he's a field coordinator for these," Kass says. "He's also done an interesting project to identify what the staff see as ethical issues they face."