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Ethics of pursuing targets in public health: the case of voluntary medical male circumcision for HIV-prevention programs in Kenya
  1. Stuart Rennie1,2,
  2. Adam Gilbertson3,
  3. Denise Hallfors4,
  4. Winnie K Luseno3
  1. 1UNC Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  2. 2Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  3. 3Pacific Institute for Research and Evaluation, Chapel Hill Center, Chapel Hill, North Carolina, USA
  4. 4Retired, Pacific Institute for Research and Evaluation, Chapel Hill Center, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Adam Gilbertson, Pacific Institute for Research and Evaluation, Chapel Hill, NC 27514, USA; adamgilbertson{at}outlook.com

Abstract

The use of targets to direct public health programmes, particularly in global initiatives, has become widely accepted and commonplace. This paper is an ethical analysis of the utilisation of targets in global public health using our fieldwork on and experiences with voluntary medical male circumcision (VMMC) initiatives in Kenya. Among the many countries involved in VMMC for HIV prevention, Kenya is considered a success story, its programmes having medically circumcised nearly 2 million men since 2007. We describe ethically problematic practices in Kenyan VMMC programmes revealed by our fieldwork, how the problems are related to the pursuit of targets and discuss possible approaches to their management. Although the establishment and pursuit of targets in public health can have many benefits, assessments of target-driven programmes tend to focus on quantifiable outcomes rather than the processes by which the outcomes are obtained. However, in order to speak more robustly about programmatic ‘success’, and to maintain community trust, it is vital to ethically evaluate how a public health initiative is actually implemented in the pursuit of its targets.

  • HIV infection and AIDS
  • circumcision
  • ethics
  • public health ethics

http://dx.doi.org/10.1136/medethics-2020-106293

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    Footnotes

    • Contributors SR, AG, DH and WKL conceived, conducted and analysed data of the qualitative study on male circumcision referred to in this article. SR wrote the first draft of this article. All authors provided input into manuscript development, that is, initial drafts, critical revisions and approval of the final version.

    • Funding Research reported in this publication was supported by funding from the National Institute of Mental Health and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number R01MH102125 (WKL, PI) and from the Center for AIDS Research, University of North Carolina at Chapel Hill (P30 AI050410). SR’s work was supported by a visiting residency at the Brocher Foundation.

    • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or any other funding body.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Ethics of pursuing targets in public health: the case of voluntary medical male circumcision for HIV prevention programs in Kenya.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available.

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