Navigating ‘ethics in practice’: An ethnographic case study with young women living with HIV in Zambia

ABSTRACT

While ‘procedural ethics’ provides essential frameworks for governing global health research, reflecting on ‘ethics in practice’ offers important insights into addressing ethically important moments that arise in everyday research. Particularly for ethnographic research, renowned for it’s fluid and spontaneous nature, engaging with ‘ethics in practice’ has the potential to enhance research practice within global health. We provide a case study for such reflexivity, exploring ‘ethics in practice’ of ethnographic research with middle-income young women living with HIV in Lusaka, Zambia. We explore the ethical issues arising from the layered interaction of the population (young women), the disease under investigation (HIV), the method of study (ethnographic), and the setting (Zambia, a lower middle income country). We describe how we navigated five key practical ethical tensions that arose, namely the psycho-emotional benefits of the research, the negotiated researcher-participant relationship, protecting participants’ HIV status, confidentiality and data ownership, and researcher obligations after the end of the research. We exemplify reflexive engagement with ‘ethics in practice’ and suggest that engaging with ethics in this way can make important contributions towards developing more adequate ethical guidelines and research practice in global public health.

KEYWORDS:

• Research ethics
• HIV
• young adults
• ethnography
• Zambia

Acknowledgements

Our biggest thanks go to the young women who participated in the study, contributing their time, energy and stories to the research. We also thank the clinic staff and volunteers who assisted with the initial recruitment of participants. Many thanks also to Madalitso Mbewe, Mwangala Mwale, Chiti Bwalya, Rhoda Ndubani, Melvin Simuyaba, Fredrick Ngwenya, Tila Mainga, Daniel Ziba and Sarah Bernays for thoughtful and supportive discussions on ethical issues as they emerged before, during and after the study. Thanks to Michael Parker for kindly reading a draft of the manuscript and for his comments. We also thank Stephanie Johnson for helpful discussions about autonomy and informed consent and Ruth Horn for providing useful references. This research was funded by the Economic and Social Research Council.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Constance R.S. Mackworth-Young http://orcid.org/0000-0002-9725-7931

Alison Wringe http://orcid.org/0000-0001-6939-3461

Additional information

Funding

This work was supported by Economic and Social Research Council.