Department of Anthropology, Johns Hopkins University, 3400 N. Charles St., 404 Macauley Hall, Baltimore, MD 21218, United States.
Soc Sci Med. 2013 Jan;77:118-25. doi: 10.1016/j.socscimed.2012.11.015. Epub 2012 Nov 19.
In the context of low rates of participation in a prospective, population-based HIV surveillance programme, researchers at a surveillance site in rural KwaZulu-Natal, South Africa, conducted an operational study from January 2009 to February 2010, with the aim of improving participation rates, particularly in the provision of dried blood spots for the surveillance. Findings suggest, firstly, that consent to participation in the HIV surveillance is informed by the dynamics of relationality in the HIV surveillance "consent encounter." Secondly, it emerged that both fieldworkers and participants found it difficult to differentiate between HIV surveillance and HIV testing in the surveillance procedure, and tended to understand and explain giving blood under the aegis of the surveillance as an HIV test. The conflation of surveillance and testing, we argue, is not merely a semantic confusion, but reveals an important tension inherent to global health research between individual risks and benefits and collective good, or between private morality and public good. Because of these structural tensions, we suggest, the HIV surveillance consent encounter activates multiple gift economies in the collection of blood samples. Thinking beyond the complex ethical dimensions provoked by new forms of long-term surveillance and health research, we therefore suggest that deepening relations between scientists, fieldworkers, and study participants in locality deserve more careful methodological consideration and descriptive attention.
在参与前瞻性、基于人群的 HIV 监测计划的比例较低的情况下，南非夸祖鲁-纳塔尔省农村监测点的研究人员于 2009 年 1 月至 2010 年 2 月进行了一项操作研究，目的是提高参与率，特别是提供监测用的干血斑。研究结果表明，首先，参与 HIV 监测的同意是由 HIV 监测“同意遭遇”中的关系动态决定的。其次，研究人员发现，外勤人员和参与者都发现很难在监测程序中区分 HIV 监测和 HIV 检测，并且倾向于将监测范围内的献血理解并解释为 HIV 检测。我们认为，监测和检测的混淆不仅仅是语义上的混淆，而是揭示了全球健康研究中个体风险和利益与集体利益之间，或者私人道德与公共利益之间固有的重要紧张关系。由于这些结构上的紧张关系，我们认为，HIV 监测同意遭遇在采集血样时激活了多种礼品经济。我们建议，超越新形式的长期监测和健康研究引发的复杂伦理维度，因此，我们建议在当地深化科学家、外勤人员和研究参与者之间的关系值得更仔细的方法考虑和描述性关注。
