Ethical Challenges in Short-Term Global Health Training
Jeffrey is seen teaching a class to community members on HIV infection and safer sex practices. Upset, many members abruptly leave. Jeffrey then consults with Dr. Zao as to what he did wrong. Click image to start video.
CASE 8: Telling the "Truth"

Vignette 3: Invigorated by his new understanding of this community, Jeffrey proceeds to his previously planned educational session with a group of community members about HIV infection and safer sex practices. The community members seem upset during the discussion of male circumcision.

Jeffrey is confused. On the one hand, he feels compelled that individuals in the community need "the whole truth" – including male circumcision. Not doing so seems dishonest. On the other hand, he realizes that reaching the community might require a different method.

What should Jeffrey do?

Jeffrey should not change his teaching method. This community needs “the whole truth” about HIV.
On rare occasions, it might be necessary for a short-term program to confront a different cultural norm in this manner. In this case, however, Jeffrey has clearly not exhausted other attempts at engaging the local community. Choose a different answer.
Jeffrey should offer an “acceptable” class to the community, then insert his health messages after they have been in attendance.
This strategy appears dishonest and disrespectful to the local community. Instead of true engagement, Jeffrey seems to be attempting a marketing ploy. Choose a different answer.
Jeffrey should avoid teaching about objectionable facts, such as male circumcision, altogether.
In some cases it might be necessary to abort a program, or its elements, if one is unable to reach the community. However, telling the “whole truth” does not imply telling the whole truth immediately, or without careful consideration and engagement. Choose a different answer.
Jeffrey should first meet with a few locals whom he knows well and have an open conversation about how collaborative educational aims could be accomplished.
This is correct. In this vignette, Jeffrey brought an educational program inappropriate to the local community. This could mean he will be unable to effectively meet his goals this time. However, spending time with the locals now could help ensure a more successful partnership in the long run.
© Stanford University Center for Global Health and the Johns Hopkins University Berman Institute of Bioethics.

Project funding provided by Doris Duke Charitable Foundation (DDCF)