Evidence Based Medicine and the Construction of Moral Agency in Ukraine

Abstrakt

This article explores the ways public health professionals working in Ukraine’s HIVprevention sphere have adopted practices and ideologies of evidence-based medicine (EBM). Public health research concerning HIV in Ukraine remains piecemeal, owing to financial and practical limitations in this region. Despite this, public health professionals remain beholdento international donors (such as USAID and The Global Fund) to adopt EBM as a fundamental standard of practice in internationally funded programs. Through ethnographic evidence
collected via interviews and participant observation among various public health professionals in Ukraine, this article outlines two major features of EBM as a discourse in this context. First, many public health professionals in Ukraine frame the validity and reliability of statistical data, the ‘evidence’ of EBM, not just practically or quantitatively, but also discursively and symbolically, creating or denying evidentiary crises in the production of statistical data according
to their own values and purposes. Second, the production of evidence has become an act of tangible social and political value, as much as it is of ‘scientific’ and practical value. By producingevidence, public health professionals are not only developing the tools to improve their public health eff orts, but they are also presenting themselves as morally appropriate and deserving.
Through these actions, Ukrainian public health professionals seek legitimacy in the eyes of powerful international actors and claim new forms of morally charged agency within a public health structure that renders them fi nancially and logistically constrained.