Privileging prevention,gendering responsibility: an analysis of the Ghanaian campaign against HIV/AIDS

This article focuses on the discourses around HIV/AIDS in the national Ghanaian ‘Stop AIDS Love Life!’ public health campaign, within non-governmental HIV/AIDS publications, and the Ghanaian national print media. I have used critical discourse analysis to interpret and deconstruct a range of these social texts collected between June and September of 2001 and 2003 in and around Greater Accra, Ghana. I argue, firstly, that these discourses are shaped by an international politics of funding for HIV/AIDS that privileges prevention through behaviour change over treatment action under the premise that prevention is a more cost-effective option for the Global South. I critique this stance, highlighting the emerging possibilities for integrated prevention–treatment efforts in resource-poor settings such as Ghana. Secondly, I argue that the discourses around HIV/AIDS presented in prevention campaign materials powerfully construct normative and gendered subjectivities with assigned roles and responsibilities. The fight against HIV/AIDS is constructed as a national project in which an idealized, and often very young, female citizen is positioned as educator, volunteer, carer and protector of herself and society. This discursive coding of responsibility places the many burdens of HIV upon some of the most vulnerable in society, ignoring the structural constraints of gender, generational and economic inequality. I conclude my paper by arguing that efforts to reduce transmission rates, stigma, and the burden of care for those living with HIV/AIDS in Ghana must integrate both preventative efforts and treatment action. Where prevention campaigns are utilized I suggest that these must recognize the limitations of behaviour change initiatives that primarily target women and acknowledge the gendered constraints faced by those very subjects identified as responsible for the protection and education of the nation.     

The Cultural Queasiness Factor: Intersections of Gender,Sexuality and HIV Prevention in Burma/Myanmar

The Ministry of Health in Burma/Myanmar considers HIV its first priority in disease prevention, and HIV prevention represents a significant element of the work of many of the international non-governmental organisations (INGOs) based in the country (CBI, 2006; Ministry of Health, 2008). Yet inBurma/Myanmar, as elsewhere in Southeast Asia, there is a “cultural queasiness” around HIV. This queasiness is a dis-ease of the emotions, transmitted through the ongoing linking of HIV transmission with “bad behaviour” (resulting, in part, from HIV prevention's own repeated use of a “risk group” approach). Indeed, the mere existence of HIV prevention work, inand of itself, sparks waves of cultural queasiness because it transgresses the norms regarding which topics are considered appropriate for public airing, and which are not. Through reference to empirical research involving in-depth interviews and observation of field work practice, this article demonstrates how the desire to minimise this queasiness can result in disavowal of the experiential and emotional complications so deeply embedded in HIV prevention and HIV transmission. Thus HIV prevention both is affected by, and reinforces, cultural queasiness.     

PLAGUE AND POWER RELATIONS

Public policy and economic practice, quintessential expressions of institutional cognition, create an opportunity structure constituting a tunable, highly patterned,‘non‐white noise’ in a generalized epidemiological stochastic resonance that can efficiently amplify unhealthy living and working conditions, particularly within highly concentrated, marginalized urban populations, to evoke infectious disease outbreaks. This is especially true for the infections carried by socially generated ‘risk behaviours’ which are usually adaptations to histories of resource deprivation or marginalization. A number of local epidemics originating in such ecological keystone communities may subsequently undergo a policy and structure‐driven phase transition to become a coherent pandemic, a spreading plague which can entrain more affluent populations into the disease ecology of marginalization. We use this approach to contrast the ecological resilience of apartheid and egalitarian social systems, and apply these perspectives to the forthcoming social and geographical diffusion of multiple drug resistant (MDR) HIV from present AIDS epicentres to the rest of the United States.     

Disease, Social Identity, and Risk: Rethinking the Geography of AIDS

The emergence of new diseases and the re-emergence of 'old' diseases necessitates a relook at what shapes vulnerability to ill health. A framework is proposed that combines a realist approach to mapping vulnerability with feminist and post-structural approaches that focus more attention upon the role of social identities and cultural framings of disease. Too often investigations of disease focus either upon structural determinants of risk such as political policy and the economy, or on discursive definitions of disease that impact its experience. A combination of these approaches would result in a more effective framework for evaluating vulnerability, and subsequently for generating effective disease prevention strategies. The social, economic, political, and cultural context of HIV/AIDS in Malawi is given as an illustration of this framework.     

Reproduction rates in multiregion modeling systems for HIV / AIDS

The persistence of HIV/AIDS has seen a revival of academic interest in the development of modeling systems to assist understanding the population dynamics of this infection. Moreover, it has become increasingly recognized that a key component of these systems for interpreting disease prevention is their reproduction rate, which provides an indication of whether an epidemic might start in a community described by a particular set of epidemiological characteristics. The properties of these rates have been explored in detail for models of a single risk behavior but not for multiregion formats that allow for the transfer of infection between geographical units. Therefore, in this paper I derive reproduction rates for a multiregion HIV/AIDS model together with their associated critical thresholds that estimate the minimum population of susceptibles necessary for an epidemic to begin. These statistics are interpreted for a simplified global setting representing regional variations in the potential onset of HIV/AIDS. In the discussion I examine the potential applicability of these results to understanding HIV/AIDS prevention.     

城市居民健康生活方式研究的时空行为视角

在宜居城市和健康城市的建设背景下,健康生活方式成为政府和公众共同追求的重要目标。已有的环境-行为-健康关系的研究主要从静态时空间的视角出发,探讨邻里环境要素与居民健康水平的相关关系,并分析健康相关行为或活动特征的中介作用。本文立足于个体导向和强调制约与企划的时间地理学、基于活动-移动模式的活动分析法、以及移动性转向下情境单元的选择问题,以个体整日活动-移动模式作为生活方式的外在行为体现,从时间、空间、个体行为和群体行为的角度,构建了基于移动性的城市环境暴露-日常活动移动模式-个体健康效应三者关系的综合分析框架,以期促进城市环境与社会的可持续发展。     

Of Sodomy and Cannibalism: Dehumanisation,Embodiment and the Rhetorics of Same‐Sex and Cross‐Species Contagion

This article explores ideas of the ‘human’ in discourses surrounding the AIDS epidemic, from the 1980s to the present. It compares two sequential lines of thought: first, the notion of AIDS as the result of ‘unnatural’ gender behaviours and queer sexualities; and second, the notion of AIDS and other zoonotics (cross‐species diseases) as the result of non‐western dietary practices and social mores. In the first case, the early years of the AIDS crisis are traced through the languages of sexual perversity utilised by the popular press and the Christian right. In the second case, the later years of the epidemic are traced, once the ‘roots’ of the virus became tied to Africa, and carriers became bestialised in narratives that located HIV as a consequence of unnatural, or inhuman, interactions with the animal world. The article argues that we have witnessed a paradigm shift in the didactics of the epidemic, from a narrative of sexual impropriety to one that also includes a narrative of dietary impropriety, each of which consistently relies upon a clear dichotomy between the human and the inhuman.     

HIV/AIDS and security: fact, fiction and evidence—a report to UNAIDS

The link between HIV/AIDS and 'security' is said by many to be well understood, particularly that between the movement and activities of uniformed services and the epidemic. There are strong opinions widely asserted. But recent research undertaken for UNAIDS by LSEAIDS (which brings together leading social scientists at the LSE to confront the social and economic implications of HIV/AIDS), reveals that this is not at all the case. The evidence base is patchy—strikingly so. It has been over-interpreted and even misinterpreted in the rush to respond to a perceived threat by asserting generalizations that do not stand up. In this article the arguments and some of the evidence are reviewed, as are the forces advocating a precipitate response based on poor evidence. The article describes the principles that should underlie an empirically more robust approach.     

Understanding the Southern African ‘Anomaly’: Poverty,Endemic Disease and HIV

The epicentre of the global HIV epidemic is southern Africa. Previous explanations point to migration patterns and highly skewed income distribution, both thought to promote risky sexual behaviour. This study emphasizes the importance of common infectious and parasitic diseases that increase the likelihood of HIV transmission by increasing contagiousness and vulnerability to infection. Using multiple regression analysis on country‐level data, the authors find that socio‐economic variables explain statistically only one‐tenth of the difference in HIV prevalence between southern Africa and other low‐ and middle‐income countries. Measures of five cofactor infections together with the socio‐economic variables, however, explain statistically about two‐thirds of the southern Africa difference in HIV prevalence. They conclude that the relative affluence of countries in southern Africa and historical migration patterns have tended to mask the vulnerability of the majority of their populations who are poor and who have very high prevalence of infectious and parasitic diseases. Those diseases replicate a cycle of poverty that produces biological vulnerability through coinfections. An important implication of this research is that integrating treatment of endemic diseases with other HIV‐prevention policies may be necessary to slow the spread of HIV.     

Imagining the social impact of museums and galleries: interrogating cultural policy through an empirical study

This paper aims to contribute to an understanding of how museums and galleries are regulated through an examination of the production and implementation of policy. It concentrates on those aspects that view them as vehicles through which social policy, such as that dealing with social inequality, can be implemented. To do this, it identifies the ways that motivations, behaviours and social outcomes of engagement are imagined by New Public Management-derived policy, and audit and evaluation tools. This is then examined using the results of a study of how visitors consume contemporary visual art galleries in north-east England, UK. The study concludes that the complex nature of engagement cannot be accommodated by policy in its present form and cannot be captured by existing audit and evaluation tools. It suggests that new approaches that acknowledge the roles visitors play in the construction of meanings need to be developed.     

Social practices and lifestyles in Italian youth cultures

Abstract

In recent decades, social research on youth in Italy has explored a wide range of issues through different interpretative and methodological approaches. However, there are very few studies that seek to identify the keynote features of the juvenile condition. This article argues that collective identities and forms of identification among youth are shaped more and more frequently through the sharing of social practices, of the meanings connected to these practices, and of more comprehensive lifestyles. With reference to four main fields (sport, music, politics, religion) and focusing on youth cultures, it analyses the connections between behaviours, attitudes, values and representations of youth actively involved in each of these different fields. The aim is to identify transversal processes through which young people today elaborate and adopt social practices and cultural profiles, create new social forms, and develop innovative signification processes.     

Time‐Dependent Functions for Avoidance Behaviors Made in Response to the Circulation of HIV and AIDS

Interventions aimed at preventing HIV transmission include avoidance behaviors like condom use and reduced partner acquisition. In turn., engagement in such activities might also entail changed patterns of travel to evade contact with infected individuals. One method of estimating the effects of these actions on the observed distribution of HIV/AIDS involves the specification of space‐time models that imitate the epidemic process. This paper presents an application of this procedure where prevention is construed as a continuous population response to the evolving distribution of HIV and AIDS. This task entails the construction of models with time‐dependent parameters adapted to predicted prevalence or incidence measures to represent the effects of specific avoidance behaviors. In this respect, a multiregion model is described that serves as a baseline for analyzing the impact of preventative actions on the HIV/AIDS epidemic in Western Europe. A series of adaptation functions are derived within this system for imitating both changed rates of partner acquisition and altered travel behaviors. The results elicit modifications to the behavior of the baseline epidemic that are generated by each of these functions. Then, the conditions supporting space‐time variations in rates of survival between core countries (relatively low) and those in the periphery (relatively high) are investigated. The discussion considers the implications of these results for health policies that promote avoidance behaviors.     

AIDS Activism in Pakistan: Diminishing Funds,Evasive State

This article draws on a year of ethnographic fieldwork in the HIV/AIDS sector of Pakistan at the moment of rolling back a World Bank‐financed programme. Classified by UN agencies as at ‘high risk’ of a generalized HIV epidemic, Pakistan has an epidemiology driven by injecting drug use, and a Penal Code and Islamist legislation which criminalize non‐therapeutic drug use and extra‐marital sex. In recent years, a sharp increase in the numbers of registered HIV‐positive people has necessitated a shift from HIV prevention among ‘high risk groups’ to the provision of care to those living with HIV/AIDS. The rolling back of external funding, which was further compounded by the effects of devolution on the Ministry of Health, created challenges for AIDS activism in Pakistan, as reflected in the everyday lives — and deaths — of the patient‐activists and their community‐based organizations. This article recounts the story of one such aspiring AIDS activist caught in multiple dilemmas emanating from these macro‐processes. This story throws light on the limitations of the complex agency of actors in development, and shows how the shifting loci of power from the state to non‐state entities in the global neoliberal order impacts the provision of vital services like HIV prevention and AIDS control.     

Children’s independent mobility: the role of school-based social capital

ABSTRACT

Research has documented the decline in children’s independent mobility (CIM) globally. CIM is a measure of the level of a child’s freedom to move about his or her local neighbourhood without direct adult supervision. This paper explores the effectiveness of three intervention programmes to change travel behaviours of children to and from school in 26 Catholic primary schools in a range of urban and regional settings in Victoria, Australia. Using pre and post intervention surveys with 1600 students and parents, and interviews with school principals, we measured the influence of a range of individual, social, and built environment factors on the effectiveness of these intervention programmes. The degree of social connectedness of the school and the individual was found to have the most impact on the effectiveness of the intervention programmes to change behaviours, while the interventions themselves were not greatly effective without being embedded in a supportive school culture.     

After the Exception: HIV/AIDS Beyond Salvation and Scarcity

Abstract: Access to treatment for HIV/AIDS became a flashpoint for global justice struggles in the late 1990s. An expanding international response, premised to a significant extent on the idea of HIV/AIDS as an exceptional global problem, has since delivered treatment, care and prevention to growing numbers of people. HIV/AIDS exceptionalism, however, has increasingly been questioned, many aspects of the response have been critiqued and donor funding has started to decline. I argue that, having been framed as an exceptional humanitarian emergency, the question of HIV/AIDS as a global problem is increasingly located within a discourse of scarcity. Tracking the growing entanglement of global HIV/AIDS relief with neoliberal governmentality and the emergence of something I term therapeutic neoliberalism, I argue that the shift from a rationality of salvation to one of administration poses new challenges for global health activism. Questioning the discourse of scarcity remains essential to an alternative global health agenda.     

Securitising HIV/AIDS in the Xinjiang Uyghur Autonomous Region

For the People's Republic of China, the localised HIV/AIDS epidemics in the Xinjiang Uyghur Autonomous Region are emerging as threats to those persons affected by the disease, but also to the stability of Xinjiang. This article examines the HIV/AIDS epidemic in Xinjiang and considers the impacts it may have on human and political security. The authors argue that due to its remote location and the religious, cultural and ethnic diversity of its population, and current political situation, Xinjiang poses difficult obstacles to effective programs in tackling HIV/AIDS, and the pandemic has disproportionately affected the minority nationalities in the region compared to their Han counterparts. If the HIV/AIDS pandemic among minority nationalities in Xinjiang continues to grow, it has the potential to further weaken social cohesion there, as well as Uyghur human security. Therefore, a HIV/AIDS pandemic in Xinjiang could tip the balance in terms of ethnic and regional stability.     

Medical Research Council Programme on AIDS in Uganda – the first 10 years

Abstract

The Medical Research Council (MRC) Programme on AIDS in Uganda is based at the Uganda Virus Research Institute of the Ugandan Ministry of Health in Entebbe on the shores of Lake Victoria. The programme was established following a request in 1988 from the Ugandan Government to the UK Government for assistance with AIDS, which had recently been discovered to be a large and growing health problem in the country. At that time Uganda had the worst published rates of HIV infection in the world. Over the past 10 years, Uganda has to some extent controlled its AIDS problem while other countries have been overtaken by even worse epidemics. From the outset of the epidemic Ugandan political leaders have discussed the dangers that HIV infection presented to the country and looked for support from community and opinion leaders, including religious groups. They have used available human resources in a relevant manner to trigger important social changes. Sex education is becoming integrated into the school curriculum, programmes have been established to improve the treatment of sexually transmitted diseases throughout the country, and the use of condoms has been actively and widely promoted through free distribution and social marketing. In Uganda today, experts estimate that 10–25% of the urban population and 4–10% of the rural population are infected with HIV.     

Towards a jus in bello of Guerrilla Warfare

Abstract

Pentecostalism is the fastest growing form of Christianity in developing countries. Paralleling Pentecostalism's growth has been the HIV/AIDS pandemic. This paper examines how post-apartheid South Africans are responding to the conflicts born of the HIV/AIDS crisis. Fieldwork conducted in 2005 shows that Pentecostals who were not involved in efforts to address HIV/AIDS saw the church's mission as almost exclusively spiritual in nature. Pentecostals who were engaged in HIV/AIDS-related work were more likely to have an integrated worldview and to see the church's mission as relevant to the physical world. Beliefs about removing racism from the church and sin as structural as well as individual were also associated with this integrated worldview. These insights lay the foundation for constructing a Pentecostal social ethic for addressing HIV/AIDS.     

Great Ancestral Women: Sexuality,Gendered Mobility,and HIV among the Bamu and Gogodala of Papua New Guinea

Faced with a potentially devastating epidemic of HIV/AIDS in Papua New Guinea (PNG), sexuality and mobility have become a focus of national research and prevention programs. In Gogodala and Bamu communities in the Western Province, gendered mobility and sexuality intersect with ancestral narratives that form part of a wider series of Hero Tales found in the southern regions of PNG and Irian Jaya. In this paper we highlight the way these stories detail the travels and activities of female ancestors – known as Sagalu among the Bamui and Sawiya among the Gogodala. We outline the way such ancestral figures are now linked to understandings of contemporary STIs such HIV/AIDS as well as gendered mobility and sexuality more generally. Among the Bamu such links are sometimes directly asserted, with Sagalu represented as the origin if not cause of a uniquely defined variant of HIV/AIDS. Among the Gogodala, however, HIV/AIDS is predominantly understood as something external to the Gogodala and unrelated to ancestors like Sawiya. To explain this difference we note that, historically, Gogodala women have been less mobile and less transactable than their Bamu counterparts who have continued to enact unique understandings of the intersection of heterosexual marriage, gendered mobility, and illness. We argue that the mobility and sexuality of gendered ancestors is salient to understanding these contemporary enactments and their potential implications in light of the HIV epidemic in PNG.