Lecture 7: Case study: Understanding HIV risk in the aids Pandemic's Epicentre

The epicentre: eastern/southern Afrika. 10% of the world population lives there. 75% of all people infected with HIV and 75% of newly infected people live there. 

Differences between psychology and anthropology

Anthropology: how individuals’ behaviour is shaped more by group norms and values, but they have been too focused on group norms. They studied only the cultures and took themselves as the norm and the other as needed of explanation. We still see this today. But, our own point of view needs explanation too. The individual perspective of a culture lacked, not everyone in a culture is the same. The lay people still see their own culture as the norm and that everyone within a culture thinks the same. 

• The cultural difference within nations and cultural similarity across nations. 
• People think that the way they learned it, is the way it should be/ it ought to be. 

Cultural relativism: becoming aware that we are also trained to see the world a certain way. The opposite of ethnocentrism. Differences between groups of people are not biological but cultural (‘man-made’/ taught). Franz Boas: "civilization is not something absolute, but is relative, and our ideas and conceptions are true only so far as our civilization goes”. cultural relativism has consequences for data collection. 

Cross-cultural research (speciality of anthropologists) 

Data collection: it suggests that the data is out there, has a form/shape, regardless of who finds it. That's not true, data is not easy to find. A lot of the time people just ask what they want to know, but when asked sensitive questions (about HIV for example), people don't always answer honestly. Also, our concepts of things/situations aren't always the same. For example, marriage is very different in the West, then in Afrika. 

Ethnographic research: a qualitative research method centred upon direct and sustained, naturalistic interaction with people in the context of their daily lives in an attempt to grasp the world from their perspective.

• Etic/outsiders’ perspective: e.g. In ‘experience-distant’, biomedical concepts 
• Emic/insiders’ perspective: ‘experience-near’, locally meaningful concepts and classifications

How to gain the trust of a culture: participate in the daily lives, activities. Trying to bond with the people. Bodily experiencing helps to understand the people.  

Differences in world views: Gender

Malawi: you squat down when talking to someone older. Social hierarchy is much more related to age/seniority than gender. Gender not a universal social stratifier in that society. In Malawi, you have words for a younger and older sibling, instead of brother or sister. 

Cultural differences in health

Everywhere people try to make sense of health problems and seek ways to prevent and cure these. So many profound differences about what health attains and how you can achieve this. 

• When is a body alive/dead/healthy/ill?
• Body-mind division
• Individual vs social body
• Naturalistic vs personalistic causes of illness 

Health & illness explanations worldwide 

Biomedical ‘belief’ system is very superficial. The biomedical doctor says take this pill and your body will be restored. This system is a belief system too. Have you seen a virus? We have been told that it works like that, and believe it. 

HIV/aids in the pandemic’s epicentre southern Africa 

Telling people is not enough.

HIV is not a very contagious virus; you need a lot of the virus and it should be released in the bloodstream. Probabilities of getting HIV when having unprotected sex: women: 1 in 500; men: 1 in 1000. Only when semen can get in the bloodstream (wound). Not everyone gets it. The campaigns say: everybody can get HIV, but it is not the reality that people see. 

Problem: HIV continues to spread despite the high levels of awareness. 

What makes this epidemic so extraordinary, why so many people there and not here, so demographically different?

Biological explanations: were there any biological difference, no. 

Cultural explanations: the claimed: stimulation of sex, uncontrolled sexual drive of African women/man. Lineage family. More freedom, not only sex with the husband.

--> it was a comfort for other people: it's them, not us. 

--> then, more epidemics. The cultural explanation did not hold anymore. 

Dr. Paul Farmer: vulnerability approach: “Real cause of most diseases is not in the biological body, but in the social context.” If people have structural deficiencies, it will affect people's health. = ’Structural violence’: social/political/economic structures or institutions which harm people by preventing them from meeting their basic needs. 

Structural vulnerabilities approach to HIV infection (paper Parker 2001)

Marginalization & impoverishment: Malnourished bodies are more susceptible to any kind of infection, including HIV. Also, low-quality living circumstance, health care services, education, infrastructure etc. If you don't have access to medication/healthcare, that will also increase the infection rates. High-risk survival strategies (migration, transactional sex) - pushing men to migrate, which leads to more short-term sexual relationships, when they migrate back, they spread the disease. 

Gender inequality: “women most disadvantaged!” -  the only thing that women have, is their body to survive. Women are especially disadvantaged in poverty. Women receive something for sex, in the West we interpret that as prostitution, but it is not like that. 

The ‘Transactional Sex’ paradigm: Assumption that low social and economic status forces women to direct exchanges of sex for resources needed for survival. It underlies much of the current thinking on African women’s persistent engagement in risky sexual practices. It leads to the conclusion that women must be economically empowered to halt AIDS pandemic. --> focus right now: Women, make them independent. Give them the choices that we think they want to make. 

The sexual and partnership choices are very risky: 

• Quick acceptance of proposals, even from unknown men, they form relationships extremely quick (for example within one day); 
• Both men and women have extramarital relationships, relationships are quite short (frequent partner change); 
• Low condom use, the use of condoms is connected to HIV/Aids, so if someone suggests the use of condoms, it is directly connected to HIV. 
• Also, people with HIV will die soon and cannot reciprocate help she gets. Or she will not get help because she will die soon. 

Men and women really need each other. Men do all the work (build houses, get food, get soap etc.). Women can’t do it; it is looked down on. A single woman is seen as strange, people will not help them, especially if she declined a husband. 

Sexual norms & values in southern Malawi:

• Elaborate initiation rites for sexual instruction, especially of girls 
• Sex is almost a sacred undertaking, to be performed with the utmost care, very powerful forces come with it. There are a lot of sexual rituals (for example the death of a partner). 
• Vital for personal health, relationship stability, and community survival 
• Should be enjoyable for both partners, there is a very positive attitude towards sex. 

But what is ’safe’ sex? What do professionals think of sex?

“Risky” sex in Mudzi (Malawi)?

In the social risk perspective, condom use and abstinence are risky. 

Intersecting forces that causes HIV to spread. 

• Biological vulnerability - women are more at risk (vaginal skin tears easily)
• Structural economic deprivation
• Cultural sex & gender & health/illness constructs 

--> Individual perceptions of risk and efficacy (etc) shaped by these wider societal, cultural and material factors! None of these can be meaningfully disentangled from the others. 

Reasons for sexual relationship: Gendered division of tasks: men provide extra’s, build house etc / Conformation to ideal of being married = respectable status, community inclusion, safety net / Sex is vital for good health & community survival (only through children can one become a real woman) / Lust & love  

So... Women’s decision to engage in (high-risk) sexual relationships partly instigated by the desire for direct material benefit. But that is rather a result of cultural constructs than the difference between male wealth/female poverty. Additional motivations are not directly related to material support that a man might provide.