Anthropology 6469
Medical Anthropology
Socio-cultural aspects of HIV/AIDS
Instructor: Nancy Romero-Daza, PhD
Meeting time and place: Monday and Wednesday, 2:00 to 3:15 p.m. SOC 258
Office hours: Monday and Wednesday 11:00 to 1:00 or by appointment
Office: SOC 137
Phone: 974-1205
E-mail: daza@chuma1.cas.usf.edu
Objective: This course is designed to provide an overview of the different social, economic, cultural, political, and ethical issues surrounding the spread of HIV/AIDS around the world. Given the extent of the literature on the AIDS pandemic, it is not feasible to cover any one topic in depth. Rather, we will briefly examine a variety of issues of special interest to anthropologists, and hope that this overview will spark students’ interest for future research on specific topics. Throughout this course we will focus our attention on anthropological contributions to the study of AIDS. However, we will also include work from other disciplines such as psychology, epidemiology, and sociology, among others. By examining other disciplines’ approaches to the study of HIV/AIDS we can better appreciate the uniqueness of anthropological contributions, and at the same time increase our understanding of the value of interdisciplinary work.
Reading materials: I have compiled approximately 45 articles that are available at Pro Copy (5219 East Fowler Avenue). In addition, we will use several articles that are not included in the package (these articles are marked with an asterisk in the bibliography). Two copies of each one of these articles will be left on reserve in suite 133. They will also be available through electronic reserve and regular reserve from the USF main library.
Requirements and expectations: This course requires the active participation of students. Rather than focusing exclusively on lecturing, I will act as a discussion leader, guiding the students in their interpretation and critique of assigned readings. Students are expected to come to class ready to discuss the assigned articles. The reading list should be considered as a basic resource guide. Students are strongly encouraged to do additional readings that will allow them to get a better grasp of the issues discussed.
Throughout the semester, each student is expected to write formal critiques for any five articles included in the reading list. These critiques should include –but not necessarily be limited to- the following items: 1. A description of the goals, methodology, and main findings of the article, 2. A discussion of the contribution the author(s) make(s) to the understanding of HIV/AIDS issues, 3. A discussion of the strengths and/or weaknesses of the approach taken by the author(s), and 4.When applicable, a description of ways in which the study could be strengthened either by the use of anthropological approaches, or the inclusion of approaches from other disciplines. The selection of articles to be critiqued is entirely up to the student. It is the responsibility of each student to ensure that he/she submits the required number of critiques throughout the semester. These critiques should be submitted via e-mail to the entire group. This will allow others to benefit from your opinions and ideas. It will also serve as a way to avoid having more than 2 people writing about the same article. Please make sure you keep copies of your e-mail messages. Each of these critiques will be graded on a 0-7 point scale. The whole set of critiques will account for 35% of the course grade (you will receive from 0 to 35 points).
Students will work in teams of 3 to 4 people to carry out additional research on a population that is not covered in our readings. Possible topics include: HIV/AIDS among college students; HIV/AIDS among elderly people; HIV/AIDS among transvestite/ transgendered individuals; the needs of AIDS care givers (e.g., relatives, partners, friends, volunteers who provide care for those suffering from AIDS).This list is not exhaustive. Students can also examine the attached bibliography for the course, and come up with their own suggestions for further research. This research project involves work through out the whole semester, so students need to choose their team partners and research topic as soon as possible. Please use the class e-mail list to exchange ideas and to find interested team members. Topics and team information must be submitted to me by Wed, September 13th at the very latest. Each research team will be responsible for the following:
1. Conducting a literature search on the topic. This should include sources from a variety of disciplines and geographic areas to get as wide a breadth of approaches as possible.
2. Identifying the way in which anthropologists have contributed to the understanding of the issue. Or, if no anthropologists have been involved, identifying ways in which anthropological approaches/methodologies could be used in this area of research.
3. Assessing the community services that are available LOCALLY to address the needs of the population you are studying.
4. Providing suggestions or recommendations about ways to enhance available resources/services to maximize their effectiveness. This should emphasize the role of anthropologists as advocates and designers of services.
Each team will present their findings to the whole group at the end of the semester, and will provide a 20-30 page project report. This report is due no later than the last day of classes. Each team will also provide their bibliographical references to the rest of the students via e-mail. The research component will account for 45% of the course grade (you will receive from 0 to 45 points). Since all the members of the team will receive the same grade, it is the responsibility of team members to work out ways to ensure that everyone contributes equally to the research project.
Finally, students will participate in an on-going research project. I have been contacted by the Ryan White Care Council, and asked for student assistance in conducting a needs-assessment in Hillsborough and surrounding counties. The goal of this project is to identify gaps in the provision of services to HIV positive individuals of different ages and ethnic backgrounds. Under the training and supervision of a Care Council member, students will assist in collecting data from community members at homeless shelters, clinics, and community-based organizations. Students are expected to work between 15 and 20 hours in total from the beginning of October to the end of November. Students should keep detailed notes of their research activities, and write a brief statement evaluating their participation in the project. These materials should be given to me on or before the last day of classes. This exercise will allow students not only to participate in an actual research project, but also to contribute their skills to the community. Participation in this project will account for the remaining 20% of the course grade (you will receive from 0 to 20 points). Please note that this is not the research project I direct, which is also funded by the Ryan White, but centers on the development of a cultural sensitivity training for agencies that provide services to HIV positive African Americans.
Final grades: The final grade will be calculated by adding the points obtained in each of the requirements described above. Letter grades will be assigned as follows (please check http://acad.usf.edu/grades.html for regulations concerning the plus/minus grading system):
95 to 100 A 90 to 94 A-
86 to 89 B+ 82 to 85 B 80 to 81 B- 76 to 79 C+ 72 to 75 C 70 to 71 C-
66 to 69 D+ 62 to 65 D 60 to 61 D-
Less than 59 F
Incomplete grades: Incomplete grades will only given under very special circumstances. To be eligible for an incomplete, the student must have had completed at least 2/3 of the course requirements and have a satisfactory grade up to that point. A contract will be signed specifying the deadline for completion of work.
Course schedule: The following is a tentative course outline. Changes will be made to this schedule as necessary
Date Topic Assigned readings
8/28 Course overview and Introduction
8/30 The AIDS pandemic in numbers Movie, “AIDS the plague
of the century”
HIV AIDS surveillance report Vol 11, No. 2
9/4 Labor day, no class
9/6 Anthropology and the study of Inhorn and Brown 1997
infectious diseases Bolton 1995*
Clatts 1994
9/11 Political economic perspective Singer 1998a, 1998b, 1994
9/13 The psychological and sociological view Bajos and Marquet 2000
Bandura 1994
Diaz and Villagran 1999
Rosentock et al. 1994
9/18 The feminist perspective Treichler and Warren 1998* Wilton 1997*
9/20 Media studies Bird 1996
Tulloch and Lupton 1997*
9/25 The power of language Leap 1995*
Nardi 1990*
9/27 Quantitative and biological studies Himmelgreen and Singer 1998 McGrath 1990
Singer et al. 1998
10/2 Methods of data collection O’Connell 2000
Pierret 2000
Trotter 1995
Singer et al. 1995
10/4 Methodological challenges Bourne 1998* Glick-Schiller et al. 1994
Schoepf 1991
10/9 HIV/AIDS and women Movie “Fighting for our
lives”
10/11 Same-sex sex and AIDS among womenHunter and Alexander 1996*
Ramos 1997*
10/16 Heterosexual transmission of AIDS Rhodes and Cusick 2000 Salgado et al. 2000
10/18 Women and HIV prevention Sobo 1998
Torres et al 1999
Weeks et al 1999
10/23 Affected women as mothers Movie: “Family album”
Lovell-Banks 1996*
10/25 The needs of children Draimin 1995*
Groce 1995*
10/30 Commercial sex and AIDS Movie: “Two dollars with or
without a condom”
Elifson et al 1993*
Esu-Williams 1995*
Romero-Daza et al 1999
11/1 Same-sex sex and AIDS among men Gorman 1997
Stokes and Peterson 1998
11/6 AIDS and drug use Burgois and Bruneau 1999 Huby 1998*
Sterk and Elifson 1999
11/8 AIDS and ethnic minorities Friedman et al 1998
Haour-Knipe et al 1999
Lang 1994
Singer and Weeks 1996
11/13 AIDS and other vulnerable groups Brown and Jemmott 2000
Clatts 1999
Grinstead et al 1999
11/15 AAA meetings. No class (work on team project)
11/20 AIDS in the developing world Movie: Oda Ya. Life with
AIDS
Farmer 1997
Kreniske 1997
11/22 AIDS in Africa Green 1999
Romero-Daza and
Himmelgreen 1998
11/27 AIDS testing and treatment Chesney and Smith 1999
Coreil et al. 1998
DeZuleta 2000
Lenelle and Harrington 1998
11/29 Research team report
12/4 Research team report
12/6 Research team report
Introduction, Anthropology and the study of infectious diseases
Bolton, R. (1995) Rethinking Anthropology. The study of AIDS. In Culture and sexual risk: Anthropological perspectives on AIDS. Australia, Gordon and Breach: 285-313
Clatts, M. (1994) All the king’s horses and all the king’s men: Some personal reflections on ten years of AIDS ethnography. Human Organization 53,1:93-95
Inhorn, MC and PJ Brown (1997) The anthropology of infectious disease. In Anthropology of infectious disease: International health perspective. Theory and practices in medical anthropology and international health. Vol 4, Amsterdam, Gordon and Breach Publishers: 31-67
Political economic perspective:
Singer, M. (1994) AIDS and the health crisis of the U.S. urban poor; the perspective of critical medical anthropology. Social Science and Medicine, 39,7:931-948.
Singer, M. (1998a) Forging a political economy of AIDS. In M. Singer (ed.) The political economy of AIDS, Baywood Publishing Company, Inc., Amityville, New York: 3-31.
Singer, M. (1998b) Articulating personal experience and political economy in the AIDS epidemic: the case of Carlos Torres. In M. Singer (ed.) The political economy of AIDS, Baywood Publishing Company, Inc., Amityville, New York: 61-73.
Psychological and sociological approaches:
Bajos, N. and J. Marquet (2000) Research on HIV sexual risk: Social relations-based approach in a cross-cultural perspective. Social Science and Medicine 50,11:1533
Bandura, A. (1994) Social cognitive theory and exercise of control over HIV infection. In Di Clemente RJ (ed.) Preventing AIDS, theories and methods of behavioral intervention, New York, NY Plenum Press
Diaz-Loving, R., and G. Villagran-Vazquez (1999) The theory of reasoned action applied to condom use and request of condom use in Mexican government workers. Applied Psychology: an International Review, 48,2:139-151.
Rosenstock, IM, VJ Strecher, and MH Becker (1994) The Health Belief model and HIV risk behavior change. In In Di Clemente RJ (ed.) Preventing AIDS, theories and methods of behavioral intervention, New York, NY Plenum Press
Feminist perspective:
Treichler, P. and C. Warren (1998) In N.L. Roth and K. Hogan (eds.) Maybe next year. Feminist silence and the AIDS epidemic. In Gendered epidemic. Representations of women in the Age of AIDS. Routledge, New York: 109-152.
Wilton, T. (1997) Sex, Text, Power. In T. Wilton EnGendering AIDS. Deconstructing sex, text, and epidemic. Sage Publications, London: 1-11.
Media studies
Bird, E. (1996) CJ’s revenge: Media, folklore, and the cultural construction of AIDS. Critical Studies in Mass Communication, 13:44-58
Tulloch, J. and D. Lupton (1997) Advertising AIDS. In J. Tulloch and D. Lupton Television, AIDS, and risk. A cultural studies approach to health communication. Allen and Unwin, Australia: 29-49.
The power of language
Leap, W (1995) Talking about AIDS: Linguistic perspectives on non-neutral discourse. In Culture and sexual risk. Anthropological perspectives on AIDS, Australia, Gordon and Breach: 227-238
Nardi, P.M. (1990) AIDS and obituaries: the perpetuation of stigma in the press. In D.A. Feldman (ed.) Culture and AIDS, Praeger, Westport, CT: 159-168.
Quantitative and biological studies
Himmelgreen, D. and M. Singer (1998) HIV, AIDS, and other health risks: Findings from a multisite study -an introduction. American Journal of Drug and Alcohol Abuse, 24,2:187-197.
McGrath, J.W. (1990) AIDS in Africa. A bioanthropological perspective. American Journal of Human Biology 2:381-396
Singer, M., D. Himmelgreen, R. Dushay, and MR Weeks (1998) Variation in drug injection frequency among out-of-treatment drug users in a national sample. In American Journal of Drug and Alcohol Abuse, 24,2:321:341
Methods of data collection
O’Connell, AA (2000) Sampling for evaluation. Issues and strategies for community-based HIV prevention programs. Evaluation and the health professions 23,2:212
Pierret, J. (2000) Everyday life with AIDS/HIV: Surveys in the social sciences. Social Science and Medicine 50,11:1589
Trotter, R. (1995) Drug use, AIDS, and ethnography: Advanced ethnographic research methods exploring the HIV epidemic. Qualitative methods in drug abuse and HIV research. National Institute on Drug Abuse research monograph series, #157 (NIH publication # 95-4025), Rockville, MD: 38-64.
Singer, M., N. Romero-Daza, M. Weeks, and P. Pelia (1995) Ethnography and the evaluation of needle exchange in the prevention of HIV transmission. Qualitative methods in drug abuse and HIV research. National Institute on Drug Abuse research monograph series, #157 (NIH publication # 95-4025), Rockville, MD: 231-257.
Methodological challenges:
Bourne, J. (1998) Researchers experience emotions too. In R.S. Barbour and G. Huby (eds.) Meddling with mythology. AIDS and the social construction of knowledge, Routledge, London: 90-103.
Glick-Schiller, N, S. Crystal, and D. Lewelen (1994) Risky business: the cultural construction of AIDS risk groups. Social Science and Medicine, 38,10:1337-1346.
Schoepf, BG (1991) Ethical, methodological, and political issues in AIDS research in Southern Africa. Social Science and Medicine 33: 748-763
Same-sex sex and AIDS among women
Hunter, J. and P. Alexander (1996) Women who sleep with women. In L.D. Long and M. Ankrah (eds.) Women’s experiences with HIV/AIDS. An international perspective Columbia University Press, New York: 43-55.
Ramos, L.J. (1997) “Si, tenemos sexo con mujeres pero no somos marimachas” (Sure, we have sex with women, but we’re not lesbians.): Sexual diversity in the Los Angeles Latina community. –Ethnographic findings, 1987-95. In N. Goldstein and J.L. Manlowe (eds.) The gender politics of HIV/AIDS in women: Perspectives on the pandemic in the United States. New York University Press, New York:127-154.
Heterosexual transmission of AIDS
Rhodes, T. and L. Cusick (2000) Love and intimacy in relationship risk management: HIV positive people and their sexual partners. Sociology of Health and Illness. 22,1:1
Salgado de Snyder, V.N., A. Acevedo, MJ Diaz Perez, and A. Saldivar-Garduno (2000) Understanding the sexuality of Mexican born women and their risk for HIV/AIDS. Psychology of women quarterly 24,1: 100
Commercial sex and AIDS
Elifson, K.W., J. Boles, and M. Sweat (1993) Risk factors associated with HIV infection among male prostitutes. American Journal of Public Health 93(1): 79-83
Esu-Williams, E. (1995) Clients and commercial sex work. In E. Reid (ed.) HIV and AIDS, the Global Interconnection. Kumarian Press, West Hartford, CT: 91-99.
Romero-Daza, N., M. Weeks, and M. Singer (1999) Much more than HIV! The reality of life on the streets for drug-using sex workers in inner city Hartford. International Quarterly of Health Education, 18,1:107-119.
Women and HIV prevention
Sobo, E. (1998) Love, jealousy, and unsafe sex among inner city women. In M. Singer (ed.) The political economy of AIDS, Baywood Publishing Company, Inc., Amityville, New York: 75-103.
Torres, M.I. R. Tuthill, S. Lyon-Callo, C.M. Hernandez, and P. Epkind (1999) Focused female condom education and trial: Comparison of young African American and Puerto Rican women ‘s assessments. International Quarterly of Community Health Education, 18,1:49-68.
Weeks, M., M. Grier, K. Radda, and D. McKinley (1999) AIDS and social relations of power: Urban African American discourse on the context of risk and prevention. In Power in the blood: A handbook on AIDS, politics, and communication Elwood, WN (ed.) Mahwah, NJ, Lawrence Erlbaum Associates: 181-197
Affected women as mothers:
Lovell Banks, T. (1996) Legal challenges: State intervention, reproduction, and HIV infected women. In R.R. Faden and N.E. Kass (eds.) HIV, AIDS, and childbearing. Public policy, private lives. Oxford University Press, New York: 143- 177.
The needs of children:
Draimin, B (1995) A second family? Placement and custody decisions. In S. Geballe et al. (eds.) Forgotten children of the AIDS epidemic, Yale University Press, New Haven: 125-139.
Groce, N.L. (1995) Children and AIDS in a multicultural perspective. In S. Geballe et al. (eds.) Forgotten children of the AIDS epidemic, Yale University Press, New Haven: 95-106.
Same-sex sex and AIDS among men
Gorman, M., B. Barr, A. Hansen, B. Robertson, and C. Green (1997) Speed, sex, gay men, and HIV: Ecological and community perspectives. Medical Anthropology Quarterly, 11,4:505-515.
Stokes JP, JL Peterson (1998) Homophobia, self-esteem, and risk for HIV among African American men who have sex with men. AIDS education and prevention 10: 278-292
Rofes, E. (1998) Creating post- AIDS lives. In E. Rofes Dry bones breathe. Gay men creating post-AIDS identities and cultures. Harrington Park Press, New York: 73-94.
AIDS and drug use:
Burgois, P. and J. Bruneau (1999) Needle Exchange, HIV infection, and the politics of science: Confronting Canada’s cocaine injection epidemic with participant observation. Medical Anthropology, 18,4:325
Huby, G.(1998) On networks and narratives. Research and the construction of chaotic drug user lifestyles. In R.S. Barbour and G. Huby (eds.) Meddling with mythology. AIDS and the social construction of knowledge, Routledge, London: 162-180.
Sterk, C.E. and K.W. Elifson (1999) Fluctuating drug markets and HIV risk taking: Female drug users and their relationship with drug markets. Medical Anthropology 18,4: 439
AIDS and ethnic minorities
Friedman, S., B. Jose, B. Stepherson, A. Neaigus, M. Goldstein, P. Mota, R. Curtis, and G. Ildefonso (1998) Multiple racial/ethnic subordination and HIV among drug injectors. In M. Singer (ed.) The political economy of AIDS, Baywood Publishing Company, Inc., Amityville, New York: 105-127.
Haour-Knipe, M, F. Fleury, and F. Dubois-Arber (1999) HIV/AIDS prevention for migrants and ethnic minorities. Three phases of evaluation. Social Science and Medicine, 49,10:1357
Lang, N. (1994) HIV, immigration policy, and Latinos/as: Public health safety versus hidden agendas. In D. Feldman (ed.) Global AIDS policy, Bergin and Garvey, Westport, CT: 61-69.
Singer, M. and M. Weeks (1996) Preventing AIDS in communities of color: Anthropology and social prevention. Human Organization, 55,4:488-492
AIDS and other vulnerable groups
Brown, E. and L.S. Jemmott (2000) HIV among people with mental illness: Contributing factors, prevention needs, barriers, and strategies Journal of psychosocial nursing and mental health services 38,4:14
Clatts, M. (1999) A demographic and behavioral profile of homeless youth in New York city. Implications for AIDS outreach and prevention. Medical Anthropology Quarterly 13,3:365
Grinstead, O.A., B. Zack, and B. Faigeles (1999) Collaborative research to prevent HIV among male prison inmates and their female partners. Health Education and Behavior 26,2: 225-238.
AIDS in the developing world
Farmer, P. (1997) Ethnography, social analysis, and the prevention of sexually transmitted HIV infection among poor women in Haiti. In The Anthropology of infectious disease: International health perspective. Theory and practices in medical anthropology and international health. Vol 4, Amsterdam, Gordon and Breach Publishers:
Green, E. (1999) Engaging indigenous African healers in the prevention of AIDS and STDs. In Anthropology in Public Health, bridging the difference in culture and society R.A Hahn (ed.) New York, Oxford Press: 63-83
Kreniske, J. (1997) AIDS in the Domenican Republic: Anthropological reflections on the social nature of disease. In G.C. Bond et al. (eds.) AIDS in Africa and the Caribbean Westview Press, Oxford: 33-50.
Romero-Daza, N. and D. Himmelgreen (1998) More than money for your labor. Migration and the political economy of AIDS in Lesotho. In M. Singer (ed.) The political economy of AIDS, Baywood Publishing Company, Inc., Amityville, New York: 185-204.
AIDS Testing and treatment
Chesney, M. and A. Smith (1999) Critical delays in HIV testing and care. The potential role of stigma. American Behavioral Scientist 42,7:1162-1174.
Coreil, J., P. Losikoff, R. Pincu, et al. (1998) Cultural feasibility studies in preparation for clinical trials to reduce maternal infant HIV transmission in Haiti. AIDS education and prevention 10:1 46-62
De Zulueta, P. (2000) The ethics of anonymised HIV testing of pregnant women: a reappraisal. Journal of Medical Ethics 26,1:25-26
Lemelle, A. and C. Harrington (1998) The political economy of care giving for people with HIV/AIDS. In M. Singer (ed.) The political economy of AIDS, Baywood Publishing Company, Inc., Amityville, New York: 149-166.
For the latest statistics, news, and updates on the pandemic and efforts in HIV/AIDS prevention and treatment, please check the following web-site periodically. This site also provides links to other useful information from PAHO, WHO, UNAIDS, etc.
http://www.cdc.gov/hiv/graphics.htm