HIV

Patrick's Wish

alicia — Thu, 04 Nov 2010 16:00:00 +0000

Patrick's Wish is a true story told from the perspective of a young girl whose brother had a serious illness. It is evident from page one that there was some serious hero worship going on when it came to her older brother, Patrick. The book itself has an almost scrapbook feel to it, with alternating pages of text and photographs from Patrick and Lyanne’s childhood, and it details Lyanne’s eventual discovery that her brother’s illness is terminal.

Patrick, a hemophiliac, contracted HIV from a blood transfusion, and while he and his parents kept this secret for many years, Patrick ultimately decided he needed to share his diagnosis with the rest of his family. As he moved through adolescence with relatively few symptoms, Patrick and his family became active in spreading the word about AIDS and raising money for medical research.

Patrick's Wish chronicles his journey as an active young man who eventually took the incredibly difficult step of educating his peers about HIV and AIDS in an effort to remove some of the stigma from those who suffer from the disease. When Patrick’s body finally succumbed to the effects of AIDS, Lyanne took up the torch and continued her brother’s work.

Patrick's Wish is aimed at children and does an admirable job of using the voice of a young girl to impart its message. Full color photographs help the reader to visualize Patrick and his family as any other family. The “hard science” of the disease itself is explained in a way that is understandable for children. I especially appreciated the HIV/AIDS facts on the last two pages of the book, which provide concrete information about the disease, its transmission, and its treatment.

My eight- and ten-year-old daughters both asked to read Patrick's Wish, which created the perfect opportunity to engage in a discussion about HIV and AIDS. The girls asked whether we knew anyone who was HIV positive and were interested to know whether their schools could benefit from presentations or special education on the disease. The book’s other merits notwithstanding, this gave us more than enough reason to read and recommend Patrick's Wish.

Written by: Kari O'Driscoll, November 4th 2010

All of Us

annette — Thu, 23 Sep 2010 10:00:00 +0000

Directed by Emily Abt

Pureland Pictures

Emily Abt's emotionally stirring documentary, All of Us, takes us not just on a journey from the South Bronx to Ethiopia and back, but to a place deep within ourselves. The film follows Dr. Mehret Mandefro, as she embarks on a mission to uncover the truth behind the startling statistics regarding women of color and HIV infections in the United States. According to the film, African-American females compose approximately 12% of the population, yet according to the 2005 CDC report, a staggering 66 % of this minority accounted for new infections with the virus in the United States. The dynamics of power, control and domination play a role in the rising rate of HIV infections. However, other crucial factors are also explored including social roles, the exploitation of women and a prison culture that allows the epidemic to thrive.

The film takes us into the personal lives of two HIV positive women struggling with not just their health but with the effects of being a disadvantaged minority. Chevelle, an addict since she was a teenager, is recently clean, raising a family and looking forward to her upcoming wedding. Positive and motivated, she is determined to get an education and to share her life experience with young African-American women who may be about to follow the same destructive path that she once did. Tara, on the other hand, is not just battling HIV but also cervical cancer. However, her deepest personal struggle may be her inability to say no to her partner given her painful past experiences of sexual abuse and rape. Her relationship is on the rocks as her fear and frailness do not hinder her boyfriend from pressuring her to have sexual relations as she is recovering from surgery.

Perhaps the real power struggle confronts the viewer when we see Dr. Mandefro herself become vulnerable in her personal life. Not just this experience but also her visit to her home country, Ethiopia, a country that has the sixth largest AIDS infection rate in the world, as well as a 'truth circle' with her privileged friends leads her to the conclusion that strong educated women are also facing a silent power struggle in the bedroom. This may be one of the most significant aspects of the film, as it emphasizes that this is not a social class issue as it may initially be perceived to be. The reality is that young, educated, empowered women are also vulnerable and risk infection because of the dynamics that thrive in their personal relationships.

All of Us is not about a young Ethiopian-American doctor, nor is it about HIV-positive women residing in the South Bronx. It is about us as women. It is the story of every woman, what we know versus what is expected of us, and ultimately, the decisions we make given the circumstances that society and culture have thrust upon us. At the core of this film is a moving realization of empowerment. It is the reality that regardless of social status, education or economic advantage we all still live as women in a society where men may have the final say not just in how we live, but rather in how we die.

Written by: Aneesa A. Baboolal, September 23rd 2010

The Other City

beth — Thu, 23 Sep 2010 02:00:00 +0000

Directed by Susan Koch

Cabin Films

Most cities are comprised of at least two distinct sub-cities, so to speak. It’s particularly appalling that Washington, D.C., the nation’s capital and symbolic of the triumph of democracy, has a higher HIV/AIDS rate than Port au Prince, Haiti or Dakar, Senegal. A one percent infection rate of a city’s population is considered an epidemic; D.C.'s can be estimated between three and five percent. While one part of the District’s population goes about the business of running the country, another goes about the business of trying to stay alive.

More than one million people in the United States are currently infected with HIV/AIDS; of those infected, one in five do not know they are infected. It is the leading cause of death for black women ages twenty-five to thirty-four. The epidemic rages on, though goes largely unnoticed outside of certain communities. The visible reminders, like public funerals and rallies that were popular in New York City in the 1980s, have largely faded from the public eye and popular discourse.

The epidemic has shifted, however. Once stereotypically attributed to men who sleep with men and drug users, the problem has largely settled over poor communities. In The Other City, the epidemic’s many D.C.-area victims and survivors are shown in a variety of situations and circumstances. Jose’s ex-boyfriend lied about being infected. Donald, who had been living in his parents’ basement, moved into the Joseph’s House hospice and thrived. Still, after more than thirty-five of his friends died, he moved out, saying, “It’s worse than war.”

J’Mia, who is twenty-eight with three kids, worries that because of the myriad legal documents needed to apply for subsidized housing—many of which she struggles to find, spending entire days making phone calls—she’ll end up on the street. If she ends up homeless, she insists that she won’t take her pills and will sleep with whoever will put a roof over her family’s heads. In the housing counseling office, she’s asked demeaning questions like “How many sex partners have you had?” Despite all of this, she speaks with authority about how women are caregivers and take care of others before themselves. Her pride and perseverance is encouraging, a hopeful ray in a dark situation.

While the stories The Other City highlights are critical, the film itself is incredibly frustrating. It shifts between narratives and profiles without helpful transitions, making it seem more like a series of vignettes about living with HIV/AIDS than an actual narrative about the epidemic in the District. Formerly incarcerated men in a support group are shown in a scene next to a hospice where AIDS patients come to die. While the theme technically holds together, the images and stories feel disjointed when presented in such a way. Shot on video, the visuals feel crude and unpolished.

As someone with a family member who has been living with HIV/AIDS since the 1980s, you would think I would be particularly drawn to this film. I was not. I appreciate what the filmmakers—many of them highly acclaimed and well respected in their field—attempted to do in telling the ignored stories of the often faceless victims of the AIDS epidemic, the problems facing needle exchange programs, and the history of mismanagement in combating the domestic epidemic. But whether the filmmakers’ efforts were hindered by class privilege or a lack of true connection to their subjects is unknown. I’m incredibly pleased that films like this one are made, but I wish they were as captivating as the subjects they feature.

Written by: Brittany Shoot, September 22nd 2010

Sin, Sex and Stigma: A Pacific Response to HIV and AIDS

admin — Mon, 12 Jul 2010 00:00:00 +0000

By Lawrence James Hammar

Sean Kingston Publishing

If you took an undergraduate course in anthropology, chances are high that you learned about the South Pacific. Notables like Margaret Mead and Bronislau Malinowski made their marks there, and it continues to be a part of the world that many think of with intrigue and wonder. Anthropologist and ethnographer Lawrence James Hammar continues on the path of many greats in Papua New Guinea, but he takes a distinctly sharp turn in his subject matter.

According to Hammar, HIV/AIDS present a problem in Papua New Guinea in a unique way. Having studied it for years, he has an incredibly passionate and firm opinion on how the country is failing its people and why. He tackles gender roles and perceptions of appropriate sexual behavior, which suggest that protected sex has no place between couples. This is precisely the problem, as HIV transmission is mainly occurring between heterosexual couples.

The current HIV/AIDS education and prevention methods fail to acknowledge Papua New Guinea’s sexual networks. The one-size-fits-all approach does not take into account the sex trade or the gross injustices that women face when it comes to expression and control over sexuality. Likewise, the pervasive influence of the Church has essentially forbidden discussion and distribution of condoms in many areas. Church leaders have gone public with anti-condom messages with blatant lies about their effectiveness and have contributed to the overall stigma of protected sex. Hammar dramatically refers to this dilemma as “Biological death versus social leperhood.” To further describe this situation, he explains the multiple interpretations of the ABC (Abstain, Be Faithful, Condoms) message. Instead of condoms, some are teaching “C” to stand for commitment or Christian values. While this alone is not objectionable, Hammar points out that this ignores the reality of what is occurring in Papua New Guinea and contributes to the overall situation of HIV/AIDS not being dealt with in a productive manner.

Hammar sounds infuriated at times in this book, and the reader cannot help but feel the same. Though this situation is replicated in other forms the world over, Hammar pounds the Papua New Guinea-specific message home: What’s being done now isn’t working and it’s harmful. In the epilogue, he finally addresses the role of the anthropologist and takes up the difficult topic of how positive change might be effected as a result of his research and findings. He acknowledges the conflicting perspectives and the respect he has for the country and its people while also setting the stage for what hopefully will lead to constructive conversation.

Overall, Sin, Sex and Stigma reads like an academic text with very few literary flourishes added for readability. Its audience is very specific, and even within that audience, some readers may have difficulty following Hammar’s writing. Though informative, the book is heavy in content and delivery, and should only be considered by those who are already interested in the topic at hand.

Written by: Shana Mattson, July 11th 2010

Missing Bodies: The Politics of Visibility

admin — Fri, 30 Oct 2009 23:59:00 +0000

By Monica J. Casper, Lisa Jean Moore

New York University Press

It is hard to deny the creeping, theatrical aspect that seems to permeate every mode of information and method of exposure we are subjected to daily. While once relegated to advertisements, television, and movies, the careful craft of showcasing and presenting certain bodies is now seen in governments, military, and the health industry. Why some bodies are overexposed while others are seemingly non-existent is useful in determining the underpinnings of American society and agenda. Monica Casper and Lisa Jena Moore explore these politics behind the visibility of certain bodies in Missing Bodies: The Politics of Visibility.

Upon first thought, this book might appear to be a critique of the media, a poignant peek into the ways in which the use of stereotype highlights certain bodies at the expense of others—but that topic is one that is otherwise understood, and largely written about. Casper and Moore delve deeper than that. They are concerned with the bodies that appear and disappear in much less talked about fields, such as female soldiers, people living and dying with HIV/AIDS, and infant mortality. With almost the same tools the media use to derive entertainment from everyday life, political institutions are doing the same to real lives and human suffering—and with graver consequences. The bodies of dead infants, those stricken with AIDS, and female soldiers are masked by numbers, lies, and underreporting. So how do real care, understanding, healing, and prevention begin when those bodies are erased in the first place?

At the root of the analysis is the preservation of Western ideals and agendas. By switching the concern of HIV/AIDS from a public health crisis to statistical, epidemiological data that helps manage government and secure the status of the state, there is a displacement of pain, suffering and death. The public has a harder time envisioning real people living with this disease amidst the quantitative numbers than they do erroneously understanding that HIV/AIDS is more of a disease that plagues other nations. Similarly, framing the release story of Jessica Lynch, a female prisoner of war in Iraq, as one of feminine passivity and rescue bolsters America’s dependency on gender dichotomies which fuels wars. While Lynch’s story is ultimately lost and retold as untrue, Lynch herself, and other female soldiers that suffer sexual discrimination are rendered invisible.

Lyrical, engaging, and encompassing, this book raises important and timely questions about the construction of identity and visibility in a post-9/11 landscape. In this fast-paced, technological world, others will readily construct our stories before us for benefits that are not our own. This book urges readers to question the sources, framing, methods, and presentation of information and tragedy so that we may recover the truth behind missing bodies.

Written by: Krista Ciminera, October 30th 2009

Hiding in Hip Hop: On The Down Low in the Entertainment Industry—From Music to Hollywood

admin — Wed, 28 Oct 2009 16:09:00 +0000

By Terrance Dean

Atria Books

Terrance Dean opens his book, Hiding in Hip Hop, with two quotes, one from Ellen Degeneres, in which she states, “If it weren’t for blacks, Jews, and gays, there would be no Oscars.” The other was from The Bhagavad Gita: “It is better to live your own destiny imperfectly than to live an imitation of somebody else’s life with perfection.” With so many ways to approach this book, the latter quote is the way in which I chose to do so.

Dean gives a personal account of the trials, tragedies, and triumphs of growing up as a gay Black man, inside a world that adamantly refuses to accept his existence. Things would be tragic enough if, on the quest for a healthy identity, one had to sift out the sickness of a drug-abusing mother who, along with two brothers, dies of AIDS. A forced and self-imposed separation from family, and the discovery of a sexuality not approved of by the proverbial church that houses wolves in sheep’s clothing, add to experiences that have forced others to become a statistic.

As the title of the book suggests, Dean’s passion for hip-hop propelled him to pursue a career in an environment where his sexuality is like an oxymoron. Dean still adheres to the code of maintaining a “tell and be killed” secrecy in addressing those who are queer, respected, and revered in the hip hop world. In a world where even a hint of being gay can relegate one to lifelong ostracism, Dean is careful to play by the rules and still tell his story with brute and poignant honesty.

The Degeneres’ quote that opens the book is important because she acknowledges not only the contributions made by a group she belongs to, but also those made by two groups to which she does not. It is important because there needs to be the realization that the greatest contributions to society are not defined by sexuality. If there’s a cure for cancer, how many of you will refuse it because you don’t approve of the curer’s sexuality?

The second quote Dean used discussed living one’s own life, not that of someone else. He revealed how difficult it was to hide his sexuality, his desire to openly express his love for another man, and be fully embraced by a culture to which he so profoundly contributed. He perfected the imitation of a straight man at the cost of his spiritual, emotional, and physical well-being. By the book ended, although still healing from these issues, Dean is now unapologetically choosing to work on the perfection of his own life.

Written by: Olupero R. Aiyenimelo, October 28th 2009

Call Me Ahab

admin — Thu, 16 Jul 2009 09:05:00 +0000

By Anne Finger

University of Nebraska Press

Anne Finger’s award-winning Call Me Ahab showcases a plethora of historical and literary characters—each of whom is in some way disabled—and imagines new scenarios for their lives. It’s an exciting concept and while several of the stories in the nine-story collection left me cold, Finger is to be lauded for her originality.

Her talent is particularly vivid in "Vincent." Here, Finger brings Vincent Van Gogh into the late twentieth century. Instead of brother Theo endlessly supporting his deranged, if talented, sibling, he cuts him off, leaving Vincent to fend for himself on the teeming streets of New York City. Vincent’s heartbreaking existence is juxtaposed with that of a young, male bureaucrat employed by the Social Security Administration. The pairing is better than a social science text on service delivery, poignantly demonstrating the system’s betrayal of them both.

"Gloucester" re-imagines King Lear, but this time through the contemporary eyes of Gloucester Barrows, a middle-aged man dying of AIDS. Although Barrows is from a prominent political family—think the Kennedy or Bush clans—his marriage dissolved when his wife-of-convenience divorced him following his diagnosis. Now blind, Gloucester is eager to settle his affairs and has no choice but to rely on his two sons. Dexter, the elder, is pursuing elected office and has little time for his ailing dad; Charlie, just twenty, is a hippie’s hippie who has renounced material privilege to live in horrifying squalor. Gloucester’s navigation of this rocky terrain is pitch perfect and emotionally riveting.

"The Blind Marksman" takes readers into a mock socialist dystopia under the rule of “the Great Pilot of Our People, the Beacon of Hope to the Proletarians of the World, the Heroic Leader of the Struggle Against the Fascist Invader,” and introduces a blind marksman whose one-time feat with a bow-and-arrow is embellished with each telling. Like the children’s game of “telephone,” the story becomes more and more absurd, until in the end regime change renders the marksman a caricature of his former self.

The story implies that socialism is no better at protecting individuals than capitalism. But is this true? Call Me Ahab, winner of the Prairie Schooner Book Prize in Fiction, is full of questions and what-ifs. For example, what if Moby Dick was told from Ahab’s perspective? What might Helen Keller and Frida Kahlo have discussed if they’d met? Finger’s "Helen and Frida" presents a bawdy conversation between the two that will leave you reeling, grinning, or both. Other stories feature those whose perspectives are not typically considered—the dwarf in painter Velasquez’ Las Meninas; a Jewish artist commissioned to draw disfigured internees for Hitler’s medics; and feeble-minded Ned Lud, the man behind the anti-machine Luddite Rebellion, among them.

Throughout, there’s attention to the Holocaust, anti-Semitism, sexism, racism, and discrimination against people with disabilities. While message is never sacrificed to craft, Finger wants readers to appreciate the contributions made by those with physical and psychological limitations. “Who is our greatest poet after Mr. Shakespeare?” she asks. “Why blind John Milton. And in my own century of origin, Monsieur Proust was by his asthma-laden lungs impaired in a major life function… I could mention fit-shaken Van Gogh, dwarf Toulouse-Lautrec, and mad Miss Woolf…Look to the signing of the Declaration of Independence. What see you? A one-legged man, and another who adds a palsied scrawl. Who raised the nation up from the depths of the Depression? Why a man with a pair of legs like cooked spaghetti.”

World affairs and letters have clearly benefited from the talents of the disabled. But Call Me Ahab is no diatribe. Instead, it is a cheering section for the forgotten and under-appreciated and a testament to creativity, whimsy, and intellect.

Written by: Eleanor J. Bader, July 16th 2009

Tapologo

admin — Thu, 25 Jun 2009 23:34:00 +0000

Directed by Gabriella Gutierrez Dewar, Sally Gutierrez Dewar

Tapologo is a full-length documentary shot in Northwest Province, South Africa. Directors Gabriella and Sally Gutierrez Dewar chronicle a handful of the 20,000 displaced African refugees in a squatter camp called Freedom Park. Here we are exposed to life and death in a place where fifty percent of the women are infected with HIV.

The film is divided into two parts. Part one opens inside the shack of an emaciated woman receiving care from two local nurses. The woman is dying from Tuberculosis, and for a moment she glances directly into the camera lens with brown eyes that appear to have lost all innocence and hope. As we get to know other patients and nurses who inhabit the park, we see that most of the women have slept with men for money, many have contracted HIV, yet only some are receiving anti-retroviral treatment. All of them are either dying or fighting to survive. Personal accounts from the women are interlaced with stunning visual images that are both emotional and relevant, and the intensity never lets up.

The second part begins with desolate music by Joel Assaizky and shots of people walking across train tracks, sitting on sides of roads, just standing around watching each other. This time is spent contextualizing the squalor of Freedom Park in the apartheid aftermath. In a place where the alternative to starvation is sexual exploitation, it’s impossible to ignore the political history.

Then we learn about Tapologo, a collective of female caregivers who self-organize and treat the hopelessness of their immediate surroundings. Before this network existed, individuals were left alone with their chronic diseases as poverty and pain devoured them. Now these strong women, many of them diagnosed with HIV themselves, have begun to administer anti-retroviral treatment and provide bedside and hospice care. As a result, a community has begun to form, and with the help of Brother Joe, Sister Georgina, and bishop Kevin Dowling (Catholic community leaders and activists who share relatively progressive ideology), Tapologo has begun to break Freedom Park's cycle of poverty, patriarchy and an overall loss of dignity.

One scene in particular illustrates the spirit of this film. A nurse named Thimbi (a former sex-worker and HIV victim) pays a visit to the shack of a helpless woman and her infant. She says confidently, "Filth can make the illness worse," and begins to wash dishes and floors on her hands and knees. For Thimbi and others, volunteering with Tapologo gave them a chance to believe in themselves, to find beauty within, and to be proud of life's small victories. This moment, and this film, is a great reminder to step out of our daily comforts and confront real issues facing real women.

Written by: Katy Pine, June 25th 2009

Sex Work and the City: The Social Geography of Health and Safety in Tijuana, Mexico

admin — Sun, 31 May 2009 23:27:00 +0000

By Yasmina Katsulis

University of Texas Press

Most studies of prostitution still focus on the supply side: the women and girls, the boys and men, and the transgender and transsexual people who toil sexually to survive, meet temporary needs, and thrive. An increasing number of studies focus on the demand side: the direct consumers and the globalizing forces that bring them together. Carved down from what was probably a fine Ph.D. dissertation, and founded upon eighteen months of ethnographic fieldwork that she conducted in Tijuana, Mexico, Yasmina Katsulis’s lively and accessible Sex Work and the City does one better. In only eight chapters and 174 pages, interspersed with field-note entries and arresting photos—for example, a family united in picnic but separated by a fence—she also explores the physicians who under- and over-diagnose STDs, the policemen who extort sexual favors, and the many agents who facilitate and profit from the sexual labor of others.

Ethnographic, archival, and other data show that Tijuana’s sex industry is fed by gringo and Mexican male migrant laborers who come and go—the causes and symptoms of staggering degrees of human migration and mobility. I appreciate her caveat about the necessity of squarely confronting centuries-old stigmas of prostitution. Throughout the book, she opposes an epidemiology and popular culture that systematically misrepresents by underestimating the HIV and STD transmissive risks of sex in, or on the way to, marriage. Katsulis demonstrates not just why, but literally how, prostitution’s labor forms and venues structure health and social risks.

She also explores the motivations for entering into, and the various outcomes of sexual labor by contrasting legal, registered sex work with that which is informal and illegal. Her analysis of the Tijuana Regulatory Model of policing and health inspection of The Body Prostitute highlights police extortion and the health and social hierarchies of strip clubs, brothels, alleyways, massage parlors, beaches, and forlorn places. The social and economic contradictions in Tijuana of skin color, gender identity, language, socioeconomic class, and ethnicity produce differing degrees of health, social, and legal hazard.

Apart from a few minor quibbles (her use of the illogical term “HIV/AIDS infection,” the sometimes interchangeable use of “sex workers” and “prostitutes”), Katsulis neglects to point out that pimping is the world’s oldest profession, not prostitution. Some of her claims—for example, regarding the general absence of pimping in Tijuana—are insufficiently grounded in historical, sociological, and ethnographic studies by Schifter, Wardlow, Kulick, Schoepf, Leonard, White, and me. I enjoyed her remarks about sexual praxis, but there was surprisingly little discussion of the tensions between sexual positionality and sexual and gender identity. Her take on “the prostitution debates” in feminism is only three pages in length. She devotes one sentence to what she takes to be one side of the ledger—“Some feminists argue that legalization of sex work serves to normalize and institutionalize the sexual exploitation of women”—which really irked me. The ensuing discussion morphs quickly into yet another Straw Woman argument about “western White feminists.” Katsulis offered her key informants free HIVab tests, but fails to mention IRB concerns and the availability of trained counselors, confirmatory assays, and antiretroviral or other therapies. Finally, the absence of a discussion of religion beyond cultural codes of macho and marianismo precludes her from analyzing a profoundly good example of a marriage:prostitution dialectic par excellence.

These criticisms aside, Katsulis has contributed a polished, well-written, vibrant, and much-needed book. I hope the university press issues a cheaper paperback edition (lower than the $50 hardcover price) so that it may be used in courses in anthropology, gender studies, and public health.

Written by: Lawrence James Hammar, Ph.D., May 31st 2009

Will to Live: AIDS Therapies and the Politics of Survival

admin — Sun, 15 Jun 2008 01:39:00 +0000

By João Biehl

Princeton University Press

Ethnographers, novelists, and prisoners write heart-wrenching books because they present simple truths. Will to Live is a powerful, at points searing ethnography of HIV antibody surveillance systems in Brazil and pharmaceutical industry influence in bringing forth new relations of politics and health care. It tells of the bodily suffering of Brazilians who contract, and eventually die from, AIDS - and of those who fear such diagnoses, although they are HIV antibody negative.

It demonstrates the varying degrees of access that Brazilians have to highly active antiretroviral therapies (HAART) and that track along the fault lines of social structure. That HAART works for many (but not others) or that it comes too late (or too early or is engaged too haltingly) signifies the contradictions and paradoxes of culture and social structure that are usually revealed in epidemics. Although it is filled with positive stories and better outcomes (HAART brings many back from the brink of death), Will to Live is as painful to read as Nancy Scheper-Hughes’ Death Without Weeping, also about Brazil but in context of infant mortality; Paul Farmer’s AIDS and Accusation, also about AIDS but set in Haiti; and Begonia Aretxaga’s Shattering Silence, about Northern Ireland women who deploy their incarcerated bodies and even bodily fluids in political protest.

Will to Live shows that the national and international response to HIV and AIDS has in Brazil “shifted from controlling the epidemic to controlling individualized disease.” “Yes,” the author writes, “distribution programs make antiretroviral therapies accessible, but they are one element in the full treatment of a disease that... remains a matter of a regional politics of nonintervention.” “It’s a shame what is happening to AIDS” is the direct utterance of an otherwise well-intended caregiver, suggesting just how much the cart has been put before the horse and what the public health costs can be of imagining only a pharmaceutical response.

João Biehl is a Brazilian anthropologist and Associate Professor of Anthropology at Princeton University who has a long time studied the conceptualization, implementation and evolution of the Brazilian AIDS Control Program (BACP). Multi-sited in location, multi-method in logistics, multi-voiced in narrative, and multi-purpose in scope, Will to Live unravels and critiques the ways in which NGOs (non-governmental organizations), churches, the Ministry of Health, pharmaceutical industry representatives, gender and sex work activists, and those suffering from HIV or AIDS mounted a “national” response to HIV and AIDS that is anything but. “A central concern of my ethnography,” the author notes, “has been to produce alternative epidemiological evidence and to generate some form of visibility and accountability for the abandoned subjects with AIDS.”

A site of Biehl’s particular focus is Caasah, a part-community house, part-hospice, part-pharmacy, part-training ground in advocacy. Caasah was formed in 1992, “when a group of homeless AIDS patients, former prostitutes, transvestites, and drug users squatted in an abandoned maternity ward in the outskirts of Salvador” and turned it into a care center. He returned to Caasah in 2001 to find a near-complete turnover there of patients and staff and a reorientation of service provision and funding source. As such, Caasah well represents both the protean nature of AIDS and the constraints upon and conditions under which local-level responses to it were mounted.

All but a very few pharmaceutical industry representatives, health authorities, and politicians talk in double-speak. Many exacerbated cleavage between rich and poor, politically visible and not:

As with all things political and economic, the reality underlying the AIDS policy is convoluted, dynamic, and filled with gaps. The politicians involved in the making of the AIDS policy were consciously engaged in projects to reform the relationship between the state and society, as well as the scope of governance, as Brazil molded itself to a global market economy. One of this book’s central arguments is that on the other side of the signifier _model policy _stands a new political economy of pharmaceuticals, with international and national particularities. As NGO activism converged with state policy making, and as the public health paradigm shifted from prevention to treatment access, political rights have moved toward biologically based rights.

Comprising eight chapters including Introduction and Conclusions, Will to Live is equally heavy and light, grim and hopeful, ethnographic and theoretical. The Introduction (“A New World of Health”) bookends painful personal stories and broadly sweeping discussion of the political-economy of pharmaceuticals. Rhetorical and other slippage in the overly optimistic assessments of AIDS bureaucrats and pharmaceutical representatives is revealed in stories of busted aid posts, iatrogenic illness, and social structures that sicken people. Chapter One (“Pharmaceutical Governance”) discusses the complexities of state-local, transnational-NGO and doctor-patient relations. Biehl writes perceptively about the successes of Brazil in manufacturing generic drugs that challenged patent rights granted by the WTO.

The particular successes and failures of Caasah are scattered in discussion throughout the book, but Chapter Two (“Circuits of Care”) looks intently at the new subjectivities (e.g., patient-citizen, “risk group” member, the “worried well”) that arise in social, technical and economic relations brought to bear by HIV, HIV antibody testing and AIDS. The failures of the surveillance system – but also its tremendous promise – are shown acutely in the next chapter, “A Hidden Epidemic,” which reveals the biases in public health and society at large with regards to surveillance, treatment and counseling. Chapter Five, “Patient-Citizenship,” examines the Phoenix-like rise from the ashes of imminent death that has been occasioned in many of those who have responded particularly well to HAART. Many have resumed reasonably normal sexual and political lives relatively free of the anxieties and technoneuroses brought on by the antiretrovirals themselves and the HIV antibody testing and counseling regime. The first section of Chapter Six, “Will to Live,” is appropriately titled “Lifelong AIDS,” for it reveals the stark contours of the limits and promises of a largely biomedical “fix” for what is clearly and also about sickness in the social-structure.

There is little for a reader about which to complain. A quotation is repeated and some Index entries are incorrect, but there are extremely few typos or grammatical infelicities. I want to highlight one particular kind of problem that mars Biehl’s presentation at many points, however. Biehl claims that “Epidemiological surveillance services registered the first HIV/AIDS cases in 1982.” This conflates HIV and AIDS, as he does ad infinitum, and HIV hadn’t yet been identified, either. It doesn’t excuse him to say that everyone else does, too - for real damage is done in such conflation, for example, that “HIVab+” means a death sentence and a rhetorical slide to “AIDS” to “contagious” to social leperhood.

Moreover, “AIDS” had not yet congealed into a biomedical category, either. This leads him at many, many points to confuse cause and effect, vector and pathogen, infection and antibody, for example, when he says that “the homosexual/bisexual mode of transmission accounted for less than thirty percent of the total number of AIDS infections.” Ontologically, epidemiological notions do no counting; epidemiologists do. Logically, “bisexual” mode of transmission (of HIV) has also to mean “heterosexual,” which then must be explained anew for its expanded and more complicated, often hidden properties. Empirically, the “total number of AIDS infections” would multiply the epidemiological categories of “HIV antibody positive” and “AIDS diagnoses” by at least five-fold if not twenty-fold, that is, in terms of pulmonary tuberculosis, cryptosporidium, toxoplasmosis, pneumocystis carinii pneumonia, persistent diarrhea, anaemia, and so on. As well, this undercuts the force of Biehl’s informants who rightly point to the endemic state of such infections and problems prior to the arrival of HIV and AIDS. Further, it suggests that these individual infections or pathogens are sexually transmitted and that there are characteristic differences along the lines of sexual identity (i.e., “heterosexual” transmission of this, “homosexual” transmission of that).

The lengthy discussion of subjectivity comprising Chapter Four is difficult to follow and jargony, although its theorization of “technoneurosis” (and elsewhere, of “auto-bioadministration”) is spot-on. Biehl argues from the standpoint of careful analyses of case studies that the “confused and painful experience of Oxygen [the pseudonym of a sick and anxious woman repeatedly testing HIVab negative] was somewhat technically engineered. This testing apparatus played a determinant role in the emergence of a socially visible imaginary AIDS.”

Nevertheless, this and other chapters exemplifies well the Foucaultian thesis that discourse about subjects (in this case, about the technical aspects of an HIV antibody test and about what constitutes “good” and “bad” sex) creates new subjects: the worried well, the sick and the anxious, the promiscuous and the guilt-ridden. The algorithm of HAART adherence is predictable on sociological grounds. “Failures” are on blamed on the individual, not the system; not the social structure; not the lack of housing, food, education, and employment. Nor was the HAART roll-out so universal and stable as its proponents claimed

Laid atop an already struggling public health system, Biehl found that “the universal availability of essential medicines has been subject to changing political winds; treatments are easily stopped, and people have to seek more specialized services in the private health sector or, as many put it, ‘die waiting in overcrowded public services.” The meaning of “primary care” has changed to mean selective targeting of those more likely to live, and triage has replaced universality as a metaphor of coverage. Clients become clinical trial subjects. Treatment trumps prevention. Risk becomes individualized instead of increasingly social. Infection becomes increasingly moral and subject to religious edict. HIV antibody test counselors compete with one another not to be the one to read the positive bands. Social scientific insights are swept aside.

This newest addition to Princeton University’s (In)Formation Series, edited by Paul Rabinow, is a sober but accessible and extremely humane text, just as well constructed as attractively presented. The black-and-white photographs taken by Torben Eskerod are arresting and invite commentary, speculation and, in my case, envy. Around this exciting new work could be wrapped all manner of upper-division or graduate-level courses in anthropology, public health, medicine and even political-economy. Like too many countries and cultures to count, ill-tempered politicians, cynical epidemiologists and overburdened healthcare workers in Brazil have contributed to an official portrait of HIV transmission dynamics, infectious burden and prevention efforts that often bears little resemblance to reality. Once again, the inequalities of social structure get off scot-free. This ethnography is a major contribution to social theory and justice.

Written by: Lawrence James Hammar, Ph.D., June 14th 2008

Encyclopedia of Prostitution and Sex Work

admin — Tue, 19 Jun 2007 00:01:00 +0000

Edited by Melissa Hope Ditmore

Greenwood Press

Five thousand words, much less the 500 allowed here, are insufficient to review critically and appreciate properly a reference work this exciting, valuable, unique and scrupulously edited. Into two sturdy, attractive-looking and easy-to-use volumes, Melissa Hope Ditmore has assembled 341 entries from 179 experts from fields and perspectives as disparate as criminal justice and sex worker activism, pop culture studies and Asian history, musicology and English literature, cinematic studies and international health, and performance art and social services. Intriguing information is presented regarding persons such as Ah Toy, Candy Barr, J. Edgar Hoover, Catherine Mackinnon, Annie Sprinkle, and Emile Zola. Well-informed essays about the structure and function of prostitution and sex work have been contributed for cities such as Bangkok, Havana, and New York, and in geographic regions such as Australia and New Zealand, the 19th-century American West and Southeast Asia. Specific sex industries in times and places as different as Imperial Russia, Medieval Europe, Vietnam-era Thailand, and pre-Revolution Shanghai are examined in often surprisingly close historical detail. Many contributors have analyzed the “labor forms” that sex work and prostitution can take, as the anthropologist Luise White has dubbed them, such as street-walking, massage, brothels, outcall and escort services, and the venues at which they can occur - including cribs, bars and cafes, display windows, highway-stopovers, dormitories, and barracks.

“Sex work” is defined as encompassing “prostitution,” but also including "phone sex, pornography, stripping, and erotic dancing,” The Preface, Introduction and many other sections and introductions thereto make immediately evident the participation of bell-boys and blues singers, cab-drivers and clients, priests and police chiefs, alongside the expected madams, pimps and providers of sexual services. Many of the relevant mental, sexual, and public health precursors and consequences are also done justice in entries that cover sexually transmitted diseases, Tenofovir, Post-Traumatic Stress Disorder, microbicides, and abortion. Representations in the form of stigma, poetry, cinematic (s), exploitation, music, zoning, guidebooks and many, many feminisms make these two volumes especially useful for academics and theorists. Although selling for $225, institutions, departments, libraries, organizations and collectives will find immediate usefulness in the broad array of subjects, personalities, statutes and issues covered here quite succinctly, including primary documents, poems and song lyrics, for example, to the “House of the Rising Sun.”

In only 819 pages, and with equal parts authority and freshness, a dazzling array of intellectual, political, medical, historical and sexual concerns have been covered. Colonialism, AIDS, religion, the Internet, globalization and migration and mobility are each explored in always sober, often lively prose. Remarkably few typos mar the text, and its presentation has been augmented by helpful appendices and indexes, and by many black-and-white photos, movie stills and drawings.

The editor, contributors and advisory board members are to be congratulated also for having responsibly walked that razor’s edge of attempting to write and edit fairly about something as protean as sexual networking, something that so vividly reveals tensions between structure and agency, Church and State, labor and capital, exploitation and choice, horror and love.

Reviewer’s disclaimer: The fact that the reviewer contributed five entries to this collection has not influenced the content of his review, which was written solely to obtain a free, review copy he could not otherwise afford (or live without).

Written by: Lawrence James Hammar, Ph.D., June 18th 2007

Broken World

admin — Fri, 25 May 2007 13:40:00 +0000

By Joseph Lease

Coffee House Press

Don’t be fooled by the title of Joseph Lease’s collection of poems, though the world may be “broken,” the collection spends its time rebuilding, rationalizing and living despite it. Repetition fuels the elegy, “Broken World (for James Assatly),” a poem built in sections, a poem that works to remember a friend and writer who died of AIDS. The poem’s repetition is representative of how the collection operates: poems announce what things are not, only to reconstruct the world with its pieces. So, in the elegy, Lease repeats what things “won’t be”:

won’t be stronger. won’t be water. / won’t be dancing or floating berries. / won’t be a year. Won’t be a song. / Won’t be taller. Won’t be accounted / a flame. Won’t be a boy. Won’t be / any relation to the famous rebel.

The repetition - such as the repetition in Gertrude Stein’s pieces in Tender Buttons - creates a plain where things will be, where the poem allows for things to be stronger, a song, and taller. The other statement Lease repeats is “and I shatter / everyone who hates you.” The poem shatters not only homophobia, not only the loss of another person to AIDS, but shatters Assatly’s anonymity. In the back of the book, it’s stated that Assatly’s novel Hejira remains unpublished; these poems provide a space to praise Assatly.

The last poem of the collection exists in sections, each titled, “Free Again.” Through the use of space play and his use of the dash, Lease allows the reader to link associations, and to continue the thought. In this poem, Lease is offering a freedom of language and a freedom to make associations. Again, his use of negation offers the reverse. He may write, “... – there are no symbols, no spells –...” but the poetry collection is full of symbols and links of image, statement, and sound. The collection ends with the lines: “I can remember my secret book – / I was a ghost, you were the only one / who could hear me –.” By ending the book with not only the second person address to the reader, but with the dash, extends the conversation past the confines of the page. Lease’s space play, elliptical poems and second person address causes the reader to engage and read in a new way.

Written by: Lisa Bower, May 25th 2007

Life Support

admin — Sat, 21 Apr 2007 22:00:00 +0000

Directed by Nelson George

HBO Films

HIV isn't the death sentence that it used to be, but that doesn't mean it isn't affecting people's lives in enormous ways. Life Support is a new film starring Queen Latifah, inspired by a true story, that tackles the complexities of living with the virus, particularly as low-income, women of color. This film couldn't come at a better time, as infection rates continue to grow among young, African American girls. It is said that the disease is getting younger, darker, and more female, and Life Support shows the importance of prevention and of letting people see the human side of those living with HIV.

Queen Latifah plays the part of Ana, an HIV+ mother of two and sex education outreach worker, who comes from a background of drug addiction and other "high risk" behavior. Her oldest daughter, Kelly (Rachel Nicks) lives with Ana's mother (Anna Deavere Smith) and harbors much anger and resentment toward Ana for her past mistakes. Ana wants nothing more than to rekindle a love bond with her daughter before Kelly leaves the city to start her own life. Both struggle to combine their own self-interest with their relationships with loved ones in a tumultuous journey. Life Support is an emotional tribute to the thousands of people touched by HIV and props to HBO for making this film available.

Written by: Mandy Van Deven, April 21st 2007