Following the call by UNAIDS in 2006 to involve people living with HIV (PLHIV) in treatment programmes, expert clients were recruited to provide services within healthcare settings as volunteers alongside paid health workers. Swazi law requires employment contracts for anyone working in a full-time capacity for three months, complicating the status of expert clients. This article traces the genesis of the volunteer framework used to engage PLHIV in the provision of HIV care in Swaziland and describes how the quest for PLHIV to be involved coupled with donors’ promotion of the Greater Involvement of People Living with HIV/AIDS (GIPA) principle have together resulted in PLHIV serving as low-cost workers, disempowering the very people GIPA was meant to empower. I call for review of GIPA-based policies and a paradigm shift regarding a non-medically trained cadre of workers in an era of acute healthworker shortages in resource-limited countries hard hit by HIV.
The Case of Expert Clients in Swaziland
The Challenges of Providing Sexual and Reproductive Healthcare to Men on College Campuses
Lilian Milanés and Joanna Mishtal
Scholarship and advocacy work regarding reproductive health have often focused on women’s experiences. Concerns about men’s sexual and reproductive healthcare (SRH) have historically been on the margins in this context. In the United States, young men are at the greatest risk for sexually transmitted infections (STIs), yet are the least likely to seek SRH. Based on research with 18 healthcare providers in a large public Florida university clinic, we examined providers’ perspectives about expanding men’s SRH provision and utilisation. Research findings demonstrate inconsistent provider strategies in treating men’s SRH needs and a clinical environment that has low expectations of men receiving preventive care, further perpetuating the placement of SRH responsibility upon women. This article contributes to applied and medical anthropology scholarship on health inequalities through its discussion of the challenges and barriers that contribute to poor SRH for young men and the critical role of providers in this context.
A Century of Anti–Human African Trypanosomiasis Campaigns in Angola
Jorge Varanda and Josenando Théophile
This analysis of over a century of public health campaigns against human African trypanosomiasis (sleeping sickness) in Angola aims to unravel the role of (utopian) dreams in global health. Attention to the emergence and use of concepts such as neglected tropical diseases (NTDs) and ideas about elimination or eradication highlights how these concepts and utopian dreams are instrumental for the advancement of particular agendas in an ever-shifting field of global health. The article shows how specific representations of the elimination and eradication of diseases, framed over a century ago, continue to push Western views and politics of care onto others. This analysis generates insight into how global health and its politics of power functioned in Angola during colonialism and post-independence.
Gift Exchange and Living-related Kidney Transplantation in the Philippines
This paper considers living-related kidney transplantation, especially that between family members in the Philippines. Drawing on the anthropological theory of gift, it explores two aspects of the gift relationship—the relationship between the donor and the recipient and the relationship between the recipient and the object—and describes two categories of acts—'acknowledging the debt/repaying the gift of life' and 'taking care of a kidney/cherishing the gift'. This paper seeks to show that there is an internal tension in live kidney transplantation between two rival principles of gift operative in the world of Filipino family and kinship: one akin to the Maussian or 'archaic' gift and the other that places cherishing of the gift over repaying of the debt.
Muslims' Ways of Ageing Well in Kerala, India
Willemijn de Jong
The author explores trajectories of creating well-being with regard to old age in a poor Muslim community in Kerala, India. Theoretically, she draws on the nonstate-led concept of 'inclusive social security' and links it with the anthropology of the house. In doing so she takes approaches of 'making' kinship, gender, age as well as citizenship into account. Care and respect for the elderly result from strong but gendered intergenerational kin relationships in and around the house, which they establish for a large part themselves. Governmental and civil provisions play an enabling or supplementary role. Elderly women, particularly widows, benefit from property relationships that are less gendered. Surprisingly, there is a remarkable tendency of creating house ownership, and thus of bargaining power, for women in this community. It is suggested that this is effected by a combination of Muslim inheritance rules, recent dowry-giving practices and Kerala's matrilineal history.
Tom Hall and Robin Smith
This article considers welfare and the city and the ways in which pedestrian practices combine in the management and production of urban need and vulnerability as manifest in the experience and supervision of urban homelessness. The article combines writings on urban maintenance and repair with recent anthropological work on wayfaring (in which cities seldom figure). Fieldwork undertaken with rough sleepers, welfare workers and city managers in the city of Cardiff , Wales, provides the empirical basis. The main body of the article is organized around three walks through the centre of Cardiff with individuals variously implicated in care, repair and welfare in the city. In closing we assert the importance of a politics of street welfare in city space.
Adapting Health-promotion Messages to Incorporate Local Meanings in Guinée Forestière
Maria Cristina Manca
Health promotion is dependent upon sharing information with local populations and adapting health-care services to make them more acceptable, and is an essential part of any Ebola intervention. Listening to the concerns of local communities and engaging them as active participants ensures that health promotion messages are relevant, acceptable and understandable as well as culturally appropriate. Ebola is associated with fear and death, thus understanding the significance and meanings of life, death, disease and sickness for the Kissi of Guinea Forestière (Guinea) is essential for ensuring acceptable health services. Community engagement was essential for this research to gain the trust of the Kissi and to facilitate the sharing of knowledge and information to reduce the transmission of the Ebola virus. This technical account is based on three periods of ethnographic fieldwork and health promotion activities conducted in Guinea between May 2014 and February 2015.
The Identity and Stigmatisation of Ebola Survivors
Survivors of the Ebola virus have been widely profiled as the success stories of the outbreak, yet they still face challenges relating to their identity and reintegration. A survivor’s body takes on new meanings aft er experiencing Ebola, and the label ‘survivor’ is as problematic as it is celebratory. Using data conducted during fieldwork in Monrovia, Liberia, this article discusses the complex identities of Ebola survivors. In Monrovia, most of the stigma and discrimination relating to survivors was directed towards men, who were considered ‘atomic bombs’ because of concerns that they could transmit Ebola through sexual intercourse. Health promotion messages around sexual transmission were often misunderstood, and communities requested the quarantine of men to reduce what they felt was a threat to the wider community. Understanding the meanings and sources of such stigmatisation is necessary to be able to work with and support survivors through psychosocial care and health promotion activities.
Lisen Dellenborg and Margret Lepp
This article describes the development of ethnographic drama in an action research project involving healthcare professionals in a Swedish medical ward. Ethnographic drama is the result of collaboration between anthropology and drama. As a method, it is suited to illuminating, addressing and studying professional relationships and organisational cultures. It can help healthcare professionals cope with inter-professional conflicts, which have been shown to have serious implications for individual well-being, organisational culture, quality of care and patient safety. Ethnographic drama emerges out of participants’ own experiences and offers them a chance to learn about the unspoken and embodied aspects of their working situation. In the project, ethnographic drama gave participants insight into the impact that structures might have on their actions in everyday encounters on the ward.
Memory is a traitor. Forty years is a short time in human history, but the attempt to remember exactly what happened in the past is fraught with problems. The clearest incidents are often the most trivial. What we really want to remember remains obscure. So my memories of the early days of European Judaism may not be entirely accurate. As the wife of the founding editor, Michael Goulston, I was fully occupied with running our household and caring for three small children. I did not participate in the meetings where Michael discussed his vision for the journal with colleagues. For this memoir I have had to rely on my memories of day-today conversations with Michael about his hopes and dreams, leafing through early issues of the journal, a chat with Lionel Blue, sadly one of the few survivors of the original Board of Editors, together with recollections of my own role.