The aim of this study was (a) to use anthropological research tools to produce a thorough description of health providers' working conditions in a low-income country; (b) sketch the impact of a specific dimension of the national HIV/AIDS programme on this environment and (c) sketch the existence and examine the extent of burnout among health workers. We conducted intensive fieldwork in a large public hospital in one major town of the far-north region. We relied on three research tools: observations, in-depth interviews and the Maslach Burnout Inventory (MBI). The data were analysed manually. We found a working environment characterised by an acute lack of equipment, lack of recognition and equity, lack of community and fairness, and value conflict, all of which are factors implicated in burnout. This was exacerbated by the implementation of a psychosocial dimension in care for people with HIV/AIDS, which created exclusion and reinforced feelings of unfairness. However, despite their challenging working environment, health-care providers were not 'burned out', leading us to suggest that burnout is a syndrome of 'rigid' working environments, as opposed to 'porous' working environments.
A Study in Cameroon
Public–Private Partnerships and Bureaucratic Culture in Pakistan
The World Bank-financed 'Enhanced HIV and AIDS Control Program' tried to reorganize HIV/AIDS governance in Pakistan by pushing a neoliberal agenda, marketizing the provision of publicly funded HIV prevention services. NGOs and the private sector competed for contracts with the government to provide services to sex workers, drug users, transgendered people and homosexuals who were deemed 'high risk' groups for HIV. With this contractualization emerged a new bureaucratic field that emphasized 'flexible organization' and 'efficiency' in getting things done in place of the traditional bureaucratic proceduralism characteristic of the Pakistani civil service. This new corporate-style bureaucratic culture and the ambiguities of a hastily contracted (and 'efficiently' rolled out) Enhanced Program meant public funds ending up in the pockets of a few powerful actors. Instead of generating more efficiency, the marketization of services dispossessed the intended beneficiaries of the World Bank loan.
An Exploration of Participation and Consensus
This article reports on an investigation into the extent to which individual involvement in community participatory research activities on HIV/AIDS created agreement or consensus among participants from four Malawian communities about the causes, risks, and behaviours associated with AIDS transmission in their communities. In this research, cultural consensus analysis was used in an exploratory manner to measure the level of agreement among participants prior to and immediately following participation in community participatory workshops. The results demonstrate variability by community and gender in the levels of consensus, or agreement, achieved through the workshops. These findings suggest that consensus is not an automatic outcome of participation in small group interventions and in some cases can result in less agreement on community issues around HIV. Moreover, we lack a clear understanding of how consensus contributes to desired or positive change. Also discussed is the potential utility of cultural consensus analysis as a tool in evaluating the effectiveness of community participatory interventions.
Jonathan A. Allan, Chris Haywood, and Frank G. Karioris
On the cover of this issue, we have another image from the Wellcome Collection. This image by ABIA (Associação Brasileira Interdisciplinar de AIDS/Grupo) is a not-for-profit organization mobilized in response to the emergence of HIV/AIDS in the
Using Photovoice to Address Stigma in the Age of AIDS
Learning Together Project
Learning Together Project
Th e photographs in this essay were taken by grade eight and nine girls in one rural school in KwaZulu-Natal, South Africa in response to the question: What is the face of stigma in our community in the context of HIV and Aids? Th e girls used inexpensive point-and-shoot cameras to document the issues on location at their school, staging scenes that tell critical stories of the impact of stigma on the community. Once they had taken the photographs they developed captions which speak to the issues that they were working to represent. Some wrote in isiZulu while others chose to write in English. Th e isiZulu captions were translated into English. The images in this photovoice project help to identify, understand and interpret incidents related to stigma and discrimination against people living with, and aff ected by, HIV and AIDS.
The Case of Expert Clients in Swaziland
of the Greater Involvement of People Living with HIV/AIDS (GIPA) principle in theory and practice; how a non-medically trained cadre ended up doing so much work without their position becoming institutionalised and how this principle has been
Involving Women in the Design of Educational Materials in Rural Costa Rica
Nancy Romero-Daza, Mackenzie Tewell, David Himmelgreen, Oriana Ramirez-Rubio, and Elsa Batres-Boni
This article describes the involvement of women from rural Costa Rica, where tourism is predominant, in the creation of HIV/AIDS awareness materials that are appropriate for families and peers. The project was conducted in four towns in the Monteverde Zone, a region that has experienced a transition from an economy based on agriculture and dairy farming, to one dependent on tourism. Informed by previous research that shows the signi ficant impact of tourism on the economic and social landscape of the zone, this project responded to local residents' desire for participatory approaches to raise awareness about the potential spread of HIV/AIDS in their communities.
Chris McCourt and Chris Peters
Dangerous Motherhood: Insanity and Childbirth in Victorian Britain. By Hilary Marland. Basingstoke: Palgrave Macmillan, 2004. 304 pp. ISBN 1-4039-2038-9 (hardback).
A View from the Tower and the Township Post colonialism, Feminism & Religious Discourse. Edited by Laura Donaldson and Kwok Pui-Lan. London: Routledge, 2002. 220 pp. ISBN 0-41592-888-5 (paperback).
‘Letting Them Die’: Why HIV/AIDS Prevention Programmes Fail. By Catherine Campbell. Oxford: James Currey, 2003. 214 pp. ISBN 0-85255-868-6 (paperback).
Acting Up on Science and Immigration in France
Michael J. Bosia
From a postcolonial left that challenges the French state over immigration policy and neoliberal globalization, Act Up has advocated for the social and political rights and needs of women, inmates, drug users, and immigrants with HIV/AIDS. This essay examines as well Act Up's engagement with science and globalization in response to new experimental medical trials in the Global South. Act Up's emphasis on local empowerment against global economic and social actors has earned criticism from American and South African AIDS activists, but at the same time these campaigns stress the universalist impulse imbedded in the Act Up brand of French Republican politics.
Heather A. Came
Glenn Laverack (2013) Health activism: Foundations and strategies, London: Sage Publications, pp. 175, ISBN: 978-1-4462-4964-2.
As a long-time public health activist I was pleased to see Laverack’s new book focussing on health activism. To date, there have been only a handful of texts available suitable for tertiary students, the most notable being Cwikel’s (2006) substantial work. The bulk of health activist texts consist of speciality texts about women’s health, HIV/AIDS activism and the ongoing fight against big tobacco. Laverack’s text serves its purpose in addressing a gap in the market for a generic introduction to public health activism.