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
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.
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.
Motherhood and HIV/AIDS as Sites of Action
Pamela J. Downe
Ongoing discussions about feminist anthropology as an active and relevant sub-discipline largely rely on historical comparisons that pit the political fervour of the past against what is deemed to be the less defined and increasingly disengaged feminist anthropology of today. In this paper, I argue that the prevailing tone of pessimism surrounding feminist anthropology should be met with a critical response that: (1) situates the current characterization of the sub-discipline within broader debates between second- and third-wave feminism; and (2) considers the ways in which the supposed incongruity between theories of deconstruction and political engagement undermines the sub-discipline's strengths. Throughout this discussion, I consider what an ethnographic study of motherhood in the context of HIV/AIDS can offer as we take stock of feminist anthropology's current potential and future possibility.
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.
When HIV Meets Government Morality
Kristin Soraya Batmanghelichi
In Iran, as in many countries worldwide, misinformation and ignorance of HIV/AIDS have encouraged a culture of secrecy and anonymity for those living with HIV. For many HIV-positive women, religious, political and economic pressures complicate their social status and access to health care. Moreover, they must contend with societal discrimination and stigmas associated with the condition. Adding nuance to contemporary studies on gender and sexuality in Iran, this report highlights the colourful narratives of a select group of HIV-positive mothers attending weekly wellness workshops in Tehran. Discussing issues of intimacy, modesty, motherhood and stigmatisation, this article explores one of Iran's expanding communities at risk of infection and the ways in which women with HIV negotiate the stigma of their condition in an Islamic Republic.
Embodied Socialities of HIV and Trauma in Uganda
Lotte Meinert and Susan Reynolds Whyte
sensations/symptoms, differential recognition of symptoms, and the embodied sociality of treatment. Our method for generating the data was intermittent anthropological fieldwork. Most of the HIV/AIDS material was collected between 2005 and 2007 and one case
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.
Waria, Anticipation and Existential Endings in Bali, Indonesia
Coming face to face with the inevitable finitude of our existence has a way of clarifying what really matters to us. Such occasions of existential breakdown demand that we actively appropriate our lives and purposely decide how to project ourselves towards the future while drawing on the possibilities available to us. But what if these possibilities offer little for constructing a future we deem desirable? In this article I take a Heideggerian approach to anticipation in order to analyse waria’s (Indonesian transgender women) often-stated intention to ‘become normal again’, while seemingly never doing so. Here, then, anticipation is less about an orientation towards specific objectives and more about a response to existential demands, while keeping at bay undesirable futures. Waria’s anticipation of a future normal does not suggest an appeal of the normal but, rather, indicates a paucity of available possibilities to draw on in order to orient oneself differently.