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Anthropological Contributions to AIDS Research
... In recent years, the participation of Anthropology in health research has been increasing (Singer, 1994). Especially, in the 1980s anthropologists were drawn the AIDS programme to make catalogue cultural practices that might carry the risk of HIV transmission (Marshall and Bennett, 1990). Since then, anthropology has developed a more prominent point of view by advocating an approach to culturally specific behaviours and beliefs related to HIV/AIDS (Gatter, 1995). ...
HIV/AIDS is a global pandemic. From the biomedical perspective, HIV is a virus. HIV stands for Human Immunodeficiency Virus. The virus attacks the immune system, and weakens the body’s ability to fight infection and disease. In recent years, the participation of anthropology in health research has been increasing. Especially, in the 1980s anthropologists were drawn the AIDS programme to make catalogue cultural practices that might carry the risk of HIV transmission. By an anthropological perspective, the HIV/AIDS epidemic is caused by poverty, starvation and hunger, war, unemployment, uneven regional development, sex traffic, migration and working away from home, prostitution and selling sex, drug transactions, and discrimination. This work considers the way in which poverty affects the HIV/AIDS epidemic, and the causes of spreading HIV pandemic are not just evaluated by poverty, also is evaluated considering by wealth.
... Some researchers, especially those interested in sexuality and gender issues, have noted the significance of anthropological studies to different aspects of the AIDS epidemic (Gorman, 1986;Feldman, 1986;Herdt, 1987;Herdt et al, 1990;Frankenberg, 1988;Marshall and Bennett, 1990;Bolton, 1991). They stress the collaborative role of anthropology in education and prevention of HIV infection with epidemiology, social psychology and nursing studies. ...
This dissertation examines specific issues surrounding the experience of living with HIV and AIDS in Rio de Janeiro, Brazil. It focuses on the process of identity formation in relation to local forms of social organization within the context of the AIDS epidemic since the mid-1980s. These processes are closely associated with factors, such as sexuality, gender and illness. Based on a historical and ethnographic perspective, fieldwork was mostly carried out in the metropolitan area of Rio de Janeiro. To investigate the social world of AIDS, I visited AIDS non-governmental organizations (NGOs), gay activist groups, and clinical settings involved with AIDS treatments and care. As a case-study, I conducted ethnographic research in the Grupo Pela Vidda-Rio, the leading AIDS NGO in the State of Rio de Janeiro. The thesis is composed of nine chapters. The first and second chapters give an introduction to the main research topics, aims, fieldwork, selected methodologies and a critical overview of the studies on sexuality, identity and AIDS in Brazil. Chapter three discusses the discursive practices and the cultural representations produced by the Brazilian news media, which contributed to popularize dominant cultural conceptions of the epidemic, particularly a stigmatizing identity: the "aidetico". Chapter four articulates the idea of the AIDS epidemic as a health crisis, which emerged alongside other moral and social problems. I focus on the role of Brazilian AIDS public policy and health structures in the social reproduction and incorporation of sexual and clinical identities, namely, "seropositive" and "seronegative" identities. Chapter five deals with the different forms of civil mobilization and social organization that constitute the social world of AIDS in Rio de Janeiro in relation to national and global levels. The local influence of global discourses on "solidarity" is analysed in its links to particular models of identity construction, especially discourses on the cultural meanings of "people living with HIV and AIDS". Chapter six is an ethnographic case-study of the Grupo Pela Vidda-Rio, its activities, composition, ideological aims and historical changes. As a final step to understand the broad determinacy of processes of identity formation, chapters seven and eight give an ethnographic analysis of how a range of identities (gender, sexual, and clinical ones) can be socially and culturally performed in the specific social setting of Grupo Pela Vidda. The complex logic of sociability and the power of social hierarchies in the definition and incorporation of identities are largely discussed in these two chapters. My main contribution, therefore, is to give a better understanding of the constitutive tension between broad processes and specific contexts of identity formation. This tension is fueled by different organizational and ideological models at work within the particular social world of AIDS in Rio de Janeiro.
... While anthropology was initially slow responding to the HIV epidemic in the early 1980s, this changed rapidly with a growing interest amongst medical researchers regarding supposed differences in sexual behaviour between different "cultural groups" (Marshall and Bennett 1990). This produced a research agenda that, as Fassin (2007) bluntly states, exoticized ethnographic knowledge and focused on the "customs of the natives". ...
In Bushbuckridge, as HIV prevalence and AIDS death increased, rumours about purposeful HIV infection and death flourished. In the late 1990s and early 2000s, rumours targeted scientists, medical professionals and technologies in tales of purposeful infection, casting HIV as a threat posed by external and foreign agents. However, by the mid to late 2000s, stories about young attractive women and wealthy men purposefully infecting people with HIV replaced these earlier rumours. I argue that this represents shifting comprehensions of AIDS from an external to an internal threat, its domestication and construction through cultural framings of moral personhood.
... Además de que el SIDA se considere la pandemia más dramática del último tercio del siglo XX, a cuya rápida expansión ha contribuido la intensificación de los desplazamientos de población, su expansión, las reacciones sociales a la enfermedad y las intervenciones políticas al respecto han ido dejando al descubierto desequilibrios estructurales, factores culturales y prejuicios sociales y morales (Schoepf, 2001). Desde que se iniciaron las primeras investigaciones, éstas se han ido diversificando hasta convertirse en uno de los temas que mayor interés ha despertado en la antropología médica, centrándose fundamentalmente en aspectos relacionados con la prevención del VIH (Marshall y Bennett, 1990). ...
Beyond "National Character": Anthropology Addressing Global Challenges: Since the beginning, social and cultural anthropology has been interested in global connections of culture. However, this interest has been increased in the last decades due to the social and cultural consequences of globalization, diversifying not only research fields, but also contexts, analytical units, research techniques, and applications. While exploring and proposing new alternatives, anthropologists are seeking new interdisciplinary approaches in different fields such as health, development, education, or migration. In doing so, current ethnographies are
focusing on family, social networks, communities at local, national, and transnational level, civil organization, citizenship, human rights, or social networks in Internet. By contextualizing these changes and developments in what has traditionally been known as applied anthropology, this article seeks to analyze how current approaches and applications are addressing socialcultural challenges posed by globalization.
Aunque el interés por las conexiones globales de la cultura se ha dado en la Antropología desde sus inicios, éste se ha intensificado ligado a las consecuencias socioculturales de los actuales procesos de globalización. De ahí que no sólo se haya ido diversificando sus ámbitos de estudio, sino también contextos, unidades de análisis, técnicas de investigación y ámbitos de aplicación, explorando y proponiendo alternativas. Y en esa misma medida, sus posibilidades de intervención en ámbitos como la salud, el desarrollo, la educación o los desplazamientos de población; y con enfoques específicos en familias, redes sociales, comunidades locales, nacionales o transnacionales o en ciberespacios participativos. Contextualizando las distintas propuestas de investigación y aplicación que se han ido dando en la disciplina, este artículo pretende analizar distintas propuestas teóricas, etnográficas y aplicadas que se están dando
... The role of anthropology in the study of HIV and AIDS has long been recognized in the development of "analytical perspectives which transcend conventional host-vector epidemiology" (El-Bayoumi and Morsy 1993:1). Anthropologists have engaged in research aimed at elucidating the meaning of AIDS in particular cultural contexts (Marshall and Bennett 1990) and the subjective experience of AIDS in different social and cultural environments (Alcano 2009;Whyte 2009). As HIV disease has evolved into a chronic condition in which individuals can experience long periods of good health, anthropological examination of the sick role (Crossley 1998) and clinician and patient's differing chronic illness models take on added significance (Hunt and Arar 2001;Sobo 1999). ...
Children born with HIV in the 1980s and 1990s are surviving into adolescence and adulthood, due to the availability of highly active antiretroviral therapy (HAART). Growing up with a chronic and stigmatized disease presents considerable challenges as young people explore their sexuality, develop relationships, and take steps to become independent and productive adults. Adherence to HAART is an essential and life-long practice for the maintenance of health and longevity. For adolescents born with HIV, a daily medication schedule is one aspect of disease management that also includes medical visits, HIV status acceptance, bouts of illness, and disclosure of HIV status to others.
This research uses a framework of medical ecology to explore the personal, socio-familial, and medical contexts in which perinatally HIV-infected adolescents, as competent social actors, navigate the complexities of HIV disease management. It examines personal behaviors and attitudes, family dynamics, peer relationships, and health care structures and relationships that affect their adherence to HAART.
A key finding of this study was increased agency and adaptation to HIV among adolescents who learned their diagnosis earlier in life and whose caregivers demonstrated acceptance of HIV and support for the adolescents. They were able to adhere to their medication regimens, despite busy schedules, non-disclosure to friends, and treatment fatigue, and also had a somewhat better understanding of the medical aspects of HIV and HAART. Yet all of the adolescents had gaps in their understanding of clinical indicators and viral resistance, and the relationship between adherence and HIV transmission.
This deficit in a medical conceptualization and understanding of HIV and its ramifications is another important finding of this study. The adolescents' notions and actions regarding HIV disease, based on social, cultural, and medical norms and interactions within their environment, have a significant impact on the natural history of HIV. The level and consequent infectiousness of HIV as it responds to medications, mutates in their absence, and multiplies or is suppressed, depends on the individual's strict adherence to medications and attention to medical details, and affects HIV transmission to the individual's sexual partners. From both an individual medical and a public health perspective, an understanding of the ramifications of adherence and non-adherence to HAART is crucial. Early acceptance and understanding of HIV increase the possibility of successful medication adherence and overall disease management.
In order to facilitate perinatally-infected adolescents' disease management and adherence to medications, it is recommended that the process of disclosure of HIV diagnosis to the child begin early so that the child is fully aware by the age of ten. The acceptance of HIV in the family and clear-cut roles and responsibilities for disease management should be facilitated by ongoing instruction and counseling. Adolescents should be given thorough, if basic, instruction on the medical aspects of HIV, and should be encouraged to have friends, and especially sexual partners, accompany them to their clinic visits. This will encourage greater understanding of HIV and perhaps lead to less stigmatization of HIV and those living with HIV. Finally, providers and adolescent patients should construct a partnership in which their individual models of disease management are integrated and power and responsibility are appropriately shared.
... While anthropology was initially slow to respond to the challenge of research on AIDS in the early 1980s, this changed rapidly with a growing interest within biomedical research on sexual behaviours and meanings between different 'cultural groups' (Marshall & Bennett 1990). This research has produced an agenda that, as Fassin (2007, 25) bluntly states, focuses on the 'customs of the natives' that promote the spread of AIDS and anthropological knowledge tends to be exoticized. ...
From the early 1990s, rates of HIV infection increased dramatically in South Africa and by the early 2000s, AIDS emerged as the main cause of death for adult South Africans. During the first half of the 2000s, the South African government’s response to this crisis was inadequate, marked by denial and delays in implementing prevention and treatment, resulting in thousands of preventable deaths. Yet, apart from the challenges posed by the predominantly urban-based Treatment Action Campaign (TAC), the absence of a social response to this crisis is notable, especially in rural settings.
This scenario forms the broad backdrop to this ethnographic study that draws on participant observation and interviews undertaken over a three-year period (2002-2005) in KwaBomba village previously in the Gazankulu Homeland, now located in the Bushbuckridge municipality of the South African lowveld. An ethnographic perspective provides an intimate vantage point from which to view peoples’ experiences of the AIDS epidemic and their responses in context. This perspective draws attention to gaps in public health and biomedical understandings of the epidemic and suggests alternatives to these understandings.
In Bushbuckridge, mortality and morbidity due to AIDS became visible in the late 1990s and early 2000s. Households were incapable of dealing with the burden of illness and death while the health services were often unwilling and ill-prepared. HIV prevention campaigns based on individual behaviour change were not well suited to a context in which HIV spread through sexual networks. Despite widespread awareness of the threat of AIDS, the disease was subjected to public censorship and AIDS suffering was concealed. Public discourses of AIDS were hidden within gossip and rumour and articulated as witchcraft suspicions and accusations. Although these discourses appear to deny and suppress the reality of AIDS, I suggest that they are active attempts to deal with the AIDS crisis: gossip and rumour allocate blame and construct a local epidemiology through which the epidemic can be surveilled; interpreting AIDS as witchcraft creates the possibility of avenging untimely death. These discursive forms are critical in informing individual and social responses to the AIDS epidemic. While the absence of public acknowledgement of AIDS as a cause of illness and death suggests denial and fatalism and appears to limit public action, subaltern discourses create shared secrets to manage the AIDS epidemic at the local level. Furthermore, these discourses may constitute a form of resistance against biomedical models of causality.
Ethnographic enquiry at the local level offers a nuanced understanding of social responses to the AIDS epidemic. By examining forms of expression that lie outside the domain of public health, the book reveals how these constitute significant forms of social action in response to the epidemic.
Drawing on ethnographic material collected over almost two decades in the South African lowveld district of Bushbuckridge, this chapter discusses the social and cultural implications of global discourses of the “end of AIDS”. I argue that in Bushbuckridge, antiretroviral therapy (ART) heralded the transformation of the epidemic into an “epidemic of ARVs” and that this consequently threatened to invisibilize social suffering in the past and the present and exposed the disjunctures between local experiences and global narratives of HIV.
HIV officially arrived in Vietnam with the reporting of the first case in
December 1990. All available research pointed to the fact that Vietnam
was about to become part of the AIDS pandemic. Through the complex,
dynamic exchanges of discourses between development agencies, HIV
prevention groups and governments, the 'threat' of HIV and AIDS was
created. 1 At the same time, Vietnam was experiencing rapid and extreme
social and economic changes. This thesis explores the modalities through
which the threat of HIV and AIDS has been socially constructed in
contemporary Vietnam. It was a time when Vietnam increased its efforts
to modernise and become once again part of the global economy and thus
it was especially vulnerable to particular readings of the dominant global
discourses about the disease.
The article describes the Internet survey, conducted for public health purposes, on the sexual behaviour of men who have sex with men (MSM). It describes the usefulness of qualitative surveys for research into the sexual behaviour of MSM in the context of the HIV/aids pandemic. The article expands the description of the social situation of MSM with a discussion of the importance the Internet has for their communication and for the research into sexual behaviour. It presents the results of the author's analysis of an openend question on respondents' ideas of the best sex life and discusses the implications for public health efforts.
M. Margaret Clark is the 1992 recipient of the Society's Malinowski Award, which was presented at the SfAA's 52nd annual meeting in Memphis, Tennessee. This annual award is given to a senior colleague in recognition of efforts to understand and serve the needs of the world through social science. Dr. Clark is Professor Emerita in the Division of Medical Anthropology, Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco CA 94143. The following is the lecture delivered by Dr. Clark on the occasion of her receiving the Malinowski Award.
Field research on prostitution has ignored the actual interactions between prostitutes and their clients. This gap is, in part, the result of the over-reliance of research on data of a confessional nature. This paper reports on the results of a field research study of street prostitution in a large Dutch city. Experimentation with the "complete observer" field research role is discussed, and a plea for multimethod approach to fieldwork is presented. The paper concentrates on certain temporal and spatial features of the sexual interaction of "finishing" that occur between street prostitutes and their clients. "Finishing" refers to the actual interaction moment where the objects of desire are exchanged. Empirical data on this crucial moment are especially difficult to obtain. In this paper, some qualitative and quantitative data about finishing are presented. Specific tensions are described of time and money, sexuality and sociability, and territoriality and proxemic conflicts. These conflicts are discussed...
This paper critically reviews the actionresearch paradigm that has evolved over the last 50years within and outside The Tavistock Insitute, withreference to radical shifts in the social construction of medicine and health that are occurring as aresult of the transition toward the informationsociety. The medical domain has been chosen as anappropriate space within which to review the actionresearch paradigm because it bridges both the past andfuture of the Institute. The paper firstly considers theoriginal conception of action research andsociotechnical systems, and the role of consultants, in relation to Foucualt's analysis of powerrelations, social control, and dividingpractices. It then describes and analyzes recentdevelopments in the field of medicine and healthcareservice provision that, on the one hand, offer opportunities forincreased self-management and control by consumers overphysical, social, and emotional self-hoodand on the other could lead to further socialsurveillance and the domination and subjectification of theindividual. Drawing on recent work using innovativemodels of action research in the field of HIV/AIDS, thepaper concludes by discussing ways in which action research could harness developments ininformation and communication technologies to maximizeindividual and collective engagement in new forms oforganizational and social relations.
Rather than serving to combat the epidemic, the use of seemingly politically neutral epidemiological categories to portray AIDS risk groups as culturally distinct may have impeded AIDS education and prevention efforts. This article critiques the construction of intravenous drug users (IVDUs) as an AIDS risk group by contrasting the portrayal of an IVDU subculture with studies that report on the diversity of behavior of people who use intravenous drugs. The tendency of epidemiologically oriented AIDS researchers to equate intravenous drug use with minority populations and to construct a category of “Hispanic” as a population at risk for AIDS is shown to be problematic. The cultural construction of HIV is analyzed as part of the hegemonic processes of the United States that exclude those seen as culturally distant from the body politic.
During the war on drug in the 1980s, state and federal laws sent thousand of street level drug offenders to prison which unwittingly facilitated the spread of HIV/AIDS. Many drug offenders were liable to be infected with HIV from sharing dirty needles. According to Moran, “Prisons are notorious breeding grounds for HIV. Infection rates are five times higher than outside the wall… One study by a national police association found that at least 40% [of incarcerated men] had sex with another man in prison. And despite strong evidence that condoms reduce the spread of AIDS, they are forbidden in all federal and most state and local prisons.” Jim Thomas, professor of public health at the University of North Carolina-Chapel Hill remarks, “To make condoms available in prison would be to admit that sex occurs in prison. And for some reason the prisons don’t want to admit that that happens. But if we want to encourage HIV transmission, this is the perfect policy.” AIDS activists suggest, although HIV/AIDS testing is available, most inmates are not tested because HIV positive inmates can demand costly treatment. Consequently, as Moran notes, “men can leave prison with HIV and never know it. And most men say that when they leave prison they will resume having sex with women.”
Processes of building research capacity in international health projects and their implications for anthropology are addressed using examples from the Applied Diarrheal Disease Research project funded by the United States Agency for International Development. Two aspects of training are examined: the way interdisciplinary methods--qualitative and quantitative approaches--are presented to researchers, given the context of international health research culture; and how researchers' local knowledge and local concerns in pursuing health research relevant to policy led them to become interested in anthropology. The consequences for anthropology's place and product in future capacity building efforts in international health research are discussed.
The paper explores the relationship between social identity and HIV/AIDS, with special reference to gay men in Britain. This relationship was first seen as significant since it might have a bearing on the spread of HIV in the population. Three major forms of commentary have emerged on the issue: (i) basic research into the relationship between sexual identities and behaviours; (ii) applied research on how to convert the findings from (i) into health promotional materials, and (iii) discourse from within the politically gay community on what HIV/AIDS means for gay people. These different forms of commentary arise from a diverse range of voices, within and outside academia. The paper draws comparison between different disciplinary approaches to questions of identity and HIV/AIDS, in terms of their relative strengths and weaknesses (for example, contrasting psychology with anthropology). An ethnography of a day centre for people living with HIV/AIDS is used to illustrate the need to understand identity from a processual perspective, so that both individual and collective identities are seen as emerging from specific historical circumstances and struggles. A dialogic approach to understanding identity, tied to qualitative empirical research, is suggested as necessary to understanding how different forms of identity engage with HIV/AIDS (gender, ethnicity, age, sexual orientation), and how the identities of individuals and groups are always complex, shifting mosaics.
North-South health development cooperation often includes research financed largely by external donors. The cooperation varies between projects and programmes with regard to subject area, mix of disciplines involved, research methods, training components and project management arrangements. A variety of problems is encountered, but they are rarely described and discussed in published project reports. We authors conducted a study of a small number of European health researchers collaborating with researchers from the Third World. We focused upon projects involving both biomedical and social science researchers, and apart from a literature review three methods were applied: self-administered questionnaires to European researchers, semistructured interviews with five IHCAR researchers, and written summaries by the three authors, each on one recent or ongoing collaborative project of their choice. Most collaborative projects were initiated from the North and are monodisciplinary or partly interdisciplinary in the sense that researchers did independent data collection preceded by joint planning and followed by joint analysis and write-up. There may be disagreements concerning remuneration such as allowances in relation to fieldwork and training. Socio-cultural misunderstanding and conflict was reportedly rare, and no serious problems were reported regarding authorship and publishing. It is concluded that collaborative research is a complex and poorly understood process with considerable potential and worth pursuing despite the problems. Difficulties related to logistics and finance are easily and freely discussed, while there is little evidence that transdisciplinary research is conducted or even discussed. We recommend that published and unpublished reports on collaborative research projects include more detailed accounts of the North-South collaborative arrangements and their management, ethical and financial aspects.
This paper is based on the author's ethnographic HIV prevention research at a community-based residence for women in New York City who have a history of homelessness and diagnosis of mental illness. The author presents the human face of this American tragedy, while exploring the ways in which larger social forces circumscribe these women's lives. The author also critically assesses the HIV prevention agenda, including the dominant paradigm in prevention intervention. Despite acceptance by the most prominent players in AIDS prevention in the United States, the most popular prevention theories are theoretically and substantively inadequate. While educational interventions and behavior change efforts may have some impact on inhibiting HIV transmission, the focus on the individual as the sole locus of change tends to obscure the social and material factors in the spread of the disease. An anthropologically informed alternative, integrating social responsibility and social justice, is explored. Also considered are dilemmas in applying anthropology to AIDS prevention research and how to translate theoretical abstractions into humane and pragmatic social programs.
This article describes the association between drug and alcohol use during sexual activity and high-risk sex for AIDS. Data to test this association are drawn from a prospective study of the behavioral changes made by gay men in San Francisco in response to the AIDS epidemic. Findings drawn from the May, 1984 and May 1985 waves of data collection are described. The cross-sectional analysis showed that use of particular drugs during sex, the number of drugs used during such activity, and the frequency of combining drugs and sex are all positively associated with risky sexual activity for AIDS. The retrospective data showed that men who currently abstained from combining drug use with sexual activity were likely to have been at no risk for AIDS over two measurement points during the previous year. The men who currently combined drug use with sex were most likely to have a history of high-risk sexual activity over the previous year. These findings show a strong relationship between drug and alcohol use during sex and non-compliance with safe sex techniques to prevent the spread of AIDS. Implications of this relationship for AIDS health education efforts are discussed.
AIDS education and prevention campaigns have resulted in the most profound modifications of personal health-related behaviors ever recorded. The response of gay and bisexual men to the threat of AIDS can guide other prevention programs once the necessary motivations, impediments, and correlates of this change are better understood. We review and critique the research literature and suggest limitations of existing studies for making inferences about nongay, nonurban, and non-White populations. We recommend increased efforts to understand the role of alcohol and other drugs in AIDS risk behavior and suggest the importance of self-efficacy and social support for initiating and maintaining behavior change.
Acquired immune-deficiency syndrome, commonly termed AIDS, has been called perhaps the most serious public health menace of the 20th century. Such pronouncements are made not on the basis of public misunderstanding or hysteria, but on sound scientific grounds. First, although the agent believed to cause the disease has been isolated in the laboratory, it is of a group of poorly understood viruses, termed retroviruses. An effective vaccine is not expected for some time. Second, AIDS affects the immune system, one of the most complex systems of human physiology. Third, AIDS has primarily affected a somewhat invisible and stigmatized subculture of American society, a fact that renders matters of health policy and prevention sensitive. This final characteristic of the epidemic means that primary and secondary prevention efforts — for the forseeable future the most effective means of controlling AIDS — are likely to be fraught with fundamental social and ethical issues, including patient confidentiality, stigma, and civil rights.
This article contributes to the cross-cultural understanding of Acquired Immunodeficiency Syndrome (AIDS) through a detailed examination of the AIDS epidemic in contemporary Brazil. Since 1983, when the first verified case was reported there, the number of AIDS victims has grown rapidly enough to place Brazil high on the list of countries with the largest number of confirmed cases. Yet the pace of this epidemic has received relatively little attention from either the international community or the Brazilian government. In addition, the model used for understanding the transmission of the disease has been developed in the rather different social and cultural contexts of Western Europe and the United States. This article draws on the author's research on Brazilian sexual culture and suggests its relevance for understanding the transmission of AIDS in Brazil. It calls for a more active and culturally appropriate response to the disease in Brazil, as well as for an increasingly sophisticated understanding of cultural differences that influence the AIDS epidemic internationally.
AIDS is a rapidly growing epidemic in Kigali, Rwanda. To understand the level of public awareness of AIDS in that city, 33 informants (15 men and 18 women) were interviewed during September, 1985. Most (66.7%) said that they first heard of the disease only within the previous eight months. About half (46.9%) could not mention one or more AIDS symptoms. Younger informants and women reported less knowledge of AIDS symptoms. While nearly everyone recognized AIDS as a stigmatized disease, most informants apparently did not know why it is stigmatized. Only about one-third of the informants (34.4%) could correctly state the mode of AIDS transmission. People who are at greatest risk for the disease, unmarried men and women, were least likely to know how it is transmitted. Half (50.0%) of those informants who responded to the question of the origins of AIDS said that it began in 'America.' While many informants are frightened by the disease, no one has yet changed their sexual behavior as a response to the epidemic. All informants agreed that more information about AIDS should be made available in Rwanda. Preventive measures against the spread of AIDS are urgently needed in central Africa.
In March 1985 an ELISA test for serum antibodies to human T-cell leukemia/lymphotropic virus type III (HTLV-III) was licensed for use in screening commercial blood products. Controversy over the appropriate use and interpretation of this test continues, and some public health officials in the United States have advocated different counselling strategies for high and low risk individuals with the same test results. The response to AIDS illustrates that contagion has a social definition, even in the context of Western scientific medicine.
KIE
The ELISA (enzyme-linked immunosorbent assay) test for serum antibodies to human T-cell leukemia/lymphotropic virus type III (HTLV-III) was licensed for use in screening commercial blood products in March 1985 as a means of controlling the spread of acquired immunodeficiency syndrome (AIDS) through blood transfusions. The test has also been implemented in a variety of other medical and nonmedical settings, where its use is often highly controversial and based on very loose social or epidemiological criteria. In addition, opposing strategies have been advocated for counseling high and low risk individuals with the same test results. McCombie discusses how the rapid diffusion of HTLV-III testing programs, despite questions about their appropriateness, illustrates the extent to which cultural beliefs and attitudes affect public health and medical practice.