Key Concepts

1. Key Concepts Anthropology 393 – Cultural Construction of HIV/AIDS Josephine MacIntosh April 5-8, 2005

2. Ethnocentrism &Cultural Relativism • Ethnocentrism: the practice of judging another society by the values and standards of one’s own society • Cultural relativism: the view that cultural traditions must be understood within the context of a particular society’s responses to problems and opportunities

3. Cultural Relativism • The values of one culture should NOT be used as standards to evaluate the behaviour of persons from outside that culture • A society’s custom and beliefs should by described objectively • Modern approach • Strive for objectivity and do not be too quick to judge

4. Important Points •  The two main goals of anthropology are: • To understand uniqueness and diversity • To discover fundamental similarities • The focus of cultural anthropology: • Contemporary societies and cultures throughout the world •  The goal of applied anthropology: • To find practical solutions to cultural problems

5. Recall… • Culture includes • Physical aspects • Objects • Actions • Mental aspects • Thoughts • Beliefs • Values • Inventions • Rules

6. Language Transmits Culture • Culture is a key concept in anthropology • Culture is the learned, shared way of life that is transmitted from generation to generation in a society • Humans learn through • Experience (situational learning) • Observation (social learning) • Symbols (symbolic learning)

7. HIV Transmission Routes • Blood transfusion is the most efficient route for HIV infection • Sexual transmission is the most commonroute of infection • 75% of all HIV infections are sexually transmitted

8. Epidemic Curves • Classical epidemic curve is bell-shaped • Steepness of slope is a measure of infectivity or contagion • Length of the curve describes duration of epidemic • Highly infectious diseases (like measles): • Short period of infectiousness (generally 2 weeks) • Relatively short duration (typically 6 months to a year)

9. Epidemic Curves • Not so with HIV/AIDS • Marked by elongated curve • Lengthy period of infectivity, enduring over generations • Several distinct peaks • As it moves through different populations (MSMs, IDUs, etc)

10. Doing the Math • Using this mathematical model and assuming: • Exponential growth • A doubling time of 3 years • It would take: • 30 years for the prevalence of HIV to change from 0.001% to a detectable level of 1% • 3 years to change from 10 to 20 percent (Anderson & May, 1992:59)

11. Doing the Math • Currently, the epidemic is spreading at twice the initial predicted rate • Between 1999 & 2002, infection rates have: • DOUBLED in East Asia & the Pacific • Increased 2 ½ times in North Africa & Middle East • Almost TRIPLED in Eastern Europe & Central Asia • Eastern Europe & Central Asia currently have the fastest-growing epidemic in the world

12. Reponses to Infectious Disease • Biologically appropriate interventions: • Eliminate source of infection and/or • Eliminate contact with source and/or • Reduce infectivity and/or • Reduce susceptibility • Socially appropriate interventions: • Limit social and economic disruption • Promote stability along prevention/care continuum (McGrath, 1991; 1992)

13. Deviance and Immorality • Historically, STIs have been stigmatized • Because of the connection with deviant or immoral behaviour • Moral judgments are made based on culpability • Lifestyles at fault?  Pronounced ‘guilty’ • Naïve partners of the guilty  pronounced ‘innocent’ • Children of innocents  pronounced ‘defenseless victims’

14. Deviance and Immorality • Fear of moral judgment isolates • Infected • Affected • ‘At risk’ • Can preclude health preserving behaviours • Busza, 1999; Gilmore & Sommerville, 1994; Goldin, 1994 • Probable result  accelerated epidemic

15. Social Construction of HIV • Negative moral judgments • Especially probable with HIV because stigma of the illness is layered upon pre-existing stigmas • Does not encourage interventions which are, at the same time, biologically and socially appropriate • Seriously disrupts social systems • Obstacle to prevention/care/treatment

16. Scope of the Problem • HIV is spreading at twice the predicted rate • Limiting exposure to STIs is complex • Many social responses to HIV increase stigma • Fear of stigma is problematicbecause many: • Dissociate themselves from risk groups • Avoid testing & counseling • Avoid accessing health care • Resist behaviour change

17. Scope of the Problem • Incidence of HIV/AIDS will continue to increase without appropriate interventions • Current public health response is inadequate • Need to address stigma • Need to provide affordable drugs by implementing the WHO ‘3 by 5 plan’ • Need concentrated social action to normalize prevention/care/treatment

18. Gender Roles & HIV • Prevailing gender roles • Considered by many to be the most pervasive and universal problem associated with HIV prevention • One of the few ethnographic commonalities between women as a group • Globally, may present the largest obstacle to HIV prevention

19. Social & Sexual Equity • Integral to HIV/AIDS prevention • It is important to change • Accepted patterns of male behaviour • Expected patterns of female behaviour • Then, women can be in a position to protect themselves from the very real threat of HIV infection -- which leads ultimately, to death

20. Coming to Grips With the Challenges • Successful programsmust: • Improve and provide health information, care and other services • Be culturally appropriate and gender-sensitive • Develop sex-specific, gender-balanced information about HIV/AIDS and other STIs • Address different audiences in different settings

21. A New Challenge • Multi- Drug Resistant HIV

22. Defining Attributes of Culture • Culture includes ideas & beliefs that shape & interpret any behaviour • Culture is different from society • Culture = the meaning of behaviour • Society = the patterns of behaviour • Patterns of behaviour can be observed, but the meaning is not apparent • Although meaning can be inferred, analyzed, or derived from asking the participants to interpret their behaviour

23. Crucial Distinction • Behaviour (social aspect) • Beliefs, ideas, & knowledge (cultural aspect) • Not necessarily consistent with each other • For example: • a couple may know (a cultural factor) that they should use condoms • But they do not use a condom (a social factor) • In this case, knowledge does not translate to behaviour.

24. Theories of Change • Popular theoretical models for HIV/STI risk reduction highlight importance of • Motivating target audiences • think & talk about own need for behaviour change (Peterson & Di Clemente, 2000) • Providing information, behavioural skills, removal of perceived barriers • integral to the maintenance of individual-level behaviour change • But… w/o personal motivation to integrate risk reduction strategies, little changes

25. Individual-level Models • Health Belief Model • AIDS Risk Reduction Model • Social Cognitive Theory • Theory of Reasoned Action • Theory of Planned Behaviour • Information-Motivation-Behavioural Skills • Transtheoretical Model

26. Individual-level Models • Individual-level theoretical models for HIV/STI risk reduction highlight the importance of • Accurate information • Motivation • Behavioural skills social norms which support safer behaviours • BUT… individual-level theories offer little insight into how to shift social norms to support safer behaviour

27. Social-level Models of Change • Diffusion Theory • Leadership Models • Social Movement Theory

28. Social-level Models of Change • Social models can shape the norms, values, & interests of at-risk social groups • Necessary adjuncts to any large-scale intervention • Norms and referents have a strong influence on individual intention to act • HIV highlights issues that are social • Individual-level risk-reduction enhanced by addressing group and subcultural norms • Capitalizing on existing community and interpersonal networks to improve public health delivery • Removing social barriers that hinder safer behaviours

29. Effective HIV & Pregnancy Prevention Programming • Focus on reducing one or more specific HRSB • Theory-based • Advocate avoiding sexual risk-taking • Provide accurate information • Attend to social pressures • Model sexual communication & negotiation skills • Use interactive teaching methods • Appropriately targeted: age, sexual & cultural exp • Adequate in length • Include and train teachers and peer leaders • Kirby, 2001

30. Challenges and Barriers • Community level barriers • Social norms surrounding sexuality and drug use •  Patient level barriers • Does person perceive that s/he is at risk? • Can they integrate change? • Motivations = pleasure seeking • Substance use • Can impede intervention efforts two ways • Associated with increased risk-taking behaviour • Associated w/ reduced ability to implement risk-reduction

31. Challenges and Barriers • Mental illness • Alcohol and HIV risk behaviours • Heavy alcohol use associated with • General increases in risky sexual behaviour • Decreased condom use • Increased risk of relapse into risky sexual behaviour • Contextual substance use appears to have the highest risk • Non-injecting drug use (e.g., Crack cocaine) • Related to associated sexual behaviour • Especially drug-related prostitution activities