Understanding men, mood, and avoidable deaths from AIDS in Western Kenya

A person diagnosed with HIV today might never experience AIDS, nor transmit HIV. Advances in treatment effectiveness and coverage has made the UN 2030 vision for the ‘end of AIDS’ thinkable. Yet drug adherence and resistance are continuing challenges, contributing to avoidable deaths in high burden African countries, especially among men. The mood of global policy rhetoric is hopeful, though cautious. The mood of people living with HIV struggling to adhere to life-saving medication is harder to capture, but vital to understand. This paper draws on ethnographic fieldwork with a high burden population in Kenya to explore specific socio-economic contexts that lead to a potent mixture of fatalism and ambition among men now in their thirties who came of age during the devastating 1990s AIDS crisis. It seeks to understand why some HIV-positive members of this bio-generation find it hard to take their life-saving medication consistently, gambling with their lives and the lives of others in pursuit of a life that counts. It argues that mood–here understood as a shared generational consciousness and collective affect created by experiencing specific historical moments–should be taken seriously as legitimate evidence in HIV programming decisions

Okbichaloni (things aren’t always what they seem to be. Know that for sure): hustling, HIV, and hope in Luoland, Western Kenya

The act of academic writing simplifies and fixes the rhythms of both long-term ethnographic fieldwork and the many-side lives that ethnographers try to represent. Finding ways to retain and meaningfully convey complexity is challenging. But it is also vital if we, as anthropologists, aspire to contribute less to objectifying and othering practices. This piece of writing is a commentary on the limitations of ethnographic writing genres and an experiment in ‘writing otherwise’ (Stacey and Wolf 2016). Drawing on ethnographic fieldwork conducted between 2008-2012, it offers an analytical reflection on the lives of a Luo generational group living in Western Kenya, disproportionately affected by HIV, who were/are trying to make a living and a good life in precarious times. It also aims to convey the intangible zeitgeist of this time, while making transparent that this is experienced second-hand by the ethnographer. To do this I use the format of song lyrics to evoke the rhythm of life during this specific time-period in Luoland, a rhythm punctuated by a poignant mix of optimism, pessimism, vitality and apathy, and underscored by the certainty of knowing that you will always be surprised by the turn of life-events. Departing from more conventional ethnographic genres, my piece is presented in three parts: 1. The written form of a song, each stanza representing a different story from my fieldwork, and composed using a bricolage of fieldnotes, Luo puns, snatches of song-lyrics popular in Kenya at the time, even a biblical verse. 2. An explanatory academic commentary annotated with images and 3. A Glossary which provides contextual understanding to the phrases used in the song. The glossary can be consulted to reveal some of the double-meanings and deeper contexts in the phrases used. But, equally, I want the reader to be able to first read the lyrics without it, in the way you might listen to a song, picking up on the feeling, and then only later getting the layered meanings. By encouraging this I celebrate the ‘elasticity of the idiom’ (Nyairo and Ogude 2005) as used by my research participants. Update: This piece of writing has been shared with some of the global health researchers working in the region described. Interestingly, feedback indicates that this unconventional format was found illuminating for helping them to understand some of seemingly puzzlingly situations they encountered during their work. More so than a more conventional publication I also shared about why young men living with HIV might struggle to adhere to their life-saving HIV medication consistently. This suggests a future where such experiments need not/should not be confined to conversations with other anthropologists within Creative Ethnography Special Issues

'Living honourably and independently’: dreaming of a good village life in an African rural health and demographic surveillance system site

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Stories in the making: what artists made of the 2018 RAI art, materiality and representation conference

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Global Health Research in an Unequal World

This book is a collection of fictionalised case studies of everyday ethical dilemmas and challenges, encountered in the process of conducting global health research in places where the effects of global, political and economic inequality are particularly evident. It is a training tool to fill the gap between research ethics guidelines, and their implementation 'on the ground'. The case studies, therefore, focus on 'relational' ethics: ethical actions and ideas that emerge through relations with others, rather than in regulations

Global health research in an unequal world: ethics case studies from Africa

This book is a collection of fictionalised case studies of everyday ethical dilemmas and challenges, encountered in the process of conducting global health research in places where the effects of global, political and economic inequality are particularly evident. It is a training tool to fill the gap between research ethics guidelines, and their implementation 'on the ground'. The case studies, therefore, focus on 'relational' ethics: ethical actions and ideas that emerge through relations with others, rather than in regulations

Seeking exposure: conversions of scientific knowledge in an African city

Transnational medical research has become a common feature in many parts of Africa. This paper explores the contribution such activity makes to the social and economic lives of those involved, including both trial subjects and local staff. By considering the value of the 'exposure' that involvement brings to staff and research participants, we reflect on the conversion of scientific knowledge into practical knowledge and its value to sustaining precarious livelihoods in an economically fragile city. We consider the interplay between science and sociality and argue for a need to take seriously the circulation of scientific knowledge beyond the confines of expert spaces

Global Health Research in an Unequal World

This book is a collection of fictionalised case studies of everyday ethical dilemmas and challenges, encountered in the process of conducting global health research in places where the effects of global, political and economic inequality are particularly evident. It is a training tool to fill the gap between research ethics guidelines, and their implementation 'on the ground'. The case studies, therefore, focus on 'relational' ethics: ethical actions and ideas that emerge through relations with others, rather than in regulations