Moving Beyond the Margins: A Narrative Analysis of the Life Stories of Women Living with HIV/AIDS in Khayelitsha

Statistics about the devastating impact of the HIV virus on the African continent, where more than 23.5 million people are infected (Poku, 2001), are widely known, and are bandied about in both social and academic speak. Within mainstream biomedicine (biomedicine dominates research and regulation of the epidemic, and permeates popular understanding), the spread of AIDS in Sub-Saharan Africa remains relatively unproblematised, with biological and behavioural models of aetiology remaining uncontested (Crewe, 1997). However, within a wide range of disciplines, such as anthropology, sociology, psychology and political science, waves of critical consciousness (postmodernism, social constructionism, post-structuralism, Marxism and feminism) are actively wearing down antiquated modes of thought that fail to take into account social constructions of the disease, and its intersection with constructions of race, gender and class, and are working to unveil the institutions and ideologies (e.g. patriarchy, capitalism, democracy) that these social discourses serve (Crewe, 1997; Durrheim, 1997; Foster, 1999; Peterson & Benishek, 2001). Of notable interest are feminist critical theorists who unpack cultural notions of disease, and seek to understand their particular impact on women’s illness experiences (Peterson & Benishek, 2001). For women, the social construction of HIV/AIDS cannot be torn apart from the oppression and regulation of women under patriarchy, and from gendered constructions of masculinity and femininity. Furthermore, feminist theorists pay special attention to the articulation between class, race and gender; black women, especially those living in Africa under conditions of incessant poverty, carry a vast burden and, when it comes to HIV/AIDS, are particularly vulnerable to projections of risk, where they are seen as ‘carriers’ of the disease, and are feared as dangerous (Fleishman, 1995; Joffe, 1999; Strebel, 1995)

Being San' in Platfontein: Poverty, landscape, development and cultural heritage

As people are relocated, dispossessed of land, or experience the altered landscapes of modernity, so their way of life, values, beliefs and understandings are transformed. For the !Kun and Khwe people living on Platfontein this has been an ongoing process. Platfontein, a dry, flat piece of land near Kimberly in the Northern Cape, was purchased for the Kun and Khwe through the provision of a government grant in 1997. They took permanent residence there in government-built housing in December 2003. Prior to this they had had numerous experiences of relocation and strife, through a long-term involvement with the SADF that brought them from the Omega army base in Namibia, to a time of uncertainty in the tent town of Schmitsdrift, to their current settlement on Platfontein. The dry barren landscape of Platfontein suggests a very different way of life from that of hunter-gathering in Angola and Namibia. In the semi-urban context of Platfontein, basic sustenance and entry into the job market are emphasized, and this brings about changes in people's way of life and understandings, as well as in how they relate to each other and the landscape. In this context, there are certain tensions and contradictions that underlie the work of social development and cultural heritage that are the mandates of SASI (South African San Institute) in Platfontein. It is essential that projects initiated by NGOs like SASI give cognizance to the complexities of people's lives, histories and story lines. Without this, people's experiences and multifaceted stories are inevitably sidelined to create essentialist narratives that meet the imaginings of tourists and sponsors. There is no doubt that SASI works from an intention of bringing about positive transformation in Platfontein, and has done useful work in the community. The essentialist discourse of the 'indigenous', however, is a ready temptation for NGOs and the groups they represent to adopt, as it is politically expedient to do so in order to gain access to land and resources. This needs to be challenged at the level of policy so that access to geographical space or political power does not necessitate a denial of history or complexity

Narrowing the Gap Through Attention to Values and Ethics in Public Health Risk Assessment

Gaps or disparities in health and health care have been widening. The divide between rich and poor people continues to grow in parallel with disparities in health. The prospect of a world in which disparities become history is the ideal under the ethical principle of distributive justice ( or, equity ). The role of professionals in perpetuating disparities or in reducing them is discussed, and the notion of professional standards of conduct is presented. Unless professionals are educated about the foundations of ethical conduct and the fact that ethics is rooted in values, the prospect of their protecting the public interest over any other interest is not likely because they will not be able to present rational argument to distinguish good from bad professional conduct. The fact that ethical conduct is context-related bears directly on ethics applied in the health field. For, the ethical health researcher, practitioner, or provider needs to obey the law of the land. And, where these laws are in conflict with professional norms of good conduct, the professional must work to alter the laws that inhibit ethical conduct. In any country, law constrains that which constitutes professional conduct. In particular, in a country founded on libertarian values, as is the case in the United States, the social context and legal frameworks have a direct bearing on the ability of the health professional to conduct themselves in ways that serve the public interest over other interests. Life, liberty and the pursuit of happiness derive from the Declaration of Independence, adopted in 177 6, and are deemed among the inalienable rights of US citizens. The individual dominates under Libertarian Theory, such that taxation for the common good is not deemed a virtue; survival of the fittest would be a more consistent response under libertarian theory, just as we see acted out today. On the other hand, Canada was founded on egalitarian values. Peace, order and good government derive from the Constitution Act of 1867 (the British North America Act). In Canada, it is expected that the health professional will uphold the principle of equality. The community is the greater concern. So, the challenge for Americans is to find a way to interpret libertarian values in a way that those less fortunate have equal access to health, consistent with what those who have the means can afford

Working with Ambivalence: Finding a Positive Identity for HIV/AIDS in South Africa.

Psychoanalytic theory draws attention to the way in which a positive identity can be asserted as a defence against underlying anxieties. Focusing specifically on the South African context, this paper highlights the way in which people attempt to forge a positive self-concept in the face of a stigmatised and self threatening HIV identity. In-depth interviews were conducted with twelve women living with HIV in a black South African township. Discursive and psychoanalytic understandings were used to explore the emotional experience of HIV/AIDS and its impact on both the participants of the study and ourselves as researchers. We elucidate the process by which our interviewees vacillated between conflicting notions of health and sickness; empowerment and disempowerment; strength and weakness; purity and contagion; and death and continuity. We argue that a more resilient self can be formed through recognition of both the positive and negative implications of an HIV diagnosis. We also maintain that it is necessary to move beyond the individualizing tendencies of mainstream psychology to recognise the social context and discursive practices which exacerbate stigma and influence the experience of those living with HIV/AIDS

Public health in the face of global ecological and climate change

Research undertaken by members of the International Association of Ecology and Health (IAEH) makes critical linkages between population health and the dynamics of ecosystem damage and climate change. The preservation of human health is indissolubly linked to the health of the environment. The International Ecohealth Forum (2008) helped position the field of ecohealth as a key international advocate for this idea. This book chapter is a call for action from the Forum’s deliberations, advocating global adoption of the ecohealth movement

Explanatory factors for health inequalities across different ethnic and gender groups: data from a national survey in England

BACKGROUND: The objective of this study was to examine the relative contribution of factors explaining ethnic health inequalities (EHI) in poor self-reported health (pSRH) and limiting long-standing illness (LLI) between Health Survey for England (HSE) participants. METHOD: Using HSE 2003-2006 data, the odds of reporting pSRH or of LLI in 8573 Bangladeshi, Black African, Black Caribbean, Chinese, Indian, Irish and Pakistani participants was compared with 28,470 White British participants. The effects of demographics, socioeconomic position (SEP), psychosocial variables, community characteristics and health behaviours were assessed using separate regression models. RESULTS: Compared with White British men, age-adjusted odds (OR, 95% CI) of pSRH were higher among Bangladeshi (2.05, 1.34 to 3.14), Pakistani (1.77, 1.34 to 2.33) and Black Caribbean (1.60, 1.18 to 2.18) men, but these became non-significant following adjustment for SEP and health behaviours. Unlike Black Caribbean men, Black African men exhibited a lower risk of age-adjusted pSRH (0.66, 0.43 to 1.00 (p=0.048)) and LLI (0.45, 0.28 to 0.72), which were significant in every model. Likewise, Chinese men had a lower risk of age-adjusted pSRH (0.51, 0.26 to 1.00 (p=0.048)) and LLI (0.22, 0.10 to 0.48). Except in Black Caribbean women, adjustment for SEP rendered raised age-adjusted associations for pSRH among Pakistani (2.51, 1.99 to 3.17), Bangladeshi (1.85, 1.08 to 3.16), Black Caribbean (1.78, 1.44 to 2.21) and Indian women (1.37, 1.13 to 1.66) insignificant. Adjustment for health behaviours had the largest effect for South Asian women. By contrast, Irish women reported better age-adjusted SRH (0.70, 1.51 to 0.96). CONCLUSIONS: SEP and health behaviours were major contributors explaining EHI. Policies to improve health equity need to monitor these pathways and be informed by them