The situation and human rights of people living with HIV and AIDS were explored through focus groups in five African countries (Lesotho, Malawi, South Africa, Swaziland and Tanzania). A descriptive qualitative research design was used. The 251 informants were people living with HIV and AIDS, and nurse managers and nurse clinicians from urban and rural settings. NVivo™ software was used to identify specific incidents related to human rights, which were compared with the Universal Declaration of Human Rights. The (...) findings revealed that the human rights of people living with HIV and AIDS were violated in a variety of ways, including denial of access to adequate or no health care/services, and denial of home care, termination or refusal of employment, and denial of the right to earn an income, produce food or obtain loans. The informants living with HIV and AIDS were also abused verbally and physically. Country governments and health professionals need to address these issues to ensure the human rights of all people. (shrink)

The situation and human rights of people living with HIV and AIDS were explored through focus groups in five African countries . A descriptive qualitative research design was used. The 251 informants were people living with HIV and AIDS, and nurse managers and nurse clinicians from urban and rural settings. NVivo™ software was used to identify specific incidents related to human rights, which were compared with the Universal Declaration of Human Rights. The findings revealed that the human rights (...) of people living with HIV and AIDS were violated in a variety of ways, including denial of access to adequate or no health care/services, and denial of home care, termination or refusal of employment, and denial of the right to earn an income, produce food or obtain loans. The informants living with HIV and AIDS were also abused verbally and physically. Country governments and health professionals need to address these issues to ensure the human rights of all people. (shrink)

As Jonathan Mann observed, the problem of AIDS-related stigma is inextricably bound to issues of health, human rights, and the law. Such stigma translates into feelings of fear and hostility directed at people with HIV. It finds expression in avoidance and ostracism of people with HIV, discrimination and violence against them, and public support for punitive policies and laws that restrict civil liberties while hindering AIDS prevention efforts. Being the target of stigma inflicts pain, isolation, (...) and hardship on many people with HIV, while the desire to avoid it deters some from being tested for HIV, seeking treatment, or practicing risk-reduction. (shrink)

Although clarity about HIV transmission biology and effective therapy should mean that an AIDS diagnosis is more socially acceptable today, for some groups the cultural stigma of HIV infection has changed little in the last 30 years. This paper will examine why representations of HIV-positive gay men suggest they pose a special civic risk and how these conceptualizations have harnessed cultural anxieties about racial and sexual minorities to shape public policy and behavior since the advent of Highly Active (...) Antiretroviral Therapy (HAART) in 1996. (shrink)

Despite changes in their representation and visibility, there are still serious concerns about the inclusion and day-to-day workplace challenges various groups face (e.g., women, ethnic and cultural minorities, LGBTQ+, people as they age, and those dealing with physical or mental disabilities). Men are also underrepresented in specific work fields, in particular those in HEED (Health care, Elementary Education and the Domestic sphere). Previous literature has shown that group stereotypes play an important role in maintaining these inequalities. We outline how insights (...) from research on stigma, social-identity, and self-regulation together increase our understanding of how targets are affected by and regulate negative stereotypes in the workplace. This approach starts from the basis that members of negatively-stereotyped groups are not just passive recipients of negative attitudes, stereotypes, and behaviors, but are active individuals pursuing multiple goals, such as goals for belonging and achievement. We argue that it is only by understanding stigma from the target’s perspective (e.g., how targets are affected and respond) that we can successfully address workplace inequality. Key in this understanding is that stereotypes, prejudice and discrimination have taken on much more subtle forms, with consequences for the way members of stigmatized-groups cope. These insights lead us to propose an approach to understanding barriers to workplace equality that highlights four key aspects: a) the different (often subtle) potential triggers of identity-threat in the workplace for members of stigmatized-groups, b) the ways in which members of stigmatized-groups cope with these threats, c) the role of supportive factors that mitigate potential threats and affect self-regulation, and d) potential hidden costs for the self or others of what appears at first to be effective self-regulation. The focus on threats, coping, support, and potential hidden costs helps us understand why current diversity efforts are not always successful in increasing and maintaining members of stigmatized-groups in organizations, and provides insight into how we can aid efforts to effectively lower barriers to workplace equality. (shrink)

In this article I read textual metaphors of ‘untouchability’ in ‘post-AIDS’ representation as an erasure of structures that condition HIV stigmatization in India. Throughout, my discussion is contextualised by the political economy of HIV and AIDS, which has been productive of particular modern sexual subjects. In the film My Brother…Nikhil, the stigmatization of Nikhil, a gay Indian man living with HIV, is constituted through visual and verbal caste metaphors, which draw on existing subject positions that are elided as (...) ‘traditional’, residual, and receding. This stigma is resolved textually through parental acceptance of the gay protagonist and his partner, projecting stigma as traditional and modernity as the resolution. Such metaphors of ‘untouchability’ prevent the representation of queer Dalit subjects in contexts of HIV and AIDS. Yet if addressing shame and social stigma are key to HIV treatment and prevention programmes, caste cannot be set aside simply as a metaphor. Expanding to include textual representations of queer Dalit subjectivity, the article reads a novel, The Boyfriend, and a poem, “Gandu Bagicha,” to show ways in which caste stigma and homophobia intersect in contexts of seroconversion risk. (shrink)

Primary research on HIV/AIDS in India has predominantly focused on known risk groups such as sex workers, STI clinic attendees and long-distance truck drivers, and has largely been undertaken in urban areas. There is evidence of HIV spreading to rural areas but very little is known about the context of the infection or about issues relating to health and social impact on people living with HIV/AIDS. In-depth interviews with nineteen men and women infected with HIV who live in (...) rural areas were used to collect experiences of testing and treatment, the social impacts of living with HIV and differential impacts on women and men. Eight focus group discussions with groups drawn from the general population in the four villages were used to provide an analysis of community level views about HIV/AIDS. While men reported contracting HIV from sex workers in the cities, women considered their husbands to be the source of their infection. Correct knowledge about HIV transmission co-existed with misconceptions. Men and women tested for HIV reported inadequate counselling and sought treatment from traditional healers as well as professionals. Owing to the general pattern of husbands being the first to contract HIV women faced a substantial burden, with few resources remaining for their own or their children’s care after meeting the needs of sick husbands. Stigma and social isolation following widowhood were common, with an enforced return to the natal home. Implications for potential educational and service interventions are discussed within the context of gender and social relations. (shrink)

The text examines the article 11 of the Universal Declaration on Bioethics and Human Rights of UNESCO that deals with the principle of non-discrimination and non-stigmatization. Both concepts are related to the theme of human dignity, while discrimination is an inherent part of stigma: stigma does not exist if there is no discrimination. In this context, this paper aims to study the relationship between stigma, discrimination and HIV / AIDS. The study argues that to loosen the (...) bonds that hold the subjects that are attached to them is necessary questioning the broader forces - social, cultural, political and economic - that structure stigma, stigmatization and discrimination as social processes directly linked to production and reproduction of structural inequalities. (shrink)

The principle of individual medical confidentiality is one of the moral principles that Africa inherited unquestioningly from the West as part of Western medicine. The HIV/AIDS pandemic in Southern Africa has reduced the relevance of the principle of individual medical confidentiality. Individual medical confidentiality has especially presented challenges for practitioners among the Bantu communities that are well known for their social inter-connectedness and the way they value their extended family relations. Individual confidentiality has raised several unforeseen problems for persons (...) living with HIV/AIDS, ranging from stigma and isolation to feelings of dejection as it drives them away from their families as a way of trying to keep information about their conditions confidential. The involvement of family members in treatment decisions is in line with the philosophy of Ubuntu and serves to respect patients’ and families’ autonomy while at the same time benefiting the individual patient. (shrink)

Background Medical aid in dying (MAID) is legal in a number of countries, including some states in the U.S. While MAID is only permitted for terminal illnesses in the U.S., some other countries allow it for persons with psychiatric illness. Psychiatric MAID, however, raises unique ethical concerns, especially related to its effects on mental illness stigma and on how persons with psychiatric illnesses would come to feel about treatment and suicide. To explore those concerns, we conducted several focus groups (...) with persons with lived experience of mental illness.Methods We conducted three video-conference-based focus groups involving adults residing in the U.S. who reported a prior diagnosis of any psychiatric illness. Only participants who reported thinking that MAID for terminal illness was morally acceptable were included. Focus group participants were asked to respond to a series of four questions. Groups were facilitated by a coordinator who was independent of the research team.Results A total of 22 persons participated in the focus groups. The majority of participants had depression and anxiety disorders; no participants had psychotic disorders such as schizophrenia. Many participants strongly favored permitting psychiatric MAID, generally on the basis of respect for autonomy, its effects on stigma, and the severe suffering caused by mental illness. Others expressed concerns, typically related to difficulties in ensuring decision-making capacity and to the risk that MAID would be used in lieu of suicide.Conclusions Persons with a history of psychiatric illness, as a group, have a diverse array of views about the permissibility of psychiatric MAID, reflecting nuanced consideration of how it relates to the public perception of mental illness, stigma, autonomy, and suicide risk. (shrink)

This article analyzes the rise and fall of a public health ‘fact’ in the US: the assertion that gay men’s Viagra use is inherently recreational and increases STD risk. Extending the science studies argument that drug development and marketing entail the construction of new publics, this article shows how strategic drug marketing silences can also constitute new populations of users. It shows how Viagra marketing’s silence about gay users, which facilitated legitimization of the drug as an aid for companionate heterosexuality, (...) created a cultural space for the development of health discourse about gay men as illegitimate, recreational and risky Viagra users. Using Susan Leigh Star’s concepts of ‘simplification’ and ‘complexification’, this article traces the construction and deployment of this public health fact, as well as its subsequent contestation. Using an arena analysis approach, this article demonstrates how marketing discourse and public health fact-making came together in the case of gay Viagra use to refresh long-standing and politically harmful American cultural associations between gay sex and sickness. (shrink)

HIV stigmatization is one of the most notable barriers to individual testing, seriously impairing global efforts in the fight against HIV/AIDS. Because stigmatization is strongly embedded in local cultural and social habits, humanitarian healthcare workers providing HIV testing, counselling and prevention programs in low and middle income countries have become a serious alternative to local healthcare providers. This case study addresses some of the ethical dilemmas that humanitarian healthcare workers face when confronted with HIV-associated stigma.

During the early twentieth century, otologists began collaborating with organizers of the New York League for the Hard of Hearing to build a bridge to “adjust the economic ratio” of deafness and create new research avenues for alleviating or curing hearing loss. This collegiality not only defined the medical discourse surrounding hearing impairment, anchoring it in hearing tests and hearing aid prescription, but, in so doing, solidified the notion that deafness was a “problem” in dire need of a “solution.” Public (...) health campaigns thus became pivotal for spreading this message on local and national levels. This paper focuses on how, from the 1920s to 1950s, as otologists became more involved with social projects for the deaf and hard of hearing — advocating lip-reading, community work, and welfare programs — at the same time, they also mandated for greater therapeutic regulation, control of hearing aid distribution, and standardization of hearing tests. The seemingly paradoxical nature of their roles continued to reinforce the stigmatization of deafness: with widespread availability of effective help, the hearing impaired were expected to seek out therapeutic or technological measures rather than live with their affliction. (shrink)

BackgroundThe issue of stigma is very important in the battle against HIV/aids in Africa since it may affect patient attendance at healthcare centres for obtaining antiretroviral medications and regular medical check-ups. Stigmatization creates an unnecessary culture of secrecy and silence based on ignorance and fear of victimization. This study was designed to determine if there is external stigmatization of people living with HIV and AIDS by health care workers at a tertiary hospital in KwaZulu-Natal province, South Africa. (...) The study investigated the impact of knowledge of HIV/aids by HCWs on treatment of patients, as well as the comfort level and attitude of HCWs when rendering care to PLWHA.MethodsA descriptive cross sectional study was designed to collect data using an anonymous self-administered structured questionnaire from 334 HCWs. The study was conducted in clinical departments of a large multidisciplinary 922-bed tertiary care teaching hospital in Durban, KZN.ResultsOverall HCWs had an above average knowledge about HIV/aids although some gaps in knowledge were identified. Tests of statistical significance showed that there was association between level of education and knowledge of HIV/aids ; occupation and knowledge of HIV/aids ; and gender and knowledge of HIV/aids. Test for comfort level was only significant for gender, with males showing more comfort and empathy when dealing with PLWHA. The study also revealed that patients were sometimes tested for HIV without informed consent before surgery, due to fear of being infected, and there was some gossiping about patients' HIV status by HCWs, thereby compromising patient confidentiality. The majority of HCWs showed a willingness to report incidents of stigmatization and discrimination to higher authorities, for better monitoring and control.ConclusionsAlthough knowledge, attitude and comfort level of HCWs taking care of PLWHA was above average, enforcement of existing antidiscrimination laws and continuing education in medical ethics and healthcare law, would greatly improve the performance of HCWs taking care of PLWHAs. More psychological support and counselling should be provided to HCWs, to further reduce the impact of stigmatization and discrimination against PLWHA. (shrink)

This paper reflects on the meanings of ‘post-AIDS’ in the Global North and South. I bring together contemporary arguments to suggest that the notion of ‘post-AIDS’ is, at best, misplaced, not least because its starting point remains a biotechnical one. Drawing on aspects of the sub-Saharan African experience, this essay suggests that, despite significant shifts in access to antiretroviral therapy, HIV continues to be fundamentally shaped by economic determinants and social and cultural practices. In this essay, I question (...) the certainty of the discourse of ‘positive progress’, which underpins the ‘post-AIDS’ narrative, and suggest that living with HIV and AIDS in our contemporary global context is a life lived with ongoing complexity, stigma and chronicity. I suggest that HIV in the Global North shares many characteristics with HIV in the Global South yet differs in significant ways, not least in the fact that a resource-rich context generates an environment where health and social care support is possible, and, mostly, usual. In both contexts, however, the experience of living with a highly stigmatized illness with no cure in both the Global South and North suggests that this is a point of shared experience. (shrink)

This article analyzes narratives about living with HIV/ AIDS amid stigma, using the notion of “fragile stories” to further detail the linguistic practices through which people narrate experiences in danger of not being told. The article is based on fieldwork in 2008 in Durban, South Africa with a Zulu gospel choir in which all group members are living with HIV/AIDS. Close analysis of recorded narratives demonstrates how institutional story frameworks and the normative performance of gender helped storytellers (...) to breach boundaries drawn by stigma. The article consolidates research on narrative tellability and fragile stories, verbal art, and stigma. The article has implications for research amid stigma, advocating linguistic analysis of narrative to emphasize the relationship between stories told and life events involving stigmatization. (shrink)

This dossier article contains four short and varied contributions from activists and other service and healthcare providers who have been agitating and working on the frontlines of HIV/AIDS in Ireland since the early 1980s. The dossier contains: (1) a history, by Bill Foley, of the early collective efforts of a group of gay men to provoke government action and healthcare under the umbrella of Gay Health Action (GHA) (2) a speech delivered by Dr. Erin Nugent to government officials on (...) the re-branding of HIV Ireland in 2015; (3) a brief history, recounted by Noel Donnellan, of ACT UP Dublin since it was revitalized in 2016 by a small cohort of dedicated activists from a dormant group into a vibrant collective that has achieved great legislative change with regards to pre-exposure prophylaxis (PrEP); and (4) a polemic, written by Thomas Strong, on living with HIV as a queer man in Ireland that demonstrates the ways in which HIV stigma not only thrives in but molds and shapes twenty-first-century gay men’s communities, both in real life and online. (shrink)

This paper traces the development of policies dealing with HIV/AIDS in Botswana from their beginning in the late 1980s to the current programme to provide population-wide anti-retroviral therapy (ARV). Using a variety of source material, including long-term ethnographic research, it seeks to account for the failure of Western-inspired approaches in dealing with the pandemic. It does this by looking at the cultural and institutional features that have created resistance to the message and inhibited effective implementation. The negative response to (...) the first educational campaign stressing condom use is described and contextualized in terms of Tswana ideas of morality and illness. Nor, as was initially expected, did the introduction of free ARV therapy operate to break the silence and stigma that had developed around the disease. Take-up was very slow, and did not operate to encourage widespread testing. In 2003, key policymakers in Botswana began to argue for a break with the AIDS position, with its emphasis on voluntarism, confidentiality and the human rights of patients. This resulted in routine testing being introduced in 2004. This links to a major argument running through the paper which is that the failure of policy cannot be attributed solely to the nature of local populations. Western cultural assumptions about also require critical examination. (shrink)

This impressive and informative book deserves a wider readership than it is likely to get. Unfortunately there are still too many people who consider they have no need to read anything about the virus as it will, to their way of thinking, never touch them. In addition there will be those who think that a volume by Catholic ethicists will be too narrow in outlook to be worthwhile. Both sets of people are mistaken: HIV is here to stay, there is (...) no cure nor is there likely to be and sooner or later it will affect, let alone infect, millions across the world. On the second count readers will be surprised and energised by the clear and honest debate concerning the teachings of the Catholic Church. The first and longest section is made up of a series of case studies ranging from needle exchange in Puerto Rico, to confronting social stigma in Uganda, and matters relating to confidentiality in Australia. The second consists of seven …. (shrink)

The economic growth in India is quite visible through infrastructural and industrial growth in metros but the same is overshadowed by the poor plight of beggars in these cities. This article addresses the living conditions of the beggars and their awareness about the various government policies. The study gives an insight into the economic status of beggars and answers why people go for begging. The solution calls for a comprehensive programme and reorientation of the existing programmes. We often read and (...) hear of aids that are directed towards the upliftment of the beggars; and the article aims to check if these aids have in any way improved their plight. Many NGOs, non-profit private organizations and corporations are helping disadvantaged populace from various segments. But this segment has not received the requisite assistance and attention and this article examines the responsibility of corporations in this concern. (shrink)

HIV/AIDS continues to constitute a serious threat to the social and physical wellbeing of African mothers and their babies. In the hardest hit countries of sub-Saharan Africa, more than 60% of all new HIV infections are occurring in women, infants and young children. Mother-to-child transmission constitutes 90% of new HIV infections among infants and young children. Most of these infections can be prevented. However, the social stigma of HIV/AIDS insidiously continues to undermine the success of prevention programs. (...) Ironically, some attributes or characteristics of prevention of mother-to-child transmission programs may in fact serve as catalysts to the stigmatization process. This paper identifies and discusses six potential initiators: Routine HIV testing, Six months exclusive breastfeeding, Incentives, Home visits, Location of PMTCT program, and PMTCT terminology. In all these areas, there are practical strategies that may be applied to reduce the chances of being stigmatized. These strategies are introduced and discussed. (shrink)

HIV/AIDS is a major public health problem in Africa. Stigmatization, discrimination and lack of appropriate health care are among the commonest challenges that HIV infected persons and their families face. It has been suggested that among the tools available in the fight against stigmatization and discrimination is public disclosure of a person’s HIV seropositive status. While public disclosure of HIV status has a place in the fight against HIV and AIDS, especially by resulting in behavioural change among people (...) who know of an HIV infected person, we argue that such disclosure also has potential attendant harms. The posthumous disclosure of HIV status is particularly problematic. Public disclosure should be accompanied by appropriate individual counselling and preparation of the community to deal with the situation, and should have regard for cultural sensitivity after consideration of the risks and benefits to individuals, families and the community. Health practitioners should keep in mind that their main duty is to the best interest of the patient, the family and the community, in that order. (shrink)

Remarks made by Lutheran leaders in Africa indicate that the churches have not been responding to the crisis of the HIV/AIDS pandemic sufficiently. In this essay I ask how the churches would be better prepared to act and also, more broadly, how the churches act to begin with. The dialogue between religion and science can assist us with both tasks as we consider the challenge of HIV/AIDS as a focus for this dialogue. First, analysis by social scientists can (...) uncover what problems face any effort to motivate churches to act—and, for that matter, any individual member of a church group. I argue, further, that we can discover the difficulties associated with producing action by religious communities by looking not at abstract theological ideas but by investigating the way those ideas are conveyed in worship. I explore the worship patterns of Lutherans to show what sort of view is actually produced by the week‐to‐week messages of liturgical texts. I contend that a different approach both to worship and to action can be produced by reconsidering our views of reality as seen through the eyes of contemporary science. (shrink)

BackgroundThe issue of stigma is very important in the battle against HIV/aids in Africa since it may affect patient attendance at healthcare centres for obtaining antiretroviral medications and regular medical check-ups. Stigmatization creates an unnecessary culture of secrecy and silence based on ignorance and fear of victimization. This study was designed to determine if there is external stigmatization of people living with HIV and AIDS by health care workers at a tertiary hospital in KwaZulu-Natal province, South Africa. (...) The study investigated the impact of knowledge of HIV/aids by HCWs on treatment of patients, as well as the comfort level and attitude of HCWs when rendering care to PLWHA.MethodsA descriptive cross sectional study was designed to collect data using an anonymous self-administered structured questionnaire from 334 HCWs. The study was conducted in clinical departments of a large multidisciplinary 922-bed tertiary care teaching hospital in Durban, KZN.ResultsOverall HCWs had an above average knowledge about HIV/aids although some gaps in knowledge were identified. Tests of statistical significance showed that there was association between level of education and knowledge of HIV/aids ; occupation and knowledge of HIV/aids ; and gender and knowledge of HIV/aids. Test for comfort level was only significant for gender, with males showing more comfort and empathy when dealing with PLWHA. The study also revealed that patients were sometimes tested for HIV without informed consent before surgery, due to fear of being infected, and there was some gossiping about patients' HIV status by HCWs, thereby compromising patient confidentiality. The majority of HCWs showed a willingness to report incidents of stigmatization and discrimination to higher authorities, for better monitoring and control.ConclusionsAlthough knowledge, attitude and comfort level of HCWs taking care of PLWHA was above average, enforcement of existing antidiscrimination laws and continuing education in medical ethics and healthcare law, would greatly improve the performance of HCWs taking care of PLWHAs. More psychological support and counselling should be provided to HCWs, to further reduce the impact of stigmatization and discrimination against PLWHA. (shrink)

During the AIDS epidemic in the 1980s, it was crucial that providers take steps to protect patients by managing HIV with the perspective of ‘HIV exceptionalism’. However, in 2020, the social and historical barriers erected by this concept, as demonstrated in this patient’s case, are considerably impeding progress to end the epidemic. With significant medical advances in HIV treatment and prevention, the policies informed by HIV exceptionalism now paradoxically perpetuate stigma and inequities, particularly for people of colour. To (...) improve overall HIV care, the medical community must move past HIV exceptionalism by liberalising diagnostics, instituting clinician implicit bias training and advocating to fully decriminalise HIV non-disclosure. (shrink)

While stigmatisation is universal, stigma research in low- and middle-income countries (LMIC) is limited. LMIC stigma research predominantly concerns health-related stigma, primarily regarding HIV/AIDS or mental illness from an adult perspective. While there are commonalities in stigmatisation, there are also contextual differences. The aim of this study in DR Congo (DRC), as a formative part in the development of a common stigma reduction intervention, was to gain insight into the commonalities and differences of stigma (...) drivers (triggers of stigmatisation), facilitators (factors positively or negatively influencing stigmatisation), and manifestations (practices and experiences of stigmatisation) with regard to three populations: unmarried mothers, children formerly associated with armed forces and groups (CAAFAG), and an indigenous population. Group exercises, in which participants reacted to statements and substantiated their reactions, were held with the ‘general population’ (15 exercises, n = 70) and ‘populations experiencing stigma’ (10 exercises, n = 48). Data was transcribed and translated, and coded in Nvivo12. We conducted framework analysis. There were two drivers mentioned across the three populations: perceived danger was the most prominent driver, followed by perceived low value of the population experiencing stigma. There were five shared facilitators, with livelihood and personal benefit the most comparable across the populations. Connection to family or leaders received mixed reactions. If unmarried mothers and CAAFAG were perceived to have taken advice from the general population and changed their stereotyped behaviour this also featured as a facilitator. Stigma manifested itself for the three populations at family, community, leaders and services level, with participation restrictions, differential treatment, anticipated stigma and feelings of scapegoating. Stereotyping was common, with different stereotypes regarding the three populations. Although stigmatisation was persistent, positive interactions between the general population and populations experiencing stigma were shared as well. This study demonstrated utility of a health-related stigma and discrimination framework and a participatory exercise for understanding non-health related stigmatisation. Results are consistent with other studies regarding these populations in other contexts. This study identified commonalities between drivers, facilitators and manifestations—albeit with population-specific factors. Contextual information seems helpful in proposing strategy components for stigma reduction. (shrink)

There are five ways in which shame might negatively impact upon our attempts to combat and treat HIV. Shame can prevent an individual from disclosing all the relevant facts about their sexual history to the clinician. Shame can be a motivational factor in people living with HIV not engaging with or being retained in care. Shame can prevent individuals from presenting at clinics for STI and HIV testing. Shame can prevent an individual from disclosing their HIV status to new sexual (...) partners. Shame can serve to psychologically imprison people, it makes the task of living with HIV a far more negative experience than it should, or needs to, be. Drawing on recent philosophical work on shame, and more broadly on work in the philosophy and psychology of emotion, we propose a framework for understanding how shame operates upon those who experience the emotion, propose a strategy for combatting the negative role shame plays in the fight against HIV, and suggest further study so as to identify the tactics that might be employed in pursuing the strategy here proposed. (shrink)

Since the introduction of drugs to prevent vertical transmission of HIV, the purpose of and approach to HIV testing of pregnant women has increasingly become an area of major controversy. In recent years, many strategies to increase the uptake of HIV testing have focused on offering HIV tests to women in pregnancy-related services. New global guidance issued by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) specifically notes these services as an entry point (...) for provider-initiated HIV testing and counseling (PITC). The guidance constitutes a useful first step towards a framework within which PITC sensitive to health, human rights and ethical concerns can be provided to pregnant women in health facilities. However, a number of issues will require further attention as implementation moves forward. It is incumbent on all those involved in the scale up of PITC to ensure that it promotes long-term connection with relevant health services and does not result simply in increased testing with no concrete benefits being accrued by the women being tested. Within health services, this will require significant attention to informed consent, pre- and post-test counseling, patient confidentiality, referrals and access to appropriate services, as well as reduction of stigma and discrimination. Beyond health services, efforts will be needed to address larger societal, legal, policy and contextual issues. The health and human rights of pregnant women must be a primary consideration in how HIV testing is implemented; they can benefit greatly from PITC but only if it is carried out appropriately. (shrink)

Encouraged by the success of smoking denormalization strategies as a tobacco-control measure, public health institutions are adopting a similar approach to other health behaviors. For example, a recent controversial ad campaign in New York explicitly aimed to denormalize HIV/AIDS amongst gay men. Authors such as Scott Burris have argued that efforts like this are tantamount to stigmatization and that such stigmatization is unethical because it is dehumanizing. Others have offered a limited endorsement of denormalization/stigmatization campaigns as being justified on (...) consequentialist grounds; namely, that the potential public health benefits outweigh any stigmatizing side effects. In this paper, I examine and reject the blanket condemnation of stigmatization efforts in public health. I argue that the moral status of such efforts are best evaluated within a contractualist, as opposed to a consequentialist, framework. Contractualism in public health ethics asks whether a particular stigmatizing policy could be justified to reasonable individuals who do not know whether they will be affected by that policy. Using this approach, I argue that it is sometimes permissible for public health institutions to engage in health-related stigmatization. (shrink)

The coupled growth of population aging and international migration warrants attention on the methods and solutions available to adult children living overseas to provide distance caregiving for their aging parents. Despite living apart from their parents, the transnational informal care literature has indicated that first-generation immigrants remain committed to carry out their filial caregiving obligations in extensive and creative ways. With functions to remotely access health information enabled by emergency, wearable, motion, and video sensors, remote monitoring technologies (RMTs) may thus (...) also allow these international migrants to be alerted in sudden changes and remain informed of their parent’s state of health. As technological solutions for caregiving, RMTs could allow independent living for older persons while any unusual deviations from normal health patterns are detected and appropriately supported. With a vignette of a distance care arrangement, we engage with concepts such as filial piety, in-absentia caregiving distress, and the social exchange theory, as well as the upholding of shifting cultural ideals to illustrate the complex dynamic of the satisfaction and quality of the informal caregiving relationship. This paper extends the traditional ethical issues in technology-aided caregiving, such as autonomy, privacy, and justice, to be considered within the context of distance care. We also posit newer ethical considerations such as consent in power imbalances, harm to caregivers, and stigma. These known and new ethical issues aim to encourage further ethically conscious design and use of RMTs to support distance care for older persons. (shrink)

Background: Studies have established that negative perceptions of people living with HIV/AIDS exist among nursing students throughout the world, perceptions which can be detrimental to the delivery of high-quality nursing care. Objectives: The purpose of this research was to explore socio-cultural influences on the perceptions of nursing students towards caring for people living with HIV/AIDS. Research design: The study was guided by stigma theory, a qualitative descriptive research approach was adopted. Data collected via semi-structured interviews were thematically (...) analysed. Participants and research context: Participants were 21 international and Australian undergraduate nursing students enrolled in a Bachelor of Nursing programme at an Australian university. Ethical considerations: Ethical approval was granted by the Social and Behavioural Research Ethics Committee at the study university. Participation was entirely voluntary; informed consent was obtained before the study commenced; confidentiality and anonymity were assured. Findings: Three major themes were found: blame, othering and values. Complex and interrelated factors constructed participant perceptions of people living with HIV/AIDS, perceptions underscored by the prevailing culturally construed blame and othering associated with HIV/AIDS. The study found discordance between the negative personal beliefs and perceptions some nursing students have towards people living with HIV/AIDS, and the professional values expected of them as Registered Nurses. Discussion: There was considerable commonality between this and previous studies on how homosexuality and illicit drug use were perceived and stigmatised, correlating with the blame directed towards people living with HIV/AIDS. These perceptions indicated some nursing students potentially risked not fulfilling the ethical and professional obligations the Registered Nurse. Conclusion: Nursing curriculum should be strengthened in relation to comprehending the meaning of being stigmatised by society. Educational institutions need to work towards enhancing strategies that assist nursing students to reconcile any incongruity between their personal beliefs and requisite professional nursing values. (shrink)

Inadequate diet is the leading risk factor for morbidity and mortality worldwide. However, approaches to identifying inadequate diets in clinical practice remain inconsistent, and dietary interventions frequently focus on facilitating ‘healthy choices’, with limited emphasis on structural constraints. We examine the ethical implications of introducing a routine question in the medical history about ability to access food. Not collecting data on food security means that clinicians are unable to identify people who may benefit from support on an individual level, unable (...) to consider relevant dietary risk factors for disease and disease progression and unable to monitor population trends and inequalities in dietary access in order to design effective policy interventions. We argue that the current lack of routine screening for food insecurity is inconsistent with our approach to other health behaviours, as well as with doctors’ frequent informal role as gatekeepers to the food aid system, and recent calls for governmental action on food insecurity and health inequalities from individual clinicians and professional bodies. Potential ethical barriers to asking patients about food security are addressed, including concerns about stigma, limiting autonomy, fair resource allocation, unclear professional remits and clinicians’ ability to offer effective interventions. We suggest that there is an ethical imperative for doctors to ask patients about their ability to access healthy food. Gathering this data provides a valuable first step in re-framing the social determinants of health as modifiable risks, rather than inevitable inequities. No data are available. (shrink)

BackgroundCarefully planned research is critical to developing policies and interventions that counter physical, psychological and social challenges faced by young people living with HIV/aids, without increasing burdens. Such studies, however, must navigate a ‘vulnerability paradox’, since including potentially vulnerable groups also risks unintentionally worsening their situation. Through embedded social science research, linked to a cohort study involving Adolescents Living with HIV/aids (ALH) in Kenya, we develop an account of researchers’ responsibilities towards young people, incorporating concepts of vulnerability, resilience, (...) and agency as ‘interacting layers’.MethodsUsing a qualitative, iterative approach across three linked data collection phases including interviews, group discussions, observations and a participatory workshop, we explored stakeholders’ perspectives on vulnerability and resilience of young people living with HIV/aids, in relation to home and community, school, health care and health research participation. A total of 62 policy, provider, research, and community-based stakeholders were involved, including 27 ALH participating in a longitudinal cohort study. Data analysis drew on a Framework Analysis approach; ethical analysis adapts Luna’s layered account of vulnerability.ResultsALH experienced forms of vulnerability and resilience in their daily lives in which socioeconomic context, institutional policies, organisational systems and interpersonal relations were key, interrelated influences. Anticipated and experienced forms of stigma and discrimination in schools, health clinics and communities were linked to actions undermining ART adherence, worsening physical and mental health, and poor educational outcomes, indicating cascading forms of vulnerability, resulting in worsened vulnerabilities. Positive inputs within and across sectors could build resilience, improve outcomes, and support positive research experiences.ConclusionsThe most serious forms of vulnerability faced by ALH in the cohort study were related to structural, inter-sectoral influences, unrelated to study participation and underscored by constraints to their agency. Vulnerabilities, including cascading forms, were potentially responsive to policy-based and interpersonal actions. Stakeholder engagement supported cohort design and implementation, building privacy, stakeholder understanding, interpersonal relations and ancillary care policies. Structural forms of vulnerability underscore researchers’ responsibilities to work within multi-sectoral partnerships to plan and implement studies involving ALH, share findings in a timely way and contribute to policies addressing known causes of vulnerabilities. (shrink)

Little research has explored the possible effects of government institutions in emerging economies on ethical reviews of multinational research. We conducted semi-structured, in-depth telephone interviews with 15 researchers, Research Ethics Committees personnel, and a government agency member involved in multinational HIV Prevention Trials Network research in emerging economies. Ministries of Health or other government agencies often play pivotal roles as facilitators or barriers in the research ethics approval process. Government agency RECs reviewing protocols may face particular challenges, as they can (...) lack resources, be poorly organized, have inconsistent review processes and limited expertise, and use differing definitions of national interests, including upholding national reputation and avoiding potential exploitation and stigma of the country's population. The MOH/governmental review body may be affected by power dynamics and politics in study reviews; may consider issues both related and unrelated to research ethics as understood elsewhere; and may prioritize particular diseases, treatments, or interventions over other topics/types of research. Poor communication and deeply-rooted tensions may exist between sponsor and host countries, impeding optimal interactions and reviews. Investigators must understand and plan for the potential effects of governmental agencies on multinational collaborative research, including preserving adequate time for agency review, and contacting these agencies beforehand to address issues that may arise. Better understanding of these issues can aid and advance appropriate global scientific collaboration. (shrink)

Within the Judeo-Christian tradition, Sodom and Gomorrah represent locales in which threats to national formation are couched in sexual terms. The biblical narrative insists on a particular social invisibility for those sexual activities not blessed by the bonds of matrimony. Reclaiming Sodom surveys a number of institutions that have had an interest in perpetuating these views: the police, the state, the church and the law. The collection ranges through biblical scholarship, an investigation of the Founding Fathers' beliefs, the legal mobilization (...) towards the category of sodomy in 18th and 19th century England, and the US Supreme Court's 1986 Bowers vs. Hardwick decision. Analysis is provided of the ways in which the Judeo-Christian tradition has shaped anthropological accounts of the same-sex practices of non-Western people, as well as essays on how colonial gestures have marked lesbian identity in the Carribean, and derformed narratives about the racial geography of AIDS. Reclaiming Sodom explores alternatives to the force of the Sodomitic biblical narrative in Islamic, non-western, and western traditions, and discusses the ways in which sodomy calls into question normative definitions of sexuality and gender. The collection pursues the "pleasures and dangers" of these alternatives, and takes on Proust's refusal to imagine a social movement founded on the "stigma" of Sodom. The collection examines the relations between sex/gender identities and sexual acts in important and provocative ways, and argues for the political use and usefulness of both Sodom and sodomy. Reclaiming Sodom makes an important and controversial contribution to the literature on sexuality and gender, as well as the nature of sex in our culture. Contributors: Dorothy Allison, Robert Alter, Neil Bartlett, Leo Bersani, Gerald Creed, Marc Daniel, Lee Edelman, Janet E. Halley, Jonathan Ned Katz, Pierre Klossowski, Rocky O'Donovan, Guy Hocquenghem, Cindy Patton, Marquis de Sade, David Shannon, Makeda Silver, Jonathan Goldberg. (shrink)

The historiography of pandemics and inequality can be characterized by two distinct but often overlapping traditions. One centers structural and political analysis, the other a race-critical approach to the production of human difference. This bibliographic essay reviews historical scholarship in these traditions spanning the past hundred years, with a focus on Anglophone literature in the history of medicine in the United States over the past half century. Early writing on the history of epidemics celebrated the conquest of disease through the (...) application of laboratory research. Insights from social history and environmental history came to inform new analyses of epidemic inequalities, drawing questions of race, class, and empire into the frame during the 1960s and 1970s. The AIDS pandemic of the 1980s further oriented scholarship toward reckoning with stigma, identity, and human experiences of inequality while also troubling the relationship between medicine and the state. In more recent decades, the scholarship on race, social inequality, and pandemics has become deep and broad, remedying longstanding biases toward elite scientific actors and the metropolitan centers of Europe and the East Coast of the United States. In expanding their vision, historians also have engaged in more nuanced analyses of racialization as a social, environmental, and ideological process of embodying difference. Further, where earlier scholarship often relied on mortality data, there has been growing awareness of how numbers shape narratives and are shaped by them in turn. In its conclusion, the essay highlights emerging themes in race and inequality with particular attention to themes that have become prominent amid the global devastation wrought by the COVID-19 pandemic. (shrink)

Working in and around the ‘chain of command’: power relations among nursing staff in an urban nursing homeBy most accounts, the discipline of nursing enjoys considerable hegemony in US nursing homes. Not surprisingly, the ethos of this setting is influenced, in large part, by nursing’s value system. This ethos powerfully impacts both the residents who live in nursing homes and the staff who work there. Using ethnographic methods, this project explored power relations among nursing assistants and nurses in an urban (...) nursing home in the United States. Factors contributing to tensions among nursing staff were the stigma attached to nursing homes and those who work in them, as well as the long history of class conflict and power struggles within the discipline of nursing. The latter struggles, in turn, reflected nursing’s quest for professional status in the face of medicine’s hegemony over health‐care. Ultimately, these factors coalesced to produce a local work environment characterized by conflict — and by aides’ resistance to nurses’ domination. (shrink)

Violence against women is a global stigma. At least two conditionsstirred the global community: Malala Yousafzai who took a bullet in 2012 andwho advocate girl’s education to date, and the 2014 reported kidnap of 300Nigerian girls by Boko Haram. There are oppressive stereotypes of women.Violence can come in different forms. These can come as verbal abuse, intimatepartners violence, non-intimate partner violence, trafficking, forced prostitution,exploitation of labor, debt bondage, physical and sexual violence, sex selectiveabortion, female infanticide and femicide, deliberate neglect (...) and girl’s education,rape in war, dowry murder, pornography, dating violence, female genitalmutilation/circumcision, and acid attack. With the aid of Hermeneutics, therich allusions and strong Feminist voices that exhume the elements of VAW areinherent characteristics of the Cebuano-Visayan Feminist poetry. The poemsconvince women to reclaim femininity, regain self-worth, challenge patriarchy,defy social prescriptions and conventions for women’s behavior. The four selectedCebuano-Visayan poetry with sound Feminist voices are support systems forwomen. Further studies on VAW in Cebuano-Visayan poetry are recommended. Keywords: Hermeneutics, poetry, Violence Against Women , descriptive research,Cebuano-Visayan language, Philippines. (shrink)

Rapid advances in digital hearing technologies, also known as hearables, are expected to disrupt the direct‐to‐consumer health market. For older adults with higher incidence of hearing loss, such disruption could reduce hearing problems, increase accessibility to hearing aids, and mitigate related stigmas. This paper delves into the intersection of disruptive innovation and hearables within the realm of biomedical ethics. Through a comprehensive exploration, we shed light on the ethical implications surrounding hearables. By critically evaluating the key ethical advantages and (...) drawbacks, we find that no single concern presents an insurmountable a priori objection to hearables. We conclude with some ideas to maximize the benefits of hearables and further promote opportunities for equitable hearing health. (shrink)

Amidst growing global endorsements of new biomedical HIV prevention strategies, ARV-based pre-exposure prophylaxis (ARV PrEP) has garnered considerable attention as a potentially promising prevention strategy. Though it may offer more effective protection for certain at-risk groups than conventional prevention strategies (such as sexual partner reduction, condom use, and prevention of mother-to-child transmission), PrEP is more costly. PrEP requires more ongoing contact between individuals and providers, and a level of surveillance from the health system that is not necessary with other preventive (...) measures. In this sense, it represents a new bio-technology for HIV prevention that poses particular challenges for worldwide implementation, given developing countries’ struggling health systems and incomplete HIV treatment programs. Since the emergence of PrEP has stimulated ethical discussions premised on incomplete knowledge of efficacy and implementation, this paper explores the ethical parameters of a likely scenario for PrEP usage in a single, resource-poor country. We first develop a plausible model for PrEP deployment and utilization based on current PrEP research, while carefully considering the reigning institutional values of feasibility and effectiveness in global health approaches. Drawing on ethnographic research of HIV treatment and prevention approaches in Lesotho, we address ethical questions arising from this scenario of PrEP delivery. Lesotho presents a compelling and emblematic case study of PrEP's potential successes and pitfalls in a developing country, given the country's high HIV prevalence, struggles to achieve universal access to HIV treatment regimes, continued existence of stigma around the epidemic, and difficulties in addressing persistent social inequalities that fuel infections. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Infertility Treadmill: Feminist Ethics, Personal Choice, and the Use of Reproductive Technologies by Karey HarwoodKathryn Lilla CoxThe Infertility Treadmill: Feminist Ethics, Personal Choice, and the Use of Reproductive Technologies Karey Harwood Chapel Hill, NC: University of North Carolina Press, 2007. 221pp. $22.00Karey Harwood’s The Infertility Treadmill, published in the University of North Carolina’s Studies in Social Medicine series, fills a lacuna in the infertility literature. Harwood takes (...) an interdisciplinary approach examining “assisted reproductive technologies” (ART) using current scientific, philosophical, theological, and—most importantly—her own ethnographic research. By way of a thick description of women’s experiences of infertility, she draws the reader into a rich ethical conversation regarding ARTs.Harwood “seeks first and foremost to offer an interpretation of the ethical significance of the increasing use of ART by bringing a particular set of normative or evaluative lenses to bear on a particular set of descriptive data” (8). She engaged in this study because of her desire to explore the connections between decisions to use ART and such factors as paid employment, delayed childbirth, and the ongoing balancing of work and family life. Harwood gathered her descriptive data by spending a year with the Atlanta chapter of RESOLVE (The National Infertility Association): attending monthly meetings and listening to speakers and participants as well as appraising RESOLVE’s national and local literature. She also conducted nine interviews with eight women and one man. Focusing on work and family conflicts in light of questions related to gender justice and the interplay between social and communal norms theories, on the one hand, and private and individual choice, on the other, Harwood teases out the ethical complexity surrounding ARTs.After surveying philosophical and theological literature relevant to her topic, Harwood names and examines existential concerns that emerged from her observations, conversations, and interviews with RESOLVE members. Clustered thematically, these concerns include the painful isolation of infertility, the stigma attached to using ARTs, people’s moralizing, how much treatment to pursue, what is the value in trying one more thing, socioeconomic status, and emotional awareness (62–97). Throughout her discussion of these concerns, [End Page 209] Harwood reminds ethicists of the importance of personal narratives for any treatment of an ethical issue like this.Moreover, her research leads Harwood to deduce that RESOLVE helps people with meaning-making, questions of purpose, language clarification, and various options surrounding infertility and ARTs. She asserts that the infertility experience can be a transformative one for the infertile. The decision-making process regarding the use of ARTs functioned as a type of ritual—albeit “a consumeristic ritual”—that aided people in working through the grief of infertility (157). Religious institutions have not always helped the infertile in these areas. Nonetheless, Harwood’s study leads her to conclude that RESOLVE members and leaders tend to be deficient in their capacities for challenging and critically examining how individual decisions intertwine with larger social contexts.Harwood acknowledges that her methodological decision to focus on one RESOLVE chapter limited her demographics (63–64). Moreover, although for the most part balanced, Harwood’s assessment of her findings is at times partial, even bordering on advocacy. For example, she clearly seeks to make the case that ethical analyses of infertility need to be more nuanced—incorporating more personal narrative—and that RESOLVE needs to be more open to critical self-reflection, especially the critical questioning of the “treadmill of infertility” (133). In her analysis of her findings, Harwood demonstrates how personal narratives help nuance ethical analysis. Less clear is whether RESOLVE can be or wants to be more self-critical and more questioning of its own core premises. Nonetheless, these limitations do not detract from Harwood’s important insights regarding “the infertility treadmill” and the host of issues related to ARTs—including consumerism, the role of rituals, meaning-making, suffering and grief, and gender justice, among others.Those struggling with infertility or considering ARTs will find Harwood to be an empathetic dialogue partner. Others will gain a deeper understanding of infertility’s toll by reading this book. Graduate and advanced undergraduate students will benefit from Harwood’s analysis of how personal decisions have wide-ranging... (shrink)

Background Genomic research on neurodevelopmental disorders (NDDs), particularly involving minors, combines and amplifies existing research ethics issues for biomedical research. We performed a review of the literature on the ethical issues associated with genomic research involving children affected by NDDs as an aid to researchers to better anticipate and address ethical concerns. Results Qualitative thematic analysis of the included articles revealed themes in three main areas: research design and ethics review, inclusion of research participants, and communication of research results. Ethical (...) issues known to be associated with genomic research in general, such as privacy risks and informed consent/assent, seem especially pressing for NDD participants because of their potentially decreased cognitive abilities, increased vulnerability, and stigma associated with mental health problems. Additionally, there are informational risks: learning genetic information about NDD may have psychological and social impact, not only for the research participant but also for family members. However, there are potential benefits associated with research participation, too: by enrolling in research, the participants may access genetic testing and thus increase their chances of receiving a (genetic) diagnosis for their neurodevelopmental symptoms, prognostic or predictive information about disease progression or the risk of concurrent future disorders. Based on the results of our review, we developed an ethics checklist for genomic research involving children affected by NDDs. Conclusions In setting up and designing genomic research efforts in NDD, researchers should partner with communities of persons with NDDs. Particular attention should be paid to preventing disproportional burdens of research participation of children with NDDs and their siblings, parents and other family members. Researchers should carefully tailor the information and informed consent procedures to avoid therapeutic and diagnostic misconception in NDD research. To better anticipate and address ethical issues in specific NDD studies, we suggest researchers to use the ethics checklist for genomic research involving children affected by NDDs presented in this paper. (shrink)

This book is an investigation into cultural variations in experiences of depression. With the aid of empirical data, and with a phenomenological outlook, the analyses presented aim to give a comparative account of the significance of culture in shaping cross-cultural variations, as seen in Iran and the UK. Through analysis of elements of Iranian culture such as literature and folk theories, and important pillars of current social make-up of the country like experience of Iran-Iraq war, the Islamic revolution and its (...) dominant religious discourse, variations in conceptions, experiences and narratives of depression are accounted for. Some of the themes explored include discussions of particular symptoms of depression such as guilt, hopelessness, loss of meaning and somatic symptoms; social stigmas and help-seeking behaviours; changes in relations with others; and metaphors used to convey experiences of depression. The findings of the empirical data examined challenge the universalist approach to psychiatry as science and practice, as well as theoretical notions like idioms of distress that aim to account for cross-cultural variations of mental illness. Instead, it is claimed that a better understanding of the workings of mental illness is achieved by situating individuals and their experience in a meaning-making sociocultural context. (shrink)

In six chapters of uneven length, Peter Lewis Allen, a former literature professor and public policy activist, offers a highly readable romp through two millennia of beliefs and attitudes regarding sin, sex, and disease. In particular, Allen draws on religious, medical, and popular literature from different eras in order to exemplify how particular “diseases”—lovesickness, leprosy, syphilis, bubonic plague, and masturbation—were causally connected with thoughts of punishment for sinful behavior. He then extends this theme into a lengthy chapter describing how the (...) same belief contributed to the chasm between conservative and activist perspectives on AIDS in the United States over the past two decades.Allen, who is admittedly not a historian, picks and chooses a “series of portraits of disease,” offering little contextualization as he creates a “tableau” of perspectives drawn from European and American discourse throughout Christianity. He flavors his chronological narrative with personal experiences drawn from his work in gay health groups. The most significant personal experiences he intersperses stem from thoughts about his one‐time lover, now dead from complications associated with AIDS. He interjects key episodes from this relationship into the book to affirm that “in its fight about how to respond to AIDS,” American society has reenacted a “drama that had been written centuries before” .Allen's engaging writing stands much more firmly as chronologically arranged comparative literature than as historical scholarship. His greatest historiographical faux pas lies in his anachronistic writing about disease. For example, he introduces his chapter on medieval leprosy with a description of the pathological destruction caused by the leprosy bacterium. Then, in selecting situations drawn from Herodotus through the sixteenth‐century “contagionist” Girolamo Fracastoro, he erroneously assumes that “leprosy” implied a singular, consistent disorder throughout this long period. Similar concerns arise regarding his coverage of syphilis. Such errors may have originated from his drawing too exclusively from pre‐1990 historical writings. Works like Charles E. Rosenberg and Janet Golden's Framing Disease: Studies in Cultural History and Linda Merian's edited volume The Secret Malady: Venereal Disease in Eighteenth‐Century Britain and France , and the voluminous literature on the history of the body, would have provided contextual concepts within which to place more concrete views about the intersections between diseases and culture. The author's desire to flash forward from particular historical periods to AIDS in our society too often leads to weakly substantiated connections between time periods.Allen's strengths lie in his ability to draw on works of literature, especially popular literature. His particular emphasis on French works reflects his own background in medieval French literature. His arguments are also strong when comparing church and society in the medieval period. For example, his chapter on lovesickness clearly delineates the persistent position of the Church Fathers against medics who regularly prescribed a “coital cure” for the disorder, without specifying what partners to select, instead of welcoming disease as a divine corrective.Allen's writing on plague, the shortest chapter of the book, clearly depicts the once‐common view that this epidemic disaster was inflicted by God as a punishment for mankind's sinful nature. However, the omission of any discussion of sex in a chapter of a work subtitled “Sex and Disease, Past and Present,” is somewhat puzzling. Even more conspicuous is the author's failure to expand upon the 1530 poem regarding the plight of the impious shepherd, Syphilis, from whom the disease in question received its name. Why would a literary scholar prone to draw on popular writings not give more than a single‐sentence mention to this historically relevant poem?Of the works Allen has drawn upon, he offers a pleasant mix of primary and secondary accounts that, like all good literary criticism, gives original sources a clear voice. Any work so selectively focused on a few diseases will leave some readers wondering about others that might have been perceived in terms of sex and sin. Were such associations discussed in regard to madness in the eighteenth century, tuberculosis in the nineteenth century, or the wide range of twentieth‐century STDs prior to AIDS? Why was no mention made of leprosy in the twentieth‐century context? Its AIDS‐like stigma has been historically contextualized in several works, including Stephanie J. Castillo's award‐winning 1992 documentary Simple Courage. Similarly, one wonders why the author chose not to drawn on standard medical history accounts on AIDS, including Elizabeth Fee and Daniel M. Fox's edited volume AIDS: The Burden of History and, perhaps more important for the Francophile Allen, Mirko D. Grmek's Histoire du SIDA: Début et origine d'une pandémie actualle .Apart from my historiographical criticisms, The Wages of Sin is a most delightful popular rendering of key relations between disease and Christianity. Works like this are extremely useful in reminding the reading public in an articulate, informative, and entertaining manner that they are part of humanity's continuum that has long sought connections between physical health and moral living. Indeed, Allen's apt description of the underlying usefulness of history underscores the importance of his own writing: “We value history because, whatever its distortions and inaccuracies, it is a way of understanding and giving value to our collective human experience and collective human memory”. (shrink)

Luke Demaitre's Leprosy in Premodern Medicine: A Malady of the Whole Body is a highly interesting study of the medical history of leprosy and the medical and social perceptions on leprosy that have been around for centuries. Remarkably, it is likely that leprosy will disappear from the face of the Earth in our generation, thanks to the development of a curative treatment and its increasing availability (although the battle has not yet been won completely). Demaitre's book is a very good (...) read not only for its information about leprosy but also for all interested in or affected by the social phenomenon of stigma. In illnesses such as leprosy, HIV/AIDS, epilepsy, and mental disorders such as schizophrenia, the stigma attached to the condition may be worse than the condition itself. (shrink)

The debate over how to best guide HIV-infected mothers in resource-poor settings on infant feeding is more than two decades old. Globally, breastfeeding is responsible for approximately 300,000 HIV infections per year, while at the same time, UNICEF estimates that not breastfeeding (formula feeding with contaminated water) is responsible for 1.5 million child deaths per year. The largest burden of these infections and deaths occur in Sub-Saharan Africa. Using this region as an example of the burden faced more generally in (...) other resource-poor settings, we contrast the evolution of the clinical standard of care for infant feeding with HIV-infected mothers in high-income countries to the current international clinical guidelines for HIV-infected mothers and infant feeding in resource-poor settings. While the international guidelines of exclusive breastfeeding for a 6-month period seem to offer the least-worst strategy for reducing mother-to-child transmission of HIV during infancy while conferring some immunity through breastfeeding post-6 months, we argue that the impact of the policy on mothers and healthcare workers on the ground is not well understood. The harm reduction approach on the level of health policy translates into a complicated, painful moral dilemma for HIV-positive mothers and those offering them guidance on infant feeding. We argue that the underlying socio-economic disparities that continue to fuel the need for a harm reduction policy on infant feeding and the harm to women and children justify: (1) that higher priority be given to solving the infant feeding dilemma with improved data on safe feeding alternatives, and (2) support of innovative, community-driven solutions that address the particular economic and cultural challenges that continue to result in HIV-transmission to children within these communities. (shrink)

En este artículo exploramos desde la literatura, por medio de Suenan timbres de Luis Vidales, la dinámica de las nacientes urbes colombianas que inician un proceso acelerado de modernización, carente de un desarrollo adecuado del pensamiento moderno, a la par con los nuevos avances materiales, lo que imposibilita debatir la pertinencia y el proceso de este tipo de transformaciones. Circunstancia que lleva a Colombia a experimentar los idiotismos de la modernización sin modernidad, impidiéndoles a los hombres entender las necesidades y (...) conflictos que genera el progreso. Estas aldeas de principios del siglo XX se convierten rápidamente en proyectos de ciudades determinadas por la aparición de nuevos objetos, creando una atmósfera móvil y ruidosa por oposición a la pasividad de las aldeas, realidad que nos recrea Vidales desde una poética comprometida con los cambios sociales y políticos como poeta de la crítica en Colombia. In this paper, from the literature of Luis Vidales’s Suenan timbres, we explore the dynamics of Colombian rising cities that initiate an accelerated modernization process, deprived of an appropriate development of modern thinking, along with the new material advances, which makes it impossible to debate the relevance and the process followed by these types of transformations. This situation leads Colombia to experience the idiotism of modernization without modernity, impeding men to understand the needs and conflicts generated by progress. These villages from twentieth century beginnings quickly turn into city projects determined by the arrival of new objects, creating a mobile and noisy atmosphere, opposed to villages’ passivity. From poetics committed to social and political change, Vidales recreates reality as a poet of criticism in Colombia. (shrink)