Epistemological frameworks and the ‘feminization’ of the HIV/AIDS pandemic

This article is part of the following series:

The Social Science Research Council (SSRC) recently set up a new blog site called “The Fourth Wave: Violence, Gender, Culture & HIV in the 21st Century.” The site is a counterpart to a forthcoming book edited by Jennifer F. Klot and Vinh-Kim Nguyen, and it makes the chapters of that book publicly-available free-of-charge. In addition to pdf and Flash versions of the complete papers, the site allows visitors to leave blog-style comments on the abstract pages.

The volume seems particularly significant and interesting for several reasons: 1) it was commissioned by UNESCO; 2) the contributors include many medical anthropologists and sociologists conducting analytically sophisticated and ethnographically-grounded work on the HIV/AIDS pandemic and on the interventions surrounding it and 3) it takes very seriously “the epistemological frameworks that are currently used to understand the epidemic and examine how these extant frameworks might be inadequate in capturing many gender-related dynamics,” (Fourth Wave).

Here are several representative excerpts from the Introduction:

“The HIV and AIDS pandemic both fuels and is fuelled by inequalities across gender, race, ethnicity and class. Its effects vary across different settings and regions of the world and are also shaped by armed conflicts, natural disasters, environmental degradation, state incapacities, famine and poverty. Its refractory impacts on women and girls – and humanity writ large – are nothing short of catastrophic.

The third decade of the pandemic is characterized by sub-epidemics that are now coursing through many parts of the globe and among groups previously considered to be unaffected. Growing and disproportionate impacts are now being seen among young women and girls, particularly in sub-Saharan Africa where young women between 15 and 24 years old are at least three times more likely to be HIV-positive than young men. Nearly half of the 30.8 million people living with HIV are women between the ages of 15 and 49. Between the ages of 15-24, gender disparities are even more extreme, with women 1.5 times more likely to be living with HIV than young men.

This volume, commissioned by UNESCO, attempts to answer the crucial and defining questions about why and how responses to the HIV pandemic are failing women…

Although the epidemiology of the pandemic continues to be explained largely in biomedical and behavioural terms, more attention is now being paid to the social, political and economic factors that shape individual behaviour and the effectiveness of responses. But even this growing attention is not nearly enough. For young women, the mutually reinforcing nature of biological and social vulnerability form a particularly toxic combination that is driving a feminization of the pandemic in some of the hardest-hit countries in the world. We continue to be concerned that the focus of HIV interventions on children affected by AIDS, on prevention technologies and on celebrity aid may be deflecting attention from broader forms of social and gendered violence which shape HIV risks for both women and men.

If the deeply rooted social and cultural norms that increase risks for girls, young women and other at-risk populations are not understood and taken into account, the impact of HIV prevention strategies will continue to be ineffectual as the pandemic unfolds over generations. Addressing the gender dimensions of the pandemic will require a far deeper understanding about how to support families and communities as they negotiate the pandemic’s repercussions for household restructuring, gender and intergenerational relations, reproductive decision-making, livelihood choices, education planning, and civic participation. Equally urgent is the need to develop the knowledge necessary for strengthening national response capacities so that those most affected by HIV and AIDS do not also have to shoulder their associated burdens.

The prevailing institutional logic of the international response requires simplification and standardization. However, careful attention must also be paid to local voices and regional differences. In addition, we need to study how international interventions are themselves shaping the course of the pandemic and how they interact locally to structure biosocial vulnerability in gendered terms,” (Klot and Nguyen 2009).

Here is the TOC for the volume:

Foreword, Saniye Gulser Corat and Lydia Ruprecht

Editors’ Introduction, Jennifer F. Klot and Vinh-Kim Nguyen

Section I: The New Geography of HIV 

Introduction, Veena Das

Globalization and Gendered Vulnerabilities to HIV and AIDS in Sub-Saharan Africa , Colleen O’Manique

Social Exclusion: The Gendering of Adolescent HIV Risk in South Africa, Kelly Hallman

HIV, Male Labour Migration and Female Risk Environments in the Southern Caucasus, Cynthia Buckley

HIV, Sexual Violence and Exploitation during Post-Conflict Transitions: The Case of Sierra Leone, Johannes John-Langba

The Price of Liberation: Economy, Gender and HIV and AIDS in China, Shao Jing

Masculinity + HIV = Risk: Exploring the Relationship between Masculinities, Education and HIV in the Caribbean, David Plummer

Section II: Cultures of Intervention

Introduction, Didier Fassin

Representations of African Women and AIDS in Bono’s Product RED, Lisa Ann Richey

The Life Course of Nevirapine and the Culture of Response to the Global HIV & AIDS Pandemic: Traveling in an Emergency, Alton Phillips

Horizontal Approaches: Social Protection and the Response to HIV and AIDS in Brazil, Inês Dourado, Vera Paiva and Francisco Inácio Bastos

How Should We Understand Sexual Violence and HIV and AIDS in Conflict Contexts?, Judy El Bushra

Section III: Cultures of Response

Introduction, Mary Crewe

Colonial Silences, Gender and Sexuality: Unpacking International HIV and AIDS Policy Culture, Hakan Seckinelgin

‘Sleeping With My Dead Husband’s Brother!’: The Impact of HIV and AIDS on Widowhood and Widow Inheritance in Kampala, Uganda, Stella Nyanzi, Margaret Emodu-Walakira and Wilberforce Serwaniko

Beyond the New Geography of Dissident Gender-Sexual Identity Categories: Masculinities, Homosexualities and Intimate Partner Violence in Namibia, Robert Lorway

Neglecting Gender in HIV Prevention and Treatment Programmes: Notes from Experiences in West Africa, Joséphine Aho and Vinh-Kim Nguyen

AIDS, Gender and Access to Antiretroviral Treatment in South Africa, Nicoli Nattrass

Section IV: Cultures of Measurement

Introduction, Philip Setel

Epidemiological Fallacies: Beyond Methodological Individualism, Catherine M. Pirkle

Measuring the Gendered Consequences of AIDS: Household Dynamics and Poverty in South Africa, Jeremy Seekings

Measuring the Impacts of HIV on Household Structure and Gender Relations, Patrick Heuveline

Behind the Scenes of Sex and Sexual Debut: Unpacking Measurement, Charlotte Watts

From Unpaid to Paid Care Work: The Macroeconomic Implications of HIV and AIDS on Women’s Time-Tax Burdens, Rania Antonopoulos and Taun Toay