In the Journals, May 2014 – Part 1

Hi all, here’s the first part of this month’s roundup:

 

American Ethnologist

Remitting wealth, reciprocating health? The “travel” of the land from Guinea-Bissau to Portugal
Maria Abranches

Homegrown food and other products of Guinea-Bissau’s natural world offer protection and well-being to Guinean migrants in Portugal. In exploring this aspect of migration, I consider well-being in relation to both body and mind, in terms of health and illness and of solidarity and its withholding. Drawing on a multisited ethnography that looked equally at migrants and their nonmigrant kin, I link food, body, and mind to relationships of giving and reciprocating across borders in ways that challenge the classic assumption that the primary value of transnational migrant exchanges is economic. I argue that the active role of home-based kin in these exchanges and the travel of the materiality and symbology of the Guinean land that they facilitate are as central to migrants’ well-being as migrants’ financial and material remittances are to the well-being of those at home.

Mayan imaginaries of democracy: Interactive sovereignties and political affect in post revolutionary Guatemala
Nicholas Copeland

Mayan farmers in rural northwest Guatemala perceive the U.S. Department of Agriculture fruit-fly eradication program, MOSCAMED, as a government and agribusiness scheme designed to addict them to agrochemicals by despoiling subsistence agriculture. This bitterly accusative view depicts the state, capital, and U.S. government as interlinked sovereigns willing to kill and harm hapless Mayas. Considering political processes in the town of San Pedro Necta in light of local mistrust of and engagement with MOSCAMED, I argue that neoliberal democracy extends an affective imaginary of defeat produced by decades of counterinsurgency warfare through targeted violence and by exchanging meager resources for complicity with racial dispossession. My research findings illuminate how Mayas live the violence of neoliberal democracy and navigate a thicket of sovereignties, including ones widely viewed as predicated on their collective misery. They also reframe Mayan participation in authoritarian politics since the 1996 peace accords.

Urban mosquitoes, situational publics, and the pursuit of interspecies separation in Dar es Salaam
Ann H. Kelly and Javier Lezaun

Recent work in anthropology points to the recognition of multispecies entanglements as the grounds for a more ethical politics. In this article, we examine efforts to control mosquitoes in Dar es Salaam, Tanzania, as an example of the laborious tasks of disentanglement that characterize public health interventions. The mosquito surveillance and larval elimination practices of an urban malaria control program offer an opportunity to observe how efforts to create distance between species relate to the physical and civic textures of the city. Seen in the particular context of the contemporary African metropolis, the work of public health appears less a matter of control than a commitment to constant urban maintenance and political mobilization.

 

Cultural Anthropology

Dear Dr. Freud
Charles Briggs

This article weaves precariously between psychoanalytic interpretations of mourning and laments sung during an epidemic of an unknown disease in the Delta Amacuro rainforest of Venezuela in 2008. This dialogue extends reflection on the ways that Freud, Klein, Laplanche, Nasio, and other psychoanalysts have characterized “the work of mourning,” urging attention to the acoustic and bodily materiality of lamentation. Focusing on a meeting that took place just before the burial of a young man, it explores claims made by lamenters on audiences, interpellating them into particular modes of listening and demanding attention to the politics of the circulation of images of lives and deaths. This intersection between psychoanalysis and lamentation provides a challenge to rethink the nature of anthropological research and writing

Writing the Implosion: Teaching the World One Thing at a Time
Joseph Dumit

This article puts a reading of Gilles Deleuze’s Cinema 2 in dialogue with Donna Haraway’s works and methods. Working through the former helps me unpack the process of Haraway’s inquisitive “implosion” method and some of its aims better. I describe this as exploring how the world is interconnected one process and thing at a time, how these connections are vitally and politically important, and how this work is inexhaustible. Following this exegesis, I offer a series of exercises for putting this method into practice, one that I use myself and teach to graduate students and undergrads.

Ironies of Laboratory Work during Ghana’s Second Age of Optimism
Damien Droney

While Ghana is touted as an African success story, the young employees of a large herbal medicine research center in Ghana make sardonic and cynical remarks about the state of science in contemporary Africa. They decry the improvisation that characterizes doing science on the continent, point out what is lacking from their laboratories, and mock the ways in which their work appears embarrassingly peculiar. They claim that their labs are “not modern” and ironically refer to dissatisfying aspects of their work as “African science,” a second-rate version of science done elsewhere. This is what Achille Mbembe has called negative interpretation, where social life is understood primarily in the ways in which it differs from an assumed Western standard. These jokes reference an earlier period in Ghanaian history, when African science formed part of the project of postcolonial nation building. Scientists of the independence period constructed the scientific and medical infrastructure of Ghana to both provide for the needs of its people and to represent the status of modern Africa to the world. The apparently incongruous relationship between the cynicism of these jokes and the strain of Afro-optimism that has recently surrounded Ghana indicates a sustained shift in the identity politics of African professionals since independence. Their jokes signal their attempts at disentangling their identities from the project of African modernity, and at positioning themselves as scientists working in the context of Ghana.

 

Health

Diagnostic vertigo: The journey to diagnosis in systemic lupus erythematosus
Elizabeth Price and Elizabeth Walker

Systemic lupus erythematosus (lupus) is a complex condition characterised by wide ranging symptoms that are sometimes transient in nature. This makes recognising and diagnosing lupus particularly challenging for both patients and practitioners. The diagnostic process in this condition is a complex interplay between the boundaries of knowledge and power, control, integrity and legitimacy, which are (re)constructed and (re)negotiated between contemporary medicine, the patient and practitioner. Utilising data generated through a qualitative research design, this article illustrates some of the challenges lupus presents in the clinical encounter. We argue that the diagnosis of lupus is not a clinical event or a ‘diagnostic moment’. Rather, it constitutes a journey in and of itself, one which, for many of the respondents in this study, has no diagnostically satisfying conclusion. We conclude that uncertain diagnoses, such as lupus, illustrate the extent of both embodied and clinical doubt in, what might be termed, contemporary conditions and, concomitantly, throw into sharp relief the nature of the diagnostic process. This process, in the context of lupus, and other uncertain conditions, generates, we would argue, a sense of diagnostic vertigo.

Transformations of self and sexuality: Psychologically modified experiences in the context of forensic mental health
Steven D Brown, Paula Reavey, Ava Kanyeredzi, and Richard Batty

Forensic mental health inpatients in medium-secure settings have a limited capacity for sexual expression during their stay in hospital. This is due to a number of factors, including a lack of willingness on behalf of staff to engage with sexual issues, as a result of safety fears and ambiguity regarding the ability of the patient to consent. Furthermore, UK forensic medium-secure units do not provide conjugal suites for patients to have sexual relations, with their spouse or other patients. To date, there is no empirical research on how forensic psychiatric patients (or service users) manage their sexuality, while in hospital and when released into the community. Here, we present an analysis of semi-structured interviews with patients at a UK medium forensic unit, in order to explore these issues further. More specifically, we examine how the public exclusion of sexuality from these units results in sexuality being experienced as sectioned off or amputated, such that a new form of sexuality emerges, one that has been cultivated by the psychologically informed practices operating within the unit. This process, we argue, produces a psychologically modified experience, a new form of self-relation that continues to modify when released into the broader ecology of the community.

Treatment resistant depression in primary care: Co-constructing difficult encounters
Susan McPherson, Richard Byng, and Donna Oxley

Many patients with depression do not recover despite medication or therapy. Individuals with treatment resistant depression often have co-morbid anxiety, personality difficulties and drug or alcohol misuse and have been characterised as difficult, heartsink or problem personalities by general practitioners. Yet critical studies of interaction in medical settings suggest that the context may have a role in constructing the patient. A total of 12 audio-recorded routine consultations were analysed following guidelines for qualitative analysis of medical discourse. The interpretation focused on ways in which the context and structure of primary care consultations in a UK setting construct difficult encounters, which may lead to patients with treatment resistant depression being seen as difficult to manage in various ways. Three overarching observations were that presentation of multiple problems in multiple domains clash with the consultation format; that patients’ atypically high level of activity in a time-limited setting prevents patient-centred work; that the question and answer format restricts multifaceted discussions of social and emotional problems, preventing shared understandings emerging. However, although interactions appear uneasy, they are repaired and may be moderately palliative. Suggestions are made for re-orienting general practitioner work with treatment resistant depression towards long-term goal setting outside of the traditional consultation structure in order to develop shared understandings.

“Mauled by a Bear”: Narrative analysis of self-injury among adolescents in US news, 2007–2012
Warren Bareiss

Self-injury among adolescents has been widely documented in the United States, Canada, Europe, and Asia; however, news coverage of self-injury has not been examined. This study analyzes 78 news accounts of self-injury among adolescents in the United States from 2007 to 2012, using critical cultural studies as a theoretical foundation and a methodology informed by Kenneth Burke’s dramatism. Narrative elements within the sample are examined in relationship to one another in order to reveal implicit meanings within the news stories. Looking across the sample, I then use a framework developed by Labov and Waletzky to examine a dominant meta-narrative that downplays social causes of self-injury—notably, various forms of trauma such as childhood sexual abuse—and instead frames self-injury as a personal choice. As a result, the remedy to the problem is not constructed as redress of contemporary pressures placed upon young people, but rather, as the responsibility of adolescents to conform to the social system that causes them to hurt themselves.

Exploring the relationship between multi-morbidity, resilience and social connectedness across the life course
Bie Nio Ong, Jane C Richardson, Tom Porter, and Janet Grime

Multi-morbidity is receiving considerable attention in public policy, health and social care. From the perspective of the individual, multi-morbidity is a more complex experience than solely having a clinical diagnosis. In this article, we will argue that understanding multi-morbidity can be facilitated by considering the relationship between adversity (in this case multi-morbidity), resilience and social connectedness within a life course framework. This provides an approach that can capture the dynamics of social relationships, social connectedness and the fluctuations in the experience of multi-morbidity. We draw on a qualitative study of 17 people who have multiple conditions, but consider themselves as being able to maintain a sense of identity and self over time and in the face of adversity. From their accounts, a more varied picture emerges of living with multi-morbidity. This then depicts a more realistic representation of how each person shapes their multi-morbidity and resilient responses within their own social context, which can help to formulate more effective ways of supporting them.

Contextualising eating problems in individual diet counseling
Søren T Kristensen and Allan Køster

Health professionals consider diet to be a vital component in managing weight, chronic diseases and the overall promotion of health. This article takes the position that the complexity and contextual nature of individual eating problems needs to be addressed in a more systematic and nuanced way than is usually the case in diet counselling, motivational interviewing and health coaching. We suggest the use of narrative practice as a critical and context-sensitive counselling approach to eating problems. Principles of externalisation and co-researching are combined within a counselling framework that employs logistic, social and discursive eating problems as analytic categories. Using cases from a health clinic situated at the Metropolitan University College in Copenhagen, we show that even if the structural conditions associated with eating problems may not be solvable through individual counselling sessions, exploration of the complex structures of food and eating with the client can provide agency by helping them navigate within the context of the problem. We also exemplify why a reflexive and critical approach to the way health is perceived by clients should be an integrated part of diet counselling.

 

Health and Place

Green schoolyards as havens from stress and resources for resilience in childhood and adolescence
Louise Chawla, Kelly Keena, Illène Pevec, Emily Stanley

This paper investigates how green schoolyards can reduce stress and promote protective factors for resilience in students. It documents student responses to green schoolyards in Maryland and Colorado in the United States under three conditions: young elementary school children׳s play in wooded areas during recess; older elementary school children׳s use of a naturalized habitat for science and writing lessons; and high school students׳ involvement in gardening. Drawing on ethnographic observations and interviews, it describes how the natural areas enabled students to escape stress, focus, build competence, and form supportive social groups. These findings have implications for theories of resilience and restoration and school interventions for stress management.

How do people with learning disability experience the city centre? A Sheffield case study
Alex McClimens, Nick Partridge, Ed Sexton

The use of city centre spaces by people with learning disability is not much debated in the literature. Here we include the thoughts and opinions of groups of people with learning disability as we undertook some guided walks through Sheffield city centre. We found that few of the participants had independent access to the city centre. Many cited concerns over personal safety and the most, on few occasions when they did visit, did so with family and/or paid staff for pre-planned purposes, usually linked to shopping. The need for appropriate support figured prominently. There is also a need to re-assess what we mean by social inclusion for this cohort.

Place-based stressors associated with industry and air pollution
Michelle C. Kondo, Carol Ann Gross-Davis, Katlyn May, Lauren O. Davis, Tyiesha Johnson, Mable Mallard, Alice Gabbadon, Claudia Sherrod, Charles C. Branas

Exposure to air pollution and its sources is increasingly viewed as a psychosocial stress, however its nature is not understood. This article explores the role of the concept of place on risk perception and community stress within data collected from eight focus groups in Philadelphia, USA. Discussions focused on air pollution, a nearby oil refinery, health, and a proposal for air monitoring. We present a framework of place-based elements of risk perception that includes place identity, stigma and social control. Our findings indicate that air pollution contributes to physical and psychosocial conditions that act as community-level social stressors. Findings also suggest that programs which seek to change behaviors and gather or spread information on issues such as pollution and other environmental concerns will be challenged unless they directly address: (1) the public׳s identification with a place or industry, (2) immediate environmental stressors such as abandonment, waste and odors, and (3) public perceptions of lack of social control and fear of displacement.

Exploring disparities in acute myocardial infarction events between Aboriginal and non-Aboriginal Australians: Roles of age, gender, geography and area-level disadvantage
D.A. Randall, L.R. Jorm, S. Lujic, S.J. Eades, T.R. Churches, A.J. O’Loughlin, A.H. Leyland

We investigated disparities in rates of acute myocardial infarction (AMI) between Aboriginal and non-Aboriginal people in the 199 Statistical Local Areas (SLAs) in New South Wales, Australia. Using routinely collected and linked hospital and mortality data from 2002 to 2007, we developed multilevel Poisson regression models to estimate the relative rates of first AMI events in the study period accounting for area of residence. Rates of AMI in Aboriginal people were more than two times that in non-Aboriginal people, with the disparity greatest in more disadvantaged and remote areas. AMI rates in Aboriginal people varied significantly by SLA, as did the Aboriginal to non-Aboriginal rate ratio. We identified almost 30 priority areas for universal and targeted preventive interventions that had both high rates of AMI for Aboriginal people and large disparities in rates.

Social capital and the utilization of maternal and child health services in India: A multilevel analysis
William T. Story

This study examines the association between social capital and the utilization of antenatal care, professional delivery care, and childhood immunizations using a multilevel analytic sample of 10,739 women who recently gave birth and 7403 children between one and five years of age in 2293 communities and 22 state-groups from the 2005 India Human Development Survey. Exploratory factor analysis was used to create and validate six social capital measures that were used in multilevel logistic regression models to examine whether each form of social capital had an independent, contextual effect on health care use. Results revealed that social capital operated at the community level in association with all three care-seeking behaviors; however, the results differed based on the type of health care utilized. Specifically, components of social capital that led to heterogeneous bridging ties were positively associated with all three types of health care use, whereas components of social capital that led to strong bonding ties were negatively associated with the use of preventive care, but positively associated with professional delivery care.

Triple jeopardy: Adolescent experiences of sex work and migration in Zimbabwe
Joanna Busza, Sibongile Mtetwa, Petronella Chirawu, Frances Cowan

Adolescence, migration and sex work are independent risk factors for HIV and other poor health outcomes. They are usually targeted separately with little consideration on how their intersection can enhance vulnerability. We interviewed ten women in Zimbabwe who experienced sex work and migration during adolescence, exploring implications for their health and for services to meet their needs. For most, mobility was routine throughout childhood due to family instability and political upheaval. The determinants of mobility, e.g. inability to pay school fees or desire for independence from difficult circumstances, also catalysed entry into sex work, which then led to further migration to maximise income. Respondents described their adolescence as a time of both vulnerability and opportunity, during which they developed survival skills. While these women did not fit neatly into separate risk profiles of “sex worker” “migrant” or “adolescent”, the overlap of these experiences shaped their health and access to services. To address the needs of marginalised populations we must understand the intersection of multiple risks, avoiding simplified assumptions about each category.

An exploration of rural–urban differences in healthcare-seeking trajectories: Implications for measures of accessibility
Jeannie L. Haggerty, Danièle Roberge, Jean-Frédéric Lévesque, Josée Gauthier, Christine Loignon

Comparing accessibility between urban and rural areas requires measurement instruments that are equally discriminating in each context. Through focus groups we explored and compared care-seeking trajectories to understand context-specific accessibility barriers and facilitators. Rural care-seekers rely more on telephone access and experience more organizational accommodation but have fewer care options. Urban care-seekers invoke the barrier of distance more frequently. Four consequences of accessibility problems emerged across settings which could be used for valid comparisons of access: having to restart the care-seeking process, abandoning it, using emergency services for primary care, and health deterioration due to delay.

The Birth of the (Gay) Clinic
Michael Brown, Larry Knopp

We apply and extend ׳s arguments about Foucault׳s Birth of the Clinic as an inspiration for health geography and the study of governance of gays. Philo identified three spaces through which he argued disease is framed: disease tabled, embodied, and institutionalized. These focus attention on the spatialities through which the medical gaze is power-laden. We adopt this framework empirically through an historical geography of an urban public health system engaged with sexually transmitted infections (STIs) in the “homosexual” population of Seattle, Washington in the 1970s. It reveals the interaction of homophobia, heteronormativity and resistances across places typically understudied in queer historical geography. Our findings also extend this framework, however, by revealing other spaces that were important in the urban politics of sexual health: the gay city, the gay doctor, and the gay community. We suggest, therefore, that these and other spaces may be helpful in other health geographies interested in the dynamics of sexuality, governmentality, and urban public health.

Cultural values and population health: a quantitative analysis of variations in cultural values, health behaviours and health outcomes among 42 European countries
Johan P. Mackenbach

Variations in ‘culture’ are often invoked to explain cross-national variations in health, but formal analyses of this relation are scarce. We studied the relation between three sets of cultural values and a wide range of health behaviours and health outcomes in Europe. Cultural values were measured according to Inglehart׳s two, Hofstede׳s six, and Schwartz׳s seven dimensions. Data on individual and collective health behaviours (30 indicators of fertility-related behaviours, adult lifestyles, use of preventive services, prevention policies, health care policies, and environmental policies) and health outcomes (35 indicators of general health and of specific health problems relating to fertility, adult lifestyles, prevention, health care, and violence) in 42 European countries around the year 2010 were extracted from harmonized international data sources. Multivariate regression analysis was used to relate health behaviours to value orientations, controlling for socioeconomic confounders. In univariate analyses, all scales are related to health behaviours and most scales are related to health outcomes, but in multivariate analyses Inglehart׳s ‘self-expression’ (versus ‘survival’) scale has by far the largest number of statistically significant associations. Countries with higher scores on ‘self-expression’ have better outcomes on 16 out of 30 health behaviours and on 19 out of 35 health indicators, and variations on this scale explain up to 26% of the variance in these outcomes in Europe. In mediation analyses the associations between cultural values and health outcomes are partly explained by differences in health behaviours. Variations in cultural values also appear to account for some of the striking variations in health behaviours between neighbouring countries in Europe (Sweden and Denmark, the Netherlands and Belgium, the Czech Republic and Slovakia, and Estonia and Latvia). This study is the first to provide systematic and coherent empirical evidence that differences between European countries in health behaviours and health outcomes may partly be determined by variations in culture. Paradoxically, a shift away from traditional ‘survival’ values seems to promote behaviours that increase longevity in high income countries.

Spatial and social inequities in HIV testing utilization in the context of rapid scale-up of HIV/AIDS services in rural Mozambique
Jing Yao, Victor Agadjanian, Alan T. Murray

The massive scale-up of HIV counseling, testing, and treatment services in resource-limited sub-Saharan settings with high HIV prevalence has significant implications for the course of the HIV/AIDS epidemic. It also offers important broader policy lessons for improving access to critical health services. Applying GIS-based methods and multilevel regression analysis to unique longitudinal three-wave survey data from rural Mozambique, this study investigates the impact of a rapid expansion of HIV-related services on access to and utilization of HIV testing. The results illustrate the declining importance of spatial barriers to utilization of HIV testing services as these services expanded. In addition, the expansion of HIV-related services decreased the spatial variability of HIV testing among the survey respondents. At the same time, some important non-spatial variation, such as that in educational level, persisted despite the expansion of services. These results illustrate the process and consequences of health service diffusion.

Neighborhood characteristics and leukocyte telomere length: The Multi-Ethnic Study of Atherosclerosis
Belinda L. Needham, Judith E. Carroll, Ana V. Diez Roux, Annette L. Fitzpatrick, Kari Moore, Teresa E. Seeman

Telomeres are the protective caps at the ends of eukaryotic chromosomes. Telomeres get shorter each time a cell divides, and critically shortened telomeres trigger cellular senescence. Thus, telomere length is hypothesized to be a biological marker of aging. The purpose of this study was to examine the association between neighborhood characteristics and leukocyte telomere length. Using data from a subsample (n=978) of the Multi-Ethnic Study of Atherosclerosis, a population-based study of women and men aged 45–84, we found that neighborhood social environment (but not neighborhood socioeconomic disadvantage) was associated with telomere length. Respondents who lived in neighborhoods characterized by lower aesthetic quality, safety, and social cohesion had shorter telomeres than those who lived in neighborhoods with a more salutary social environment, even after adjusting for individual-level socioeconomic status and biomedical and lifestyle factors related to telomere length. Telomere length may be one biological mechanism by which neighborhood characteristics influence an individual׳s risk of disease and death.

 

Social Theory & Health

Dementia and the inter-embodied self
Nicholas Jenkins

In the twenty-first century, new forms of community in dementia are emerging. The existence of these communities challenges the individualisation of the self, which has come to characterise ‘person-centred’ approaches to dementia care over the past 30 years. In this article, an alternative approach (the inter-embodied self) is presented. This approach to promoting selfhood in dementia is based on the premise that the self is not an intrinsic aspect of embodied Being but is instead a transactive phenomenon, which exists in a perpetual state of becoming. As such, the primary goal of practitioners should not be the fixing, reviving or re-unifying of a pre-morbid self but, instead, enabling a rich and polyphonic montage of selves to emerge. Drawing on a short documentary film about experiences of friendship in dementia, the article concludes by highlighting the potential contribution of the inter-embodied self to contemporary dementia care.

Lifestyle as a choice of necessity: Young women, health and obesity
Alex Dumas, Jeanne Robitaille and Shannon L Jette

Sociologists of health have regularly called into question strictly knowledge-based health promotion approaches that focus on individual lifestyle change, claiming preference for collective actions on social determinants of health. These critiques have more recently been directed towards the issue of obesity. Although there is a growing body of work that shows the connection between poverty, obesity and ill health, few studies have focused on the concerns for health and lifestyle of vulnerable populations. In this qualitative study, 15 in-depth interviews were conducted with young underprivileged women in order to capture their dispositions towards health practices by outlining sociocultural factors that do (or do not) incline them to pursue a health regimen and weight control strategies. By drawing on Pierre Bourdieu’s concepts of habitus, practical sense and ‘choice of the necessary’, the results suggest that inclinations to follow normative health guidelines are strongly influenced by family and financial responsibilities and by pressing health concerns rather than a calculation of how the prescribed risk avoidance behaviours will improve personal health and/or prevent illness for one’s own sake. In conclusion, this study highlights the limits of prescribed ‘solutions’ to health improvement that have little to no consideration of embodied social knowledge and lived experiences.

Relative bodies of knowledge: Therapeutic dualism and maternal–foetal individuation
Carla Meurk, Alex Broom and Jon Adams

A strong body of knowledge attests to the fact that Australian women are using complementary and alternative medicine (CAM) at increasing rates. However, use of CAM in the context of maternity care is variable and distinctive because of heightened sensitivity to risk and the complexities that arise in managing maternal and foetal well-being concurrently. Drawing on qualitative interviews with 40 women who had recently given birth residing in a major city in Australia, we trace their use of CAM and biomedicine through a sequence of important health-care events during their pregnancies and up until the point of labour. We show that these women’s engagement with CAM and biomedicine depicts a pattern whereby CAM is used to ensure the women’s well-being while biomedicine is used to ensure a safe and healthy baby. We employ the concept of therapeutic dualism to analyse how this form of medical pluralism reproduces contemporary forms of pregnant embodiment – specifically the ontological separation of mother and foetus. However, we also highlight how this dualism is inexact. That is, bodies of medical knowledge may be separated and combined at specific points during pregnancy, and so too can the foetal and maternal body.

(Re)reading the political conflict over HIV in South Africa (1999–2008): A new materialist analysis
Kiran Pienaar

This article recasts a critical moment in the history of HIV/AIDS in South Africa: the struggle over the science of HIV that emerged under former South African President Mbeki (1999–2008). It compares how the Mbeki administration and prominent South African AIDS organisation, the Treatment Action Campaign (TAC) responded to the dominant scientific model of HIV/AIDS. Contrary to existing research, which presents the government and TAC’s positions as polarised, this article draws attention to some important commonalities in their understandings of HIV. I argue that both parties were doing the ‘boundary-work’ of science (Gieryn, 1995, p. 404): tussling over the demarcation between science and non-science in order to assert the ‘truth’ about HIV/AIDS. In so doing, they constitute HIV as a biologically self-evident disease possessed of intrinsic attributes. The article draws on science studies and new materialist scholarship to query this conventional view and its presumption that disease is a static object that precedes political processes and practices. It argues instead that disease is made through politics and it traces some significant political practices that have contributed to making HIV/AIDS in South Africa in specific, sometimes damaging ways.

Methods of resistance: A new typology for health research within the neoliberal knowledge economy
Kate Rossiter and Ann Robertson

Over the past several decades, the field of health research has been divided according to methodological trajectory: qualitative versus quantitative methodology. However, this division conceptually fails to incorporate the increasing force of the neoliberal knowledge economy. This force has had particularly profound effects on health research that, because of its potential for application, is susceptible to forms of economic rationalization. As such, we argue that health research is a social process in need of theoretical attention, and propose a paradigmatic shift away from the quantitative/qualitative divide and toward a recategorization that accounts for the ways in which the landscape of knowledge production has altered to accommodate these demands. We suggest that health research may best be understood from its political/epistemological underpinnings and thus propose understanding the research process as either ends oriented and driven by the demands of the economized knowledge market (instrumental), or emergent and reflexively interpretive (hermeneutic). Recategorizing health research along political/epistemological lines offers an important means of articulating, and thus critiquing, the impact of neoliberalism on processes of knowledge acquisition, development, generation and translation. This work also holds open a conceptual space open for creative and critical processes of knowledge generation that resist the demands of the neoliberal knowledge economy.

The social support model for people with chronic health conditions: A proposal for future research
Dennis Owen Frohlich

Social support is an important component of health care for people with chronic health conditions. Previous research has described the types of messages created in support groups and found evidence for positive health outcomes of social support. Social support has been conceptualized in myriad ways, however, making it difficult to have a unified body of research. I propose a model to explain how the social support process works for people with chronic health conditions. I articulate what facets of the social support process need more study, and how the support environment should be conceptualized. Researchers should study a person’s entire support environment, rather than isolated support groups, as research has often been limited to in the past, taking into account the particular issues of any chronic illness.