Showing papers in "Anthropology & Medicine in 2009"

Mapping the body: tracing the personal and the political dimensions of HIV/AIDS in Khayelitsha, South Africa

Abstract: This article offers an analysis of the body-mapping dimension of the ‘treatment literacy’ initiatives of the Treatment Action Campaign (TAC), an HIV/AIDS-focused social movement in South Africa. It situates body mapping within the politics of HIV/AIDS activism in South Africa. The alliance between activists and biomedical practitioners is explored and the emphasis on the ‘science of HIV’ in TAC treatment literacy considered alongside the foregrounding of social realities, such as poverty and inequality. The article argues that the education activities of the TAC illustrate ‘context-sensitive’ science, rather than following a linear model of ‘public understanding of science’. The personal accounts published alongside the first body maps are explored to illustrate an evident re-socialisation of biological organs and an emphasis on the relationality of bodies. The bounded bodies and the activist emphasis on body politics become ways to counteract fears of the virulence of the illness.

From social liminality to cultural negotiation: Transformative processes in immigrant mental wellbeing

Abstract: The underlying psychosocial processes that produce immigrant mental wellbeing are understudied in anthropology and medicine. This paper provides insights into these processes by describing culturally diverse immigrants' perceptions of mental health and adaptation strategies. Qualitative data were collected from 21 focus groups as part of a large, multidisciplinary, participatory action research project about mental health with five ethnolinguistic groups (Mandarin-speaking Chinese, Polish, Punjabi Sikh, Somali and Spanish-speaking Latin American) in Ontario, Canada. In framing the analysis, transformative concepts are applied to address dimensions of power and culture - social liminality and cultural negotiation - to the ongoing psychosocial processes of coping with mental distress. 'Social liminality' describes how immigrants perceive themselves to be in a psychologically stressful, transitional state, whereas 'cultural negotiation' describes how they actively cope with cultural tensions and respond to mental health challenges. Study findings show that while social liminality and cultural negotiation are stressful, they also have the potential to help individuals adapt by producing a positive synthesis of ideas about mental health in new social and cultural contexts. The study contributes to the shift from problem identification using a biomedical model of mental illness to a more psychosocial and ecological approach that reveals the potential for resolving some mental health problems experienced in immigrant communities. Describing active psychosocial process of adaptation also reinforces the therapeutic and educational value of partnerships between practitioners and clients and immigrant communities and mental health systems.

Tests for life chances: CD4 miracles and obstacles in Uganda

Abstract: This article discusses the relationship between technologies, socialities and inequities based on case material from a recent study about the first generation of people living with ART – Antiretroviral Therapy – in Uganda. The authors discuss how the diagnostic technologies of HIV tests, ‘CD4 counts’, and weight measuring produce results and numbers that are appropriated by people living with HIV to reflect upon their lives, bodies and relationships and hence influence their socialities and subjectivities. It is argued that because treatment programmes and especially their associated technologies vary greatly in Uganda, the programmes themselves introduce inequity in the already unequal landscape of HIV patients. In debates about biomedical technology and about HIV/AIDS it has been suggested that new kinds of socialities emerge, which have been conceptualised as ‘therapeutic citizenship’ and ‘bio-sociality’. In the study on which the present article is based, clientship, friendship and kinship are kinds o...

Bionetworking: experimental stem cell therapy and patient recruitment in India

Abstract: Over the last three to four years, an increasing number of private and public sector tertiary level hospitals and research centres in India have been using stem cell therapy, especially adult stem cell therapy, in the guise of experimental therapy for a variety of medical conditions. The promotion and growth of this experimental field across local and national borders traverses regulatory, ethical, social and financial boundaries. In this complex context, the article examines how healthcare centres in India negotiate bio-medical and health care circumstances in promoting a therapy that raises questionable medical, technical and ethical issues. The process of promoting experimental stem cell therapy is explained here by employing the concept of bionetworking and illustrated by two case studies of hospital groups. The case studies show how through bionetworking a centre creates and maintains novel networks of mutual exchanges with other collaborative bodies situated in local, national and global relations of inequality. Drawing on a three-month period of fieldwork and interviews in various locations in India, this article shows that: (1) Questionable stem cell therapy is promoted through bionetworks that resonate across local, national and global constellations; (2) Regulatory gaps facilitate the growth of such therapeutic practices; (3) The experimental stem cell therapies augment the healthcare divide in Indian society; (4) The weakening Indian state facilitates commercialisation of health, indirectly supporting the 'bionetworking' practices of therapy providers.

'A person of two countries'. Life and health in exile: Somali refugees in Sweden.

Abstract: Meeting and treating patients from other countries and cultures constitutes a challenge for health care. The number of immigrants and refugees has seen a rapid increase in recent years in Sweden. Expectations and experiences of health and illness often differ among these immigrant groups compared with the inhabitants of the majority society. This paper examines the situation of Somali refugees living in a multicultural suburban area of a large city in southern Sweden, and the aim was to illuminate and document their thoughts and experiences in relation to health and illness. Thirteen interviews with Somalis of different sexes and ages were conducted in the informant’s homes. A hermeneutic-phenomenological approach was used in the analysis. The findings revealed an essential theme – a life in exile – that permeated every subject that was discussed and talked about. This was expressed in the following aspects: longing for the homeland, pain – a companion in exile, prejudice and discrimination, family – comfort and trouble, religion and beliefs in Jinns. Complex feelings of bi-nationality and of being uprooted were expressed. Prior knowledge about the hardships involved in a life as a refugee may allow and increase the possibilities for better communication, increased trust and mutual respect in order to achieve a meaningful encounter with health care personnel.

Problems in the Latina paradox: measuring social support for pregnant immigrant women from Mexico.

Abstract: Women who have immigrated to the United States from Mexico have better than expected birth outcomes. Part of this apparent health ‘paradox’ has been explained by high levels of social support which are thought to offset known risk factors for low birth weight. Yet common measures of social support during pregnancy suffer from presumptions of cultural homogeneity and a-priori definitions of meaningful social support. Analysis of qualitative data from ethnographic research with 28 low-income immigrant women from Mexico living in south Texas demonstrates that preferences for certain kinds of social support vary considerably, based on how each woman makes meaning of being pregnant. This diversity is one more piece of evidence that minority cultures cannot be essentialised in health disparities research. By not measuring the diversity of desire for different kinds of support, existing correlations between social support and birth outcomes may obscure other important psychosocial mediators, such as pregnancy-re...

Technologies of hope? Motherhood, HIV and infant feeding in eastern Africa.

Abstract: A vast number of HIV positive mothers live with a known HIV positive status without an experienced ability to prevent the virus from spreading to their offspring. This article focuses on the dramatic effects on identity and sociality instigated by prevention of mother to child transmission of HIV (PMTCT) programmes, and discusses the potential for the development of HIV related activism linked to programme enrolment. Paying particular attention to the infant feeding options that are promoted through the programme – exclusive breastfeeding and replacement feeding – the article explores women's experiences struggling to secure an HIV free baby. At the heart of the findings lie devastating transformations in perceptions of body and self among HIV positive mothers enrolled in the PMTCT programmes, transformations highlighted by the shifting interpretations of mother's milk. The women suffer from extreme fear of feeding their babies HIV infected mother's milk. Very few mothers could afford formula products, an...

Genomics as public health? Community genetics and the challenge of personalised medicine in Cuba

Abstract: Making use of a comparative perspective on the emergence of 'breast cancer genetics' in the different cultural context of the UK and Cuba, this article examines the tensions between the modern promise of genomics as personalised medicine and a commitment to public health. Focusing primarily on the Cuba context and drawing on ethnographic research as part of a collaborative project working with genetic professionals and publics, the article examines the particular technologies, identities and socialities at stake in an emerging and evolving field of genetic medicine. It highlights how long-standing continuities in the commitment to the equitable provision of public health, particularly as this relates to 'family medicine', are central to understanding the scope and expansion of 'community genetics' interventions, even when at the level of local practice, public health is also now subject to the unequal dynamics of economic necessity through the working out of 'lo informal'. Illuminating the different ways agency, risk, responsibility, citizenship and activism get configured by and between publics and health professionals in Cuba, the article reveals the challenges and opportunities posed by predictive genomic medicine in relation to the dynamic and shifting terrain of public health.

Structural violence and emotional health: a message from Easington, a former mining community in northern England.

Abstract: This discussion paper, written by a UK general practitioner and graduate student of anthropology, explores the uncomfortable relationship between institutionalised inequalities of wealth and opportunities, and emotional health, in a disadvantaged community in the north-east of England. The author begins by locating the thesis in the corpus of anthropological literature which acknowledges human suffering and refuses to adopt a position of cultural relativism. The complex and elusive phenomenon of structural violence is unpacked, followed by a description of the setting and the author's methodology. Clinical observations are presented as contextualised narratives located around three themes: alcohol misuse; gendered violence; and inter-generational violence. The vignettes portray how the consequences of institutionalised inequalities are manifest in the embodied and emotional lives of many who live in economically marginalised communities. The author concludes with a discussion of the dilemma at the heart of a morally engaged practitioner's clinical practice as one who eschews the dominant ideology of individual responsibility for health and recognises that agency is compromised by structural violence.

Of butterflies and wolves: enacting lupus transformations on the Internet.

Abstract: This article explores how women with lupus use the Internet to construct discourses about illness and transformation. The textual and symbolic content of Internet websites and message boards offers unique perspectives on the relationship between embodied experience and textual construction, and demonstrates the ways in which women use their participation on the Internet to communicate about themselves. Using common search engines, an array of lupus websites were identified, including message boards and personal pages, and the textual and symbolic content was analysed for reoccurring themes. Three distinct types of transformational discourses were identified: adjustment narratives; expert narratives; and transformations of personhood. These transformations are achieved and given renewed value through online participation. The article suggests that online communication provides a unique opportunity to understand embodiment but also that transformational discourses may ultimately be limiting.

Living and working in spite of antiretroviral therapies: strength in chronicity

Abstract: This article is a reflection on the relationship between antiretroviral therapies and work It is concerned with the impact of biomedical protocols and biotechnologies on the ‘lifeworlds’ of a small group of seropositive men employed in the construction industry in Milan Construction workers stand out as a category with specific issues because of their physically demanding jobs and are more subject to the potentially damaging physical consequences of antiretroviral therapies, as data suggest The article is focused on biomedical rationalities and technologies and interrogates the forms of knowledge and the practices that contribute to reshaping seropositive individuals as ‘biological and therapeutic citizens’ At the same time, the relationship between identity and health technologies is explored, examining the individual trajectories and strategies displayed by construction workers in order to cultivate their own ideas of personhood and conception of identity How they rethink their presence within the

Cultural interpretations of the efficacy and side effects of antimalarials in Tanzania

Abstract: This paper examines the cultural interpretations and the perceived efficacy and side effects of antimalarials in Tanzania. Interviews with 56 mothers of children diagnosed with malaria revealed that they were nostalgic about chloroquine, a banned antimalarial. Additional findings indicated that a majority of the mothers had an overall negative disposition toward sulfadoxine-pyrimethamine (SP), the first-line antimalarial. Mothers considered the persistence of fever as the primary undesirable side effect of SP, while also mentioning a range of other side effects. Mothers who could not afford an alternative to SP, rationalized the drug's side effects as indicative of disease egress. It is argued that ethnographic studies of cultural perceptions of malaria and antimalarials provide useful perspectives on how people negotiate the identity of a febrile illness, and how they understand and interpret the efficacy of existing antimalarials. In acknowledging the intra-cultural variability in perceptions of malaria...

The moment of sale: Treating malaria in Abidjan, Côte d'Ivoire.

Abstract: Beyond home care without active treatment, the first step of home-based management of malaria (HMM) is the health provider-customer interactions that often lead to the purchase of drugs or herbs to treat symptoms. In Abidjan, Cote d'Ivoire, the quality and content of such interactions in pharmacies where antimalarials are sold officially, with illegal drug vendors and with herbal medicine sellers, vary considerably. Commercial encounters associated with adult illness episodes of locally identified malaria, observed in 2004-5, illustrate that customers present to sales points, on behalf of people who are ill, with a pre-established diagnosis and the intent of purchasing medication with which they have prior familiarity. Customers sought neither diagnosis nor clarification, and communication between vendor and customer was limited to minimal enquiries or suggestions. These findings have important implications related to the need for vendor training to support HMM and so ensure prompt and appropriate treatment outside clinical settings.

Rationalisation and racialisation in the Rainbow Nation: inequalities and identity in the South African bone marrow transplant network.

Abstract: This article examines discourses and practises in the professional network of people and organisations in South Africa that comprise the bone marrow/haematopoietic stem cell transplantation (BMT) network. A prominent discursive inter-relationship asserts that some genetically inherited Human Leukocyte Antigen (HLA) types appear in certain ethnic populations more commonly than others, meaning that patients are most likely to find a transplant match with someone in the same ethnic group. The South African BMT network efforts to increase the number of donors from ethnic groups not well represented on the registry are crucial given South Africa's unique and diverse gene pool. This inter-relationship is at the heart of a complex interweaving of genomics, ethnicity, culture, South African nationhood, and the limits of bodily integrity. It necessitates serious engagement in health resource inequalities and burgeoning biosocial identities in a diverse South Africa, especially given its history and its contemporary political agenda of transformation. The analysis of fieldwork is particularly informed by Troy Duster's concept of feedback loops and Paul Rabinow's work on biosociality. Drawing from this analysis, the article also suggests possibilities for policy and practical application.

Special Edition for anthropology and medicine biomedical technology and health inequities in the global north and south

Abstract: Biomedical technology can have far reaching effects on the body, identity, and sociality, as much recent research in sociology and anthropology has shown. The experience, perception and practice of the body can be transformed by biomedical techniques such as screening, in vitro fertilisation, and organ transplantation (Treichler et al. 1998; Rapp 1999; Lock 2002; Lock and Farquhar 2007). Identity, subjectivity and sociality itself may take on new forms with different sorts of diagnostic, therapeutic and rehabilitative technologies (Clarke et al. 2003; Mol 2002). At the same time variously defined collectives or activist patient communities may be implicated in the practice, and central to the development or ‘co-production’, of biomedical technologies (Lock et al. 2000; Dumit 2003; Gibbon 2007; Hess 2004; Epstein 1996, 2007). New theoretical concepts such as ‘biosociality’ (Rabinow 1996) and ‘biological citizenship’ (Rose and Novas 2005; Heath et al. 2004) have been especially influential in informing recent social science research examining these developments in Euro-American societies, particularly in relation to novel genetic knowledge and technologies. These concepts have been important tools in describing how high-tech interventions are re-shaping (and themselves being shaped by) individual and collective identities and in examining how ‘contemporary regimes of the self’ (Rose and Novas 2005) are implicated in cultures of health activism and identification at the intersection with novel medical knowledge and technologies. Yet as several commentators have pointed out, there is an urgent need to examine the applicability and utility of these concepts in comparative perspective, in transnational and global arenas (Gibbon and Novas 2008; see also Ong and Collier 2004). Differential access to medical techniques and resources may have concrete and often unexpected consequences with respect to perception of and engagement with novel arenas of health care. Biomedical technology may not in fact transform identity and citizenship in all settings; other aspects of sociality, such as work, the family and community, may be far more important in people’s management of their health and lives (see for instance Gammeltoft 2008). Highlighting the dangers of recent approaches to health identities and subjectivities focused exclusively on medical technologies or disease categories, Whyte points out how such studies may not only

Between religious philanthropy and individualised medicine: situating inherited breast cancer risk in Greece

Abstract: This article explores cultural articulations of inherited breast cancer risk at the meeting-point between religious philanthropy and individualised medicine. Drawing on the particularities of the ethnographic context of Northern Greece, in a rural area among a population facing the uneven distribution of biotechnologies, this analysis intends to show how developments in the field of breast cancer prevention and genetics are interwoven with the challenges and possibilities of the modernisation and secularisation processes. Notions of ‘control’ or ‘protection’ are put to work in medical discourse and the religious domain, through a renewed repertoire of pre-existing meaning-systems that highlight often contrasting aspects of collectivity and individuality. For women with high-risk family history of breast cancer, these tensions are reflected in ways they negotiate articulations of their biology, inherited risk and female subjectivity. In effect, the issues of inequality and religious philanthropy bring fort...

Local perceptions of dengue fever in northeast Thailand and their implications for adherence to prevention campaigns

Abstract: The government of Thailand has invested heavily in community-based dengue fever prevention campaigns, yet community participation has been inadequate to prevent transmission This ethnographic study explored local understandings of dengue in rural northeast Thailand, and their implications for adherence to government-initiated prevention measures centred around mosquito control While community members recognised the most severe manifestation of the disease - dengue haemorrhagic fever (DHF) - as life threatening, they were unaware of the existence of the milder form of dengue fever (DF) that makes up the majority of cases Consequently, milder fevers were believed to be something other than dengue, such that dengue was perceived as a rare illness, hindering participation in prevention Furthermore, a local illness category, khai mak mai ('fruit fever') complicated the diagnosis, treatment and prevention of dengue fever, as people viewed it as both difficult to distinguish from dengue, and untreatable by biomedicine

Translating malaria as sumaya: Justified convention or inappropriateness?

Abstract: In exchanges between health professionals and consultants in the West African context, the word malaria is often replaced by its equivalent in the local dialect. In the Nouna health district of Burkina Faso the term malaria is regularly translated as sumaya. Acknowledging that there may be important epistemological differences between malaria, a term issued from the biomedical epistemology, and sumaya, which is borrowed from traditional medicine epistemology, the possible mismatches between these two terms have been assessed to anticipate problems that may result from their translation by different health stakeholders. By consulting various traditional healers and other members of the communities about the local meaning of the term sumaya, it has been possible to compare the conceptualisation of sumaya to the biomedical conceptualisation of malaria and assess the gap between them. An investigation based on a sample of 13 traditional healers and over 450 individuals from Nouna's health district was conduct...

The anti-politics of health reform: household power relations and child health in rural Senegal

Abstract: This article employs ethnographic evidence from rural Senegal to explore two dimensions of health sector reform. First, it makes the case that health reforms intersect with and exacerbate existing social, political, and economic inequalities. Current equity analysis draws attention to the ways that liberal and utilitarian frameworks for health reform fail to achieve distributive justice. The author's data suggest that horizontal power relations within households and small communities are equally important for understanding health disparities and the effects of health reform. Second, the article explores how liberal discourses of health reform, particularly calls for 'state-citizen partnerships' and 'responsiblization', promote depoliticised understandings of health. Discourses associated with health reform paradoxically highlight individual responsibility for health while masking the ways that individual health practice is constrained by structural inequalities.

Practitioners, postnatal depression, and translation: An investigation into the representation of Bangladeshi mothers in the East End.

Abstract: This paper is based on research that investigated the personal, localised and institutional representations of the emotional experiences of Bangladeshi mothers in Tower Hamlets, London. The research was conducted during 2003 and 2004. Whilst the London borough of Tower Hamlets is not deprived by global standards, within the UK the borough ranks very low on certain socio-economic indicators. Simultaneously, the ‘East End’ can still conjure up images of heart-warming kinship and of a place that welcomes migrants. These, and other contradictory depictions, are used by the people who both live and work in the borough. Through the investigation of the narratives of those who work with Bangladeshi mothers, this paper explores the role of culture as presented in both self-conscious and implicit terms. Further to this, it examines what claims are based on these conceptions. This analysis demonstrates that institutions are not neutral spaces in which identities and representations of experience are produced, but i...

Eloquent bodies: conflict and ritual in northern Sri Lanka

Abstract: It is increasingly apparent that hostilities continue in the aftermath of war and conflict, where presuppositions of peace and safety are rarely reflected on the ground. In Sri Lanka, the 2002 ceasefire agreement between the Sri Lankan government and the Liberation Tigers of Tamil Eelam (LTTE) has recently collapsed. This collapse developed slowly over a period of several years, beginning with cautious optimism before descending into deep pessimism with increasingly high levels of violence brought about by the absence of any real progress. Efforts to rebuild and reintegrate both rural and urban communities in the north of the country have had to take place within an atmosphere of silence, suspicion and a marked escalation towards the renewed outbreak of war. This article, following sixteen months of fieldwork in the northern Jaffna peninsula, examines how Tamil youths - many of whom were imprisoned and tortured during the war - have transformed a well-known ritual that has seen a dramatic increase since occupation of the far north by government troops in 1996. The ritual, previously an act of devotion to a popular Tamil god, Murugan, has transformed into a demonstration of strength and youthful challenge. This article examines how toleration of ritual pain can be contrasted with the pain and suffering of war, and articulated not only for the self, but also for the entire community.

Functionalists and zombis: Sorcery as spandrel and social rescue.

Abstract: At one level, anthropologists remain functionalists in that they generally see acts and institutions as contributing to a greater social whole only through which they make sense. Thus, sorcery accusations have been traditionally interpreted in terms of maintaining social harmony and cohesion. In the case of Haitian zombification, the zombi seems a locally misidentified victim who is frequently mentally ill. As a hapless non-agent, the zombi cannot initiate the sorcery accusations, so how do we understand the recognition and rescue of the zombi, either in terms of social function or social action?

Culture, subject, psyche. Dialogues in psychoanalysis and anthropology, edited by Anthony Molino.

Abstract: Greenblat gives an alternative view of Alzheimer’s; one that is radically brighter and more positive than the prevailing view of the disease. The residents, she shows, are offered choices and are shown to be responsive and engaged in this alternative to conventional nursing homes. While medicine tries in vain to find effective treatment for sufferers of this disease, Greenblat’s book becomes a manifesto on how those suffering from Alzheimer’s should, and could, be treated.

The wife of God.

Abstract: The case was presented of an ultra-orthodox Jewish woman who believed that she is the wife of God. Such a belief may be normative in some religions, but not in Judaism, where closeness to God is understood as a metaphor. Although the patient's beliefs are not acceptable within ultra-orthodox beliefs, there are examples of such ideas within the history of religious Judaism. The deviance of her delusions from the religious norm would appear to be deceptively minor. The similarities in content and underlying factors with possession states such as dybbuk and maggid are considered. Being the wife of God may be understood in terms of her disappointments and represent gaining control over the uncontrollable in her life and society. The details of the case management are presented to demonstrate the importance of discussing her ideas with her and working with community authority figures while respecting their status and rulings.

The concept of ‘mental trauma’ and its transcultural application

Abstract: Impaired 'traumatic' memory of disaster-affected populations has come to the forefront of humanitarian work. In this article, the application of the notion of 'mental trauma' by psychosocial intervention programmes, relating to the tsunami disaster, will be critically examined. It will be shown in which type of theoretical structure the guidelines' notion of 'mental trauma' is rooted, presenting 'traumatic' experience as a division of the self, which is defined through agency and coherence. It will be argued that this entails a certain subjectivity of representation, which may not have transcultural validity. It is concluded that rehabilitation and development programmes after disasters have to integrate and address multiple levels, including community-level interventions, drawing on local coping strategies and resources.

The power of place: geography, destiny, and globalization's rough landscape, by Harm de Blij

Abstract: The power of place: geography, destiny, and globalization's rough landscape, by Harm de Blij, New York, Oxford University Press, 2008, 304 pp., US$27.95, ISBN: 978-0-19-536770-6 Reliable global dia...

Muslim communities of grace, by Jamil M. Abun-Nasr.

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Impotent Warriors: Gulf War Syndrome, Vulnerability and Masculinity, by Susie Kilshaw.

Abstract: Impotent Warriors: Gulf War Syndrome, Vulnerability and Masculinity, by Susie Kilshaw, Oxford, Berghahn, 2009, 266 p., bibliography, notes, appendix, ISBN: 978-1-84545-526-2 In the present climate ...

Ageing In Today's World: Conversations between an Anthropologist and a Physician by Renee Rose Shield and Stanley M. Aronson

Abstract: paradigm for understanding AIDS in Thailand is overly technological and statistically-driven, so instead he concerns himself with local understandings of disease, the increased publicity of sex, the construed deviance of minorities, the consolidation/affirmation of biomedical hegemony, the role of linguistics in social construction processes, and the corroborative role of the AIDS industry in the generation of a normative model. Fordham’s research leads him to conclude that the normative model for understanding the Thai AIDS epidemic is based on misconceived assumptions and that only a more anthropological understanding of Thai culture will lead to a more accurate portrayal of the situation. All of this argument is made in spite, of the fact, which Fordham acknowledges, that HIV intervention efforts in Thailand were highly successful. Rather, Fordham decries the current paradigm for legitimating and reinforcing unfair prejudices. He claims it is over-simplified and lacks reflexivity. Ultimately, he believes it is disempowering and sexually de-liberating. Fordham concludes his analysis by calling for a more robust understanding of sex and sexuality in Thai culture and he urges people to think critically about our commonsense assumptions about HIV and their social repercussions. Fordham’s book was easily the most courageous and provoking of these books on HIV, and he leaves us with an important reminder to always consider the implications of and local responses to our intervention efforts.