Abstract: HIV/AIDS and Culture: Implications for Policy, Carol Jenkins

Posted on September 19, 2011 by

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Abstracted by Brian J. Delas Armas

Carol Jenkins’ article is a response to the discourses of HIV/AIDS prevention which state one of three things: that culturally-appropriate messages will reach people, that cultural traits must change, or that individual sexual behaviors need to change.   Jenkins takes special aim at the third discourse, saying that it is difficult to separate out and affect significant change in these individual behaviors without attempting to address the social structures, norms, and cognitive systems in which these individuals live.

According to Jenkins, when Anthropologists have entered the conversation, they have been criticized for writing ethnographic accounts of a culture, as if to represent how everyone in a culture feels and behaves.  In response to this sentiment, Jenkins says that cultures differ greatly in context.  With such difference in cultures, National HIV programs cannot be expected to address the problems.  This sets the stage for her broad survey on sexual attitudes and behaviors spanning multiple regions, backed up by a combination of ethnographic studies on sex attitudes and behaviors and statistics.

Jenkins notes that the meanings of sexual practices take on importance when no other body of information exists to challenge them.   As a result some norms and practices will continue unchallenged.  For example, Jenkins found that what counts as “sexual culture” almost-universally means a closedness or hiddenness from youth.  This fosters a culture of secrecy and privacy around sex, which can be injurious and potentially fatal to those involved.

She attacks the idea that repression of sexual behaviors is a good strategy for AIDS prevention. “Abstinence messages for youth, although morally acceptable to many, cannot meet the challenge of creative manipulation of action and desire,” she states, noting that individuals attempting to live up to ideas of “abstinence” could subvert the requirement through anal and oral sex.  Anal intercourse is the most efficient method of HIV transmission   Further, she notes that the level of homophobia makes HIV a risk factor for people;  in other words, if people are secretive or dodgy about their sex lives and their status in attempt to save face, the more likely they are to spread the virus.   She emphasizes that it is these “sexual practices” as opposed to sexual identities or orientation that places people at risk for acquiring HIV.

She highlights how women have suffered injuries as a result of attitudes and practices perpetuated by different societies.  She highlights the treatment of sex workers.  Given the rise of global consumerism of sex, she notes that it makes sense to organize them as a group.  However, many people look down upon it, suggesting that prostitution is an affront to women in society and will not support any policies.  She also notes that woman have few rights with regard to their partners and husbands.  For example in a survey in Papua New Guinea of young men, if they were refused sex, 1% said they would kill their partner, and 17.4% said they would rape or force her anyway.  Additionally, it was found by the author that gang rapes were ways to initiate and retaliate against rivaling clans.

The answer to this structural violence has been largely invisible.  She notes that there have been few to no politicians and decision makers in developing countries and societies to stand up for women, possibly because it could implicate less control.

Drug use has also been a means of transmission of AIDS, but attitudes towards users and their treatments have been even more dismissive, despite growth in its recreational use.   She notes that drug use has risen to the point where “simply being [next to an area of high usage]” was a risk factor.  However, there has been much stigma placed on drug users and as a result many have been unreachable.  All cultures have stigmatized drug users, but that the burden is lighter in some areas.

Jenkins suggests that one way to deal with drug users effectively can be done through providing education and making clean needles readily available as a means of reaching people.  The ideas have had garnered little support.  She says that the cost of not investing in these type of programs that do reach the users could lead to greater expense to society in the future.

Overall, her solution is for AIDS intervention programs to take cultural codes into account, but to avoid strict adherence to them.   She suggests that where big agencies are unable to maneuver and reach stigmatized populations, smaller agencies on the ground need to be present to work directly with affected individuals.  In particular, she notes that the strategies thus far have failed to reach small tribes.