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Annu. Rev. Anthropol. 2001. 30:163–79


Copyright °
c 2001 by Annual Reviews. All rights reserved

SEXUALITY, CULTURE, AND POWER


IN HIV/AIDS RESEARCH

Richard Parker
Institute of Social Medicine, State University of Rio de Janeiro; Brazilian
Interdisciplinary AIDS Association; and Sociomedical Sciences Division, Joseph L.
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Mailman School of Public Health, Columbia University, New York, New York
10032-2603; e-mail: rgp11@columbia.edu

Key Words sexual practices, cultural analysis, political economy


■ Abstract This article examines the development of anthropological research in
response to AIDS. During the first decade of the epidemic, most social science re-
search focused on the behavioral correlates of HIV infection among individuals and
failed to examine broader social and cultural factors. By the late 1980s, however, pio-
neering work by anthropologists began to raise the importance of cultural systems in
shaping sexual practices relevant to HIV transmission and prevention. Since the start
of the 1990s, this emphasis on cultural analysis has taken shape alongside a growing
anthropological research focus on structural factors shaping vulnerability to HIV infec-
tion. Work on social inequality and the political economy of HIV and AIDS has been
especially important. Much current research seeks to integrate both cultural and struc-
tural concerns in providing an alternative to more individualistic behavioral research
paradigms.

INTRODUCTION

Like many other disciplines, anthropology largely failed to distinguish itself in


its initial responses to the HIV/AIDS epidemics. Certain other social science
disciplines—in particular, psychology—were quick to mobilize themselves in-
ternally during the mid-1980s in order to lobby the U.S. federal government for
funding and to offer institutional responses to the epidemic through the foundation
of HIV/AIDS research centers (typically based in academic departments of psy-
chiatry or psychology and well-integrated into largely epidemiological research
efforts). However, anthropologists for the most part contributed only irregularly
to such early research mobilization, largely on the basis of their own individual
research initiatives and publications rather than as part of a formal or organized re-
search response. This is not to say that no important anthropological contributions
were made to the study of HIV and AIDS during this time (e.g., Bolognone 1986;
Conant 1988a,b; Feldman 1985; Feldman & Johnson 1986; Feldman et al 1987;

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164 PARKER

E. Gorman 1986; M. Gorman 1986; Herdt 1987; Lang 1986; Nachmann & Dreyfuss
1986; Sindzingré & Jourdain 1987; Stall 1986; for further references to early
anthropological work on HIV/AIDS, see Bolton et al 1991). But the dominant
paradigm for the organization and conduct of AIDS research—both in the United
States, where the epidemic was most intense at the time, and internationally, where
its size and shape were only beginning to be perceived—was established in large
part independently of anthropological contributions. The paradigm was character-
ized by a heavily biomedical emphasis and a largely individualistic bias in relation
to the ways in which the social sciences might contribute meaningfully to the
development and implementation of an HIV/AIDS research agenda.
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This historical context proved to be especially important in shaping the domi-


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nant tendencies in the study of sexuality in relation to HIV and AIDS. One of
the most immediate consequences of the HIV/AIDS epidemic was a remark-
able increase in concern with (and funding for) research on sexuality—as well
as a growing awareness of the extent to which the widespread neglect and even
marginalization of sex research over much of the twentieth century had left vir-
tually all countries largely unprepared to respond to an epidemic that appeared
to be driven, above all else, through the sexual transmission of a viral infection
(Herdt 1987; Herdt & Lindenbaum 1992). As policy makers and planners found
themselves returning to the Kinsey surveys of sexual behavior—carried out in the
United States more than fifty years earlier but now often invoked as if they ap-
plied to the historical present or, even more problematically, to the sexual practices
found in radically different cultural traditions—new emphasis was placed on the
urgent need for more adequate, current data on the nature of sexual behavior (see
Turner et al 1989).
Indeed, much of the social science research activity that emerged in response
to AIDS, not only during the mid- to late 1980s, but up to the present time, focuses
on surveys of risk-related sexual behavior and on the knowledge, attitudes, and
beliefs about sexuality that might be associated with the risk of HIV infection.
Most of these studies have aimed to collect quantifiable data on numbers of sexual
partners, the frequency of different sexual practices, previous experience with other
sexually transmitted diseases, and any number of other similar issues that were
understood to contribute to the spread of HIV infection (e.g., Carballo et al 1989;
Chouinard & Albert 1989; Turner et al 1989; Cleland & Ferry 1995). On the
basis of such data, the primary goal was to point the way for prevention policies
and intervention programs designed to reduce behaviors associated with increased
risk for HIV infection. By focusing on the links between empirical data on sexual
behavior and largely psychological theories of individual behavior change (such as
the Health Belief Model, the Theory of Reasoned Action, or the Stages of Change
Model), it was assumed that more broad-based prevention programs could be
developed in order to persuade individuals to change their behaviors in ways that
would ultimately reduce the risk of HIV infection (e.g., Turner et al 1989).
Increasingly, however, as behavioral research and behavioral interventions be-
gan to be developed in a growing range of diverse social and cultural settings,
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AIDS AND SEXUALITY 165

the relative effectiveness of both the research instruments and intervention strate-
gies came to be questioned, notably by anthropologists (see Herdt et al 1991,
Parker et al 1991). The difficulties of translating or adapting research protocols for
cross-cultural application quickly became apparent in the face of often radically
different understandings of sexual expression and practices in different societies
and cultures—and even in different subcultures within the same society (Bibeau
1991, Bolton et al 1991, Singer 1992, ten Brummelhuis & Herdt 1995, Clatts 1994,
Herdt & Lindenbaum 1992, Parker 1994, Pollak 1988). The limitations of behav-
ioral interventions based on information and reasoned persuasion as a stimulus
for risk reduction also quickly became evident. In study after study, the finding
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that information in and of itself is insufficient to produce risk-reducing behavioral


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change was repeated, and the relative limitations of individual psychology as the
basis for intervention and prevention programs became apparent (see Carrier &
Magaña 1991, Clatts 1989, Herdt & Boxer 1992, Herdt et al 1991). By the late
1980s, therefore, on the basis of both research findings and practical experience
around the world, it had become clear that a far more complex set of social, struc-
tural, and cultural factors mediate the structure of risk in every population group,
and that the dynamics of individual psychology cannot be expected to fully ex-
plain, let alone produce, changes in sexual conduct without taking these broader
issues into account (see Bolton & Singer 1992; Carrier 1989; Flowers 1988; Herdt
& Lindenbaum 1992; Herdt et al 1991; Obbo 1988; Parker 1987, 1988; Schoepf
et al 1988).

FROM BEHAVIORAL RISKS TO CULTURAL MEANINGS


Although anthropological work has played only a very limited role during the
1980s in the development of HIV/AIDS research agendas and initiatives focusing
on sexual behavior, quite the opposite is the case for anthropology in the 1990s,
in relation to finding the most important alternative approaches to research on
sexuality and AIDS. While there has in fact been increasing convergence between
these approaches over time, it is nonetheless possible to identify at least two major
tendencies that, by the early 1990s, had begun to mount a serious challenge to
the dominance of biomedically and epidemiologically driven behavioral research
agendas for the study of HIV and AIDS, as well as to the psychological approach
to sexuality described above.
On the one hand, particularly during the early 1990s, there was a growing
focus on the interpretation of cultural meanings (as opposed to the calculus of
behavioral frequencies) as central to a fuller understanding of both the sexual
transmission of HIV in different social settings and the possibilities that might exist
for responding to it through the design of more culturally appropriate prevention
programs (Treichler 1999). On the other hand, emerging at the same time but
gaining greater attention over the mid- to late 1990s, there was increasing concern
with the impact of a range of wider structural factors that could be seen as shaping
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166 PARKER

vulnerability to HIV infection as well as conditioning the possibilities for sexual


risk reduction in specific social contexts (see Farmer 1992; Farmer et al 1996;
Schoepf 1992a,b,c; Schoepf et al 1988; Treichler 1999).
By the early 1990s, a range of broader cultural factors began to be identified
as centrally important to an adequate understanding of the social dimensions of
HIV and AIDS. Furthermore, the limitations of traditional behavioral research ap-
proaches in public health had begun to become apparent, particularly with regard
to the development of prevention and intervention activities (see Bolton & Singer
1992; Herdt & Lindenbaum 1992; Herdt et al 1991). Heavily influenced by de-
velopments within interactionist sociology and interpretive cultural anthropology,
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as well as by insights emerging from fields such as women’s and gay and lesbian
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studies, attention turned to the broader set of social representations and cultural
meanings that could be understood as shaping or constructing sexual experience
in different contexts (Alonso & Koreck 1989; Carrier & Magaña 1991; Daniel
& Parker 1993; Gorman 1991; Herdt & Boxer 1991, 1992; Obbo 1993; Schoepf
1992a,b). Stimulated by such social constructionist concerns, an important shift of
emphasis began to take place from an earlier focus on individual psychology and
individual subjectivity to a new concern with intersubjective cultural meanings
related to sexuality (Brummelhuis & Herdt 1995; Gagnon & Parker 1995; Herdt
& Lindenbaum 1992; Paiva 1995; Parker 1991; Parker & Aggleton 1999).
Fundamentally informed by anthropological approaches to other cultural phe-
nomena (such as religious belief and political ideology), this new attention to
sexual meanings emphasized their shared or collective character—their constitu-
tion not as the property of atomized or isolated individuals but rather of social
persons who are integrated in the context of specific cultural settings (Herdt &
Lindenbaum 1992). This new wave of anthropological research on HIV and AIDS
thus sought to go beyond the calculation of behavioral frequencies. In order to
examine and explicate what sexual practices mean to the persons involved, the sig-
nificant contexts in which they take place, the social scripting of sexual encounters,
and the diverse sexual cultures and subcultures that are present or emergent within
different societies, the research also sought to go beyond the identification of sta-
tistical correlates aimed at explaining sexual risk behavior (e.g., Bolton & Singer
1992; ten Brummelhuis & Herdt 1995; Herdt & Lindenbaum 1992; Parker 1994,
1996a). It is perhaps not surprising that much of this work first emerged in cross-
cultural research and in analyses of the situation in non-Western settings in which
the biomedical categories used in epidemiological analysis failed to be fully appli-
cable (Carrier 1989; Parker 1987, 1988; Wilson 1995; de Zalduondo et al 1991).
Increasingly, cultural analysis has also been applied when considering specific
sexual cultures or subcultures in the industrialized West, offering important new
insights even in settings where extensive behavioral research had already been car-
ried out (see Alonso & Koreck 1989; Clatts 1995; Henriksson 1995; Irvine 1994;
Kane & Mason 1992; Magaña 1991; Sobo 1993, 1995a).
The focus of much important research on sexuality in relation to HIV and AIDS
over the course of the past decade has thus moved from behavior, in and of itself, to
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AIDS AND SEXUALITY 167

the cultural settings within which behavior takes place—and to the cultural sym-
bols, meanings, and rules that organize it (see Bolton 1992; González Block &
Liguori 1992; Henriksson 1995; Henriksson & Mansson 1995; Herdt 1997a,b,c;
Herdt & Boxer 1991, 1992; Hogsborg & Aaby 1992; Kendall 1995; Lyttleton
2000; Paiva 1995, 2000; Setel 1999). Special emphasis has been given to analyz-
ing indigenous cultural categories and systems of classification that structure and
define sexual experience in different social and cultural contexts—with particular
stress on the cross-cultural diversity that exists in the construction of same-sex in-
teractions (Alonso & Koreck 1989; González Block & Liguori 1992; Carrier 1989;
Carrier et al 1997; Carrillo 1999; Lichtenstein 2000; Ligouri & Aggleton 1999;
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Preston-Whyte et al 2000; Tan 1995, 1996). Indeed, it has become increasingly


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apparent that many of the key categories and classifications [not only “homosex-
uality,” but also categories such as “prostitution,” or “female sexual partner” (of
male injecting drug users)] that have typically been used in biomedicine to describe
sexual behaviors, or account for vectors of infection of interest to public health
epidemiology, are in fact not relevant in all cultural contexts. Indeed, the meanings
of these concepts are not stable even in those contexts in which these categories are
in wide circulation (e.g., Alonso & Koreck 1989; Avila et al 1991; Carrier 1989,
1995, 1999; Carrier et al 1997; Carrillo 1999; Dı́az 1998; Herdt 1997b,c; Herdt
& Lindenbaum 1992; Irvine 1994; Jenkins 1996; Kane & Mason 1992; Larvie
1997, 1999; Law 1997; Lichtenstein 2000; Liguori & Aggleton 1999; Liguori
et al 1996; Preston-Whyte 1995; Preston-Whyte et al 2000; Silva 1999; Tan 1995,
1996, 1999, 2000; Wright 1997; de Zalduondo 1991). By focusing more carefully
on local categories and classifications, the cultural analysis of sexual meanings
has thus sought to move from what, in other areas of anthropological or linguis-
tic investigation, have been described as an “etic” or “outsider” perspective, to
an “emic” or “insider” perspective—or, perhaps even more accurately, from the
“experience-distant” concepts of biomedical science to the “experience-near” con-
cepts and categories that the members of specific cultures use to understand and
interpret their everyday lives (see Geertz 1973, 1983; Parker 1991).
This shift of emphasis from the study of individual behaviors to the investi-
gation of cultural meanings has drawn attention to the socially constructed (and
historically changing) identities and communities that structure sexual practice
within the flow of collective life (see Bolton 1992; Carrillo 1999; Herdt & Boxer
1992; Klein 1999; Rubin 1997; Tan 1995; 1999; Terto 2000). On the basis of such
work, an important reformulation of the very notion of intervention has begun
to take place. It has become increasingly apparent that the idea of a behavioral
intervention may in fact be a misnomer, since HIV/AIDS prevention interventions
almost never function at the level of behavior but rather at the level of social or
collective representations (Parker 1996a). New knowledge and information about
perceived sexual risk will always be interpreted within the context of pre-existing
systems of meaning—systems of meaning that necessarily mediate the ways in
which such information must always be incorporated into action. Because action
has increasingly come to be understood as socially constructed and fundamentally
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168 PARKER

collective in nature, earlier notions of behavioral intervention have given way


to ethnographically grounded AIDS education and prevention programs that are
community-based and culturally sensitive—programs aimed at transforming so-
cial norms and cultural values, and thus at reconstituting collective meanings in
ways that will ultimately promote safer sexual practices (see Altman 1994; Bolton
& Singer 1992; Paiva 1995, 2000).

FROM CULTURAL MEANINGS TO STRUCTURAL VIOLENCE


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Such ethnographically grounded descriptive and analytic research on the social


and cultural construction of sexual meanings provides important insights to the
representations shaping HIV-related risk and offers the basis for the development
of culturally sensitive and culturally appropriate, community-based HIV/AIDS
prevention programs. However, since the start of the 1990s it has also become
increasingly evident that the range of factors influencing the construction of sexual
realities is far more complex than previously perceived. It has become evident that
not just cultural, but also structural, political, and economic factors shape sexual
experience (and hence constrain the possibilities for sexual behavior change) to a
far greater extent than had previously been understood (Singer et al 1990; Farmer
1992; Schoepf 1991). In particular, research has emphasized that political and
economic factors have played a key role in determining the shape and spread of
the epidemic and has emphasized that these same factors have been responsible for
many of the most complex barriers to effective AIDS prevention programs (Baer
et al 1997; González Block & Liguori 1992; Farmer 1992, 1999; Farmer et al
1996; Lindenbaum 1997, 1998; Schoepf 1991, 1995; Singer 1994, 1998; Singer
et al 1990, 1992). By the early to mid-1990s, cultural analysis had emerged as an
important corrective to the perceived limitations of earlier behavioral approaches.
At the same time, a new focus on political and economic analysis of the structural
factors associated with an increased risk for HIV infection, and with both the
structural barriers and facilitators for risk reduction, emerged as central to the
evolving anthropological response to the epidemic (Farmer et al 1996; Feldman
1994; Singer 1994, 1998).
Because this research on structural factors in relation to HIV/AIDS has emerged
in a number of different social settings, ranging from deeply impoverished rural
areas in developing countries to the marginalized inner cities in the United States,
the language that it has used, the conceptual tools that it has employed, and the
specific focus of analysis have often varied (e.g., Bond et al 1997b; Farmer 1992;
Kreniske 1997; Schoepf 1991, 1992a,b,c, 1995; Singer 1994, 1998). In spite of
the differences in terminology and at times in research emphasis, this work has
consistently focused on what can be described as forms of “structural violence,”
which determine the social vulnerability of both groups and individuals. In deve-
loping these concepts, the work considers the interactive or synergistic effects of
social factors such as poverty and economic exploitation, gender power, sexual
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AIDS AND SEXUALITY 169

oppression, racism, and social exclusion (Farmer et al 1996; Singer 1998; Parker
& Camargo 2000; Parker et al 2000b). And the research has typically linked this
vulnerability to a consideration of the ways in which such structural violence is
itself situated in historically constituted political and economic systems—systems
in which diverse political and economic processes and policies (whether related
to economic development, housing, labor, migration or immigration, health, edu-
cation, and welfare) create the dynamic of the epidemic and must be addressed
in order to have any hope of reducing the spread of HIV infection (Bond et al
1997a; de Zalduondo & Bernard 1995; González Block & Liguori 1992; Farmer
et al 1996; Kammerer et al 1995; Long 1997; Porter 1997; Romero-Daza 1994;
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Romero-Daza & Himmelgreen 1998; Susser & Kreniske 1997; Symonds 1998).
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To respond to this growing perception of the importance of structural factors and


structural violence in shaping sexual experience and vulnerability to HIV infection,
attention has increasingly focused on the ways in which societies and communities
structure the possibilities of sexual interaction between social actors—the ways in
which they define the available range of potential sexual partners and practices, as
well as the ways in which they impose both the sexual possibilities and options
that will be open to differentially situated actors. With whom one may have sex, in
what ways, under what circumstances, and with what specific outcomes are never
simply random questions (Akeroyd 1997; de Zalduondo & Bernard 1995; McGrath
et al 1992, 1993; Parker et al 1991; Rwabukwali et al 1994).1 Such possibilities
are defined through the implicit and explicit rules and regulations imposed by the
sexual cultures of specific communities as well as the economic and political power
relations that underpin these sexual cultures. They can never be fully understood
without examining the importance of issues such as “class,” “race” or “ethnicity”
and the other multiple forms through which different societies organize systems
of social inequality and structure the possibilities for social interaction along or
across lines of social difference.
This awareness of the ways in which social orders structure the possibilities (and
obligations) of sexual contact has drawn special attention to socially and cultur-
ally determined differentials in power—particularly between men and women (de
Zalduondo & Bernard 1995; Gupta & Weiss 1993; Parker 1991; Schoepf 1992a,b;
Sobo 1993, 1994, 1995a,b, 1998)—but also, in some instances, between different
types of men (Carrillo 1999; González Block & Liguori 1992; Liguori et al 1996;
Prieur 1998; Silva 1999; Tan 1995, 1999).
Because different societies organize sexual (as well as other forms of) inequality
in specific ways, social and cultural rules and regulations place specific limitations
on the potential for negotiation in sexual interactions. These rules and regulations,
in turn, condition the possibilities for the occurrence of sexual violence, for pat-
terns of contraceptive use, for sexual negotiation, for HIV/AIDS risk reduction

1
These concerns have of course long been present in anthropological studies of sexuality in
non-Western societies and, in particular, in the anthropological literature on kinship (e.g.,
Fortes 1967; Goody 1973; Leach 1961; Lévi-Straus 1969; Malinowski 1929, 1955).
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170 PARKER

strategies, and so on. The dynamics of gender power relations have thus become
a major focus for contemporary research, particularly in relation to reproductive
health and the rapid spread of HIV infection among women in many parts of the
world (e.g., Farmer et al 1996; Ginsberg & Rapp 1995; Gupta & Weiss 1993;
Schoepf 1992a,b, 1995; Ward 1991). Just as detailed cross-cultural and compar-
ative investigation of the social construction of same-sex interactions provided
perhaps the key test case for demonstrating the importance of cultural analysis
in relation to sexuality and HIV/AIDS, issues related to gender and power have
been central to a better understanding of the importance of structural factors in
organizing sexual relations and HIV/AIDS-related vulnerability (Akeroyd 1997;
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de Zalduondo & Bernard 1995; de Zalduondo et al 1991; Farmer 1999; Farmer


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et al 1996; Farmer et al 1993; Gupta & Weiss 1993, Long 1997; Obbo 1995; Paiva
1995; Romero-Daza 1994; Schoepf 1992b,c; Sobo 1993, 1995a,b).
As Farmer’s work, in particular, has demonstrated, the political economic fac-
tors that drive the HIV/AIDS epidemic in virtually all social settings are inter-
twined with gender and sexuality, whose hierarchies make women, and low-income
women in particular, especially vulnerable to HIV infection (Farmer 1992). In spite
of this, there have still been relatively few ethnographically grounded studies on the
ways in which gender and sexuality as structural (rather than behavioral) factors
shape the AIDS epidemic. Farmer, Lindenbaum and Delvecchio-Good attribute
this neglect to the initial predominance of AIDS cases among gay men in the
industrialized Western countries, the fact that sexuality is a topic poorly under-
stood by nearly all social scientists, and the fact that AIDS intervention programs
often rely on superficial “rapid ethnographic assessment” procedures rather than
on more detailed ethnographic description and analysis (Farmer et al 1993). The
inappropriateness of many AIDS interventions directed toward women increas-
ingly led a number of anthropologists to look more closely at gender and sexuality
systems with the hopes of developing more realistic and effective HIV risk reduc-
tion options for women (Kammerer et al 1995; Schoepf 1991, 1992a,b; Symonds
1998).
Over the course of the 1990s, this growing interest in understanding the role of
gender and sexuality structures in promoting HIV vulnerability, particularly among
heterosexually active women and men, has increasingly generated a number of
impressive ethnographic analyses that are attentive to both cultural and political
economic factors. For example, Kammerer et al examine the ways in which the
mountain tribes of the northern Thailand periphery are being exposed to the threat
of HIV (Kammerer et al 1995). The vulnerability of these hillside tribes to HIV
is in large measure generated by state and capitalist penetration, which has led
to a breakdown of the material base rural life and has caused young people to
migrate to valley towns in order to work not only as prostitutes but also as maids,
waiters, and construction workers. These socioeconomic transformations have
affected hillside sexuality, which until recently was structured around core values
of “shame, name and blame.” The authors provide ethnographic descriptions of
these core values in relation to HIV/AIDS and how the gender power relations and
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AIDS AND SEXUALITY 171

customary prescriptions and prohibitions of hillside sexuality make talking about


sex and taking precautions against HIV transmission difficult.
Similarly, Symonds, writing on the Hmong in Northern Thailand, has examined
how the epidemic of HIV/AIDS in Thailand, and the place of Hmong within it, can
be explained only by a combination of inter-related factors: the commercial sex
industry, the prevalence of injection drug use, the political economic changes that
have forced the Hmong living in the highlands to rely on lowland markets, racism
and discrimination against the Hmong by the Thai majority, and sexual double
standards, which permits polygyny among men yet controls the sexuality of young
women (Symonds 1998). Finally, Schoepf has used vignettes from the life histories
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of women from various socioeconomic classes in Kinshasa, Zaire to demonstrate


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that HIV is spreading not through exotic cultural practices but because of many
people’s normal responses to situations of everyday life, such as dealing with
substantial economic hardship and uncertainty (Schoepf 1992c). Like Kammerer
et al and Symonds, Schoepf has promoted a participatory and collaborative form
of action research with vulnerable women as a means to help redefine the gendered
social roles and socioeconomic conditions that have contributed to the rapid spread
of HIV in many parts of the world (Schoepf 1992a,b; Schoepf et al 1988).
In turning to issues of power, attention has focused not only on gender but also on
poverty, both in the context of developing countries (see Farmer 1992, 1995, 1999;
Farmer et al 1996; Farmer et al 1993; Kreniske 1997; Paiva 1995, 2000; Schoepf
1991) and in the impoverished inner-city ethnic communities of the United States
(Farmer et al 1996; Singer 1994, 1998; Sobo 1993, 1994, 1995a), particularly as
poverty interacts with gender power relations. Especially in the U.S.-based urban
ethnography of HIV and AIDS, the impact of race and racism has necessarily been
linked to issues of both poverty and gender, creating a kind of synergistic effect
(Baer et al 1997; Farmer et al 1993; Singer 1994, 1998), involving multiple forms
of oppression and shaping the nature of HIV/AIDS-related risk due to injecting
drug use and voluntary as well as involuntary sexual practices (Singer 1998; Sobo
1995a). Although it has received less attention (perhaps because of the homophobia
that affects anthropology as much as any other discipline), the extension of gender
power inequalities together with pervasive heterosexism have also increasingly
been understood as interacting with other forms of structural violence, including
both poverty and racism, in creating situations of extreme vulnerability in relation
to gender nonconformity, to transgender and male sex work, to gay men from
ethnic minority groups, and among young men who have sex with men generally
(see Dı́az 1998; Carrier et al 1997; Khan 1996; Lichtenstein 2000; Parker et al
1998; Silva 1999; Tan 1995, 1999; Whitehead 1997; Wright 1993, 1997).
Ultimately, work casting the body as both a symbolic and a material product of
social relations—a construct that is necessarily conditioned by a whole range of
structural forces—has provided an especially important way of reframing recent
research on sexuality in relation to HIV and AIDS (e.g., Bishop & Robinson 1998;
Manderson & Jolly 1997; Parker 1999). The potential implications of this under-
standing for prevention interventions and strategies are farreaching. In seeking to
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172 PARKER

broaden the potential scope and impact of intervention strategies, a number of new
approaches have been developed that have been heavily influenced by anthropo-
logically and ethnographically grounded understandings of the political economy
of HIV and AIDS. What have been described as structural interventions have come
to the fore. For example, there are attempts to change the employment options for
sex workers or improve the logistics of condom availability and distribution, with
the ultimate goal of altering the structural conditions that may impede or facili-
tate the adoption of safer sex (Parker et al 2000a,b; Preston-Whyte et al 2000).
Strategies aimed at “community mobilization” and the stimulation of activism or
advocacy have also drawn attention, with a growing number of intervention stud-
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ies now focusing on the dynamics of community organizing in different settings


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(Susser & Kreniske 1997). In some of the most innovative work currently being
carried out, HIV/AIDS intervention research has increasingly drawn on theories of
“social transformation” and “collective empowerment” in order to examine issues
related to power and oppression. The research has increasingly turned from the
psychological theorists of reasoned decision-making to the work of community
activists and popular educators in seeking the basis for a transformative or dia-
logical educational process in which participants explore and question their own
lives and realities. Through this exploration and questioning, the participants be-
gin to undergo a process of collective empowerment and transformation in order
to respond to the forces that threaten and oppress them (see Paiva 2000, Parker
1996b).
All of this recent work has called attention to the need for structural changes
aimed at transforming the broader forces that structure HIV/AIDS vulnerability
and at enabling the members of affected communities to more adequately respond
to these forces. Perhaps most important, it has focused on the extent to which
HIV/AIDS prevention (and prevention research, in anthropology as in other dis-
ciplines) must be understood as part of a broader process of social transformation
aimed not merely at the reduction of risk but at the redress of the social and eco-
nomic inequality and injustice that has almost universally been found linked to
increased vulnerability in the face of HIV and AIDS.

CONCLUSION
Anthropologists were rather slow to respond to the initial impact of the HIV/AIDS
epidemic during the early and mid-1980s, allowing an essentially biomedical and
highly individualistic model of AIDS research and intervention that has continued
up to the present time as the dominant approach to the epidemic. Nevertheless
anthropological perspectives have taken a leading role in defining what have been
perhaps the most important alternative currents of social research in response to
AIDS. Since the late 1980s, and increasingly over the course of the 1990s, an-
thropological research on the cultural meanings that shape and construct sexual
experience, and on the political economy of structural forces that impinge upon
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AIDS AND SEXUALITY 173

sexual life, have provided alternative models and paradigms for responding to the
epidemic both locally and cross-culturally (Parker et al 2000a; Treichler 1999).
Although these two approaches for the most part emerged independently, inspired
by distinct tendencies within the discipline more broadly, by the end of the 1990s
both cultural and political economic or structural approaches increasingly merged
in offering an important counterpoint to the more biomedical and behavioral per-
spectives that continue to dominate the field and to receive the lion’s share of
funding and prestige. Although it is impossible to fully predict the ways in which
HIV/AIDS research will develop in the future, the fact that the epidemic continues
to expand in large part independent of all of the efforts thus far to control it, and the
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fact that it continues to take its greatest toll in the so-called developing world and
Annu. Rev. Anthropol. 2001.30:163-179. Downloaded from www.annualreviews.org

among the most impoverished and marginalized sectors of all societies, suggests
that the kinds of approaches that anthropologists have offered for the study of
sexuality and HIV/AIDS will continue to be important. The kind of response that
anthropology continues to make in relation to the epidemic will be an important
indicator of the relevance of the discipline as we enter the new millennium.

Visit the Annual Reviews home page at www.AnnualReviews.org

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