Ann Swidler

Reassessing HIV prevention

The largest investments in AIDS prevention targeted to the general population are being made in interventions where the evidence for large-scale impact is uncertain.

Cultural Power and Social Movements

In several ways, Swidler provides a more developed analysis of the relationship between culture and social movements than does McAdam. First, she focuses on the ways culture shapes individual beliefs and desires. Thus, culture provides a means by which people make sense of the world. Second, Swidler examines the ways culture provides repertoires of public symbols that structure the kinds of expected responses that individuals develop from their social interactions. A handshake on first meeting a person could be seen as such a symbol: Failure to shake hands once another has been extended is a deliberate insult. Thus, once they have offered it, most people expect that their hand will be shaken. Such an expectation represents cultural knowledge that exists even when no handshake is ongoing. Such assumptions may shape how a social movement acts even if its members are ideologically divided and its contention with the broader society sharp. Third, Swidler pays attention to the ways social institutions shape movement activities: If official organizations and others try to integrate or co-opt a group, for example, the movement is likely to behave differently than if it faces aggressive, perhaps violent, repression. Culture, then, is more than just the private beliefs of individual group members, and it is more than a set of broad principles that can be used for group purposes. It involves a dynamic interaction that shapes private and public acts together.

What properties of culture should we measure

Abstract This paper argues that current challenges for the sociology of culture are more conceptual and the theoretical than methodological in nature. It discusses persistent issues in the conceptualization of culture, the quasi-hierarchic linkages between different cultural elements, and the importance of attention to levels of analysis for the measurement of cultural properties.

Public health. Reassessing HIV prevention.

The largest investments in AIDS prevention targeted to the general population are being made in interventions where the evidence for large-scale impact is uncertain.

Measuring concurrent partnerships.

We are encouraged that UNAIDS is developing new indicators to measure concurrent sexual partnerships (Feb 20, p 621). However, we believe that adding a measure of coital frequency to the agency’s proposed list of questions would provide an important improvement. Each additional act of intercourse is associated with a signifi cantly increased risk of infection and thus coital frequency is crucial to the risk of HIV acquisition. Consider a scenario in which a man with two partners has sex with one of them only a few times a year and with the other a dozen times a year. This man would be regarded as practising concurrency according to the UNAIDS defi nition, but even if such behaviour were universal among men and women in a population, it would be very unlikely to generate a signifi cant AIDS epidemic. New modelling research suggests that sustained heterosexual HIV transmission requires that a signifi cant number of overlaps be long enough and coitally frequent enough so that a relatively large number of people have sex with someone who also has another partner, particularly while some of these individuals are in the highly risky “acute phase” of early HIV infection. Little research on coital frequency in concurrent partnerships has been done, but some studies suggest that it may be quite high in some high-HIVprevalence hetero sexual populations that practise concurrency—even when overall partner numbers are low. We recommend that, in addition to the questions listed by UNAIDS, an additional one such as the following be asked for each overlapping partner: “Let’s talk about this partner. During the past year, how often do/did you have intercourse with him/her? (a) only once; (b) more than once, but less than once per month; (c) about once per month; (d) a few times per month; (e) about once per week; (f) about two or three times per week; (g) more than two or three times per week.” Furthermore, we recommend that UNAIDS and others explore better ways to collect more accurate selfreported data on intimate sexual behaviour. Under-reporting of risky sexual activity, especially by women, is a signifi cant problem, particularly if strict confi dentiality is not perceived by inter viewees.

African affirmations: The religion of modernity and the modernity of religion

This article contrasts three broad traditions that organize competing patterns of authority, community, and cooperation in contemporary Africa: the Axial religions (Christianity and Islam); indigenous chieftaincy systems based around chief, lineage, and clan; and globalized modernity, represented primarily by NGOs and the global human rights agenda. The article argues that in many respects it is the Axial religions that are the most modernizing, as they directly counter the power of traditional kin obligations (and the overwhelming dangers of witchcraft), while the purportedly modern and secular NGOs practice a ritualized version of modernity, even as they are penetrated by the norms and practices of the kin-based chieftaincy system and its related system of patron–client ties.

HEARSAY ETHNOGRAPHY: A METHOD FOR LEARNING ABOUT RESPONSES TO HEALTH INTERVENTIONS

How can we know how health interventions – the dissemination of health knowledge and the promotion of behavior change – are received by the people whom our interventions address? In this paper, we describe a practical methodology that contributes to the project of studying collective meaning making as it unfolds and changes. By fixing episodes of public discourse as texts, rather than directly interrogating respondents in interviews or focus groups, conversational journals convey a sense of spontaneous issues that comprise the dynamic world of publicly available, collectively constituted meanings. While several theoretical traditions, from the Durkheimian to the symbolic-interactionist, posit such a dynamic public realm, few methods capture its texture.

Rethinking HIV Prevention: PUBLIC HEALTH

The largest investments in AIDS prevention targeted to the general population are being made in interventions where the evidence for large-scale impact is uncertain.

What Free Schools Teach

Alternative schools are no more, and often less effective in teaching academic skills than are traditional schools. Alternative schools do, however, teach a “hidden curriculum,” a set of norms nearly the inverse of those traditional schools teach. Using the work of Dreeben, On What Is Learned in School (1968), and contrasting his findings with those from a two-year study of two alternative high schools, it is argued that in place of the values of individualism and achievement, alternative schools teach group skills. Students do not learn to cope with the stress of evaluation and the risk of failure; instead they are encouraged to develop autonomy, self-direction, and emotional openness. In contrast to the universalistic, specific norms of traditional schooling, free schools stress diffuse, particularistic, intimate relations between teachers and students and within the student peer group. The paper concludes with an analysis of the social class implications of the norms which free schools teach.

Accurate information as a tool to decrease HIV test refusals in research studies.

It has been argued that researchers conducting surveys that include testing for human immunodeficiency virus (HIV) have a duty to tell potential subjects that they do not have the right to participate if they refuse to receive their HIV test results.1,2 Furthermore, promotion of the routine feedback of such test results has been based on the grounds that knowledge is power and information is liberation.3 However, other researchers argue that, although it is desirable to offer study participants post-test counselling, for practical and ethical reasons some study participants should be given the right to refuse such counselling.4 Although we support the right of participants to opt out of post-test counselling and thus not to receive their test results, we also propose that subjects who are – or may be – tested for HIV should be given information that may decrease their resistance to learning their test results. We draw on data, collected between 1998 and 2013, on rural Malawians’ experience with – and perceptions of – HIV testing. From the perspective of the organizations that promote HIV testing, it is axiomatic that people will benefit from knowing their HIV status. In Maher’s view, such benefit justifies sanctioning those who refuse to receive their test results.2 We disagree, for two reasons. First, the experience of many Malawians is that refusal to consent to testing may have serious consequences. For example, although the policy for antenatal HIV testing in Malawi includes an opt-out provision, accounts from pregnant women attending antenatal clinics show that HIV testing is compulsory if the women are to receive antenatal care.5 Moreover, in population-based HIV surveys, fieldworkers are always under pressure to minimize the numbers of test refusals and may exert undue pressure on individuals who do not want to receive their test results. While exclusion from antenatal services is, presumably, much more serious than exclusion from survey participation, in both of these examples people are sanctioned for not giving consent – which is a clear ethical violation. Second, our ethnographic data depict the anguish that many suffer as they anticipate the future receipt of their test results – an issue that has rarely been discussed in the public health and social science literature.6 Two common misperceptions among rural Malawian adults are that the result of an HIV test will almost always be positive and that a positive result will inevitably be followed by hastening psychological deterioration, suicidal thoughts and death. Yet survey data from people living in rural Malawi show that between 80% and 90% of respondents who believed that they were HIV-positive before they were tested learned that they were HIV-negative.7,8 That so many are convinced, wrongly, that an HIV test will inevitably produce a positive diagnosis is the consequence of rural Malawians’ incorrect understanding of the probabilities of HIV transmission. For example, most of our survey respondents believed that an uninfected individual was certainly or highly likely to be infected with HIV during a single act of unprotected intercourse with an infected person.8 Would it not be preferable to treat those living amidst the HIV epidemic as having an ethical right to accurate information on the probabilities of transmission? Efforts should be made to evaluate the potential benefits of disseminating accurate information on the probabilities of transmission, the approximate prevalence of HIV infection and the probability of a positive result in an HIV test – such that consent for HIV testing in surveys is fully, rather than incompletely, informed. We need to know whether such health education would be a liberation, lead to fewer test refusals in research studies and, importantly, increase the number of people who are willing to know their HIV status.