Anne-Lise Middelthon

Mandates of Trust in the Doctor–Patient Relationship

We examine the conditions for trust relationships between patients and physicians. A trust relationship is not normally negotiated explicitly, but we wanted to discuss it with both patients and physicians. We therefore relied on a combination of interviews and observations. Sixteen patients and 8 family physicians in Norway participated in the study. We found that trust relationships were negotiated implicitly. Physicians were authorized by patients to exercise their judgment as medical doctors to varying degrees. We called this phenomenon the patient’s mandate of trust to the physician. A mandate of trust limited to specific complaints was adequate for many medical procedures, but more open mandates of trust seemed necessary to ensure effective and humane treatment for patients with more complex and diffuse illnesses. More open mandates of trust were given if the physician showed an early interest in the patient, was sensitive, gave time, built alliances, or bracketed normal behavior.

Not at all so hard-to-reach: same-sex attracted men in Dar es Salaam.

Based on research in Tanzania, this paper critically examines the widely circulating notion that African same-sex attracted men are hard-to-reach individuals and populations. Despite expectations to the contrary, it was neither time consuming nor difficult to identify and get to know same-sex attracted men in Dar es Salaam. On the contrary, a large and diverse group of such men could readily be encountered, befriended and involved in HIV-related research. The fieldwork was characterised by communicative openness and the researcher was treated with immense kindliness, hospitality and inclusivity. While we may not be in a position to say that the situation is identical everywhere else, we find reason to caution against accepting and propagating unexplained, unexamined and unverified claims to the effect that same-sex attracted men in Africa cannot be reached. We argue that such claims contribute to stigmatise same-sex attracted men and to hinder much-needed HIV-related research and programming.

Negotiated silence: the management of the self as a moral subject in young Ethiopian women's discourse about sexuality

In Ethiopia, as in many other countries, moral discourses about female sexuality in general, and pre- and extramarital sexual experience in particular, create an environment that discourages women from engaging in open dialogue about their sexuality and their past or future sexual experience. In the study of induced abortion among unmarried women in Addis Ababa on which this paper rests, women describe a situation in which they are both surrounded by silence about sexual issues and forced to remain silent themselves. This paper investigates the nature of, and conditions for, this silence and the ways in which it is socially brought about and negotiated. In particular, it explores the ways through which young, unmarried women who have undergone abortion seek to reconcile seemingly contradictory, condemning discourses about premarital sex and more general codes addressing social, as well as moral, propriety and integrity. The discussion highlights that, while issues of sexuality are silenced, neither the silence nor the silencing power of dominant, gendered moral discourses is absolute. Moreover, silence may also be jointly produced and negotiated in social discourse fraught with moral objectives and ends.

Gays, Guys, and Mchicha Mwiba: Same-Sex Relations and Subjectivities in Dar es Salaam

Drawing on 15 months of fieldwork, this article explores ways in which same-sex relations are perceived and performed in Dar es Salaam, Tanzania. While several different constructions of same-sex sexuality coexist in Dar es Salaam, it is common to conceive of same-sex practicing men as falling into two main categories. Men belonging to each of these differ with respect to the corporeal, gendered, and social positions that are open to them, and typically form dyads across the conceptual boundary of difference that runs between them. The article speaks to the importance of examining sexuality and gender in particular sociocultural settings.

The tale of the hearts: deciding on abortion in Ethiopia

In contemporary Ethiopia, abortion decision-making is a challenging process involving moral and/or religious dilemmas, as well as considerations of health and safety. Amidst widespread condemnation of female premarital sex and clear moral sanction against induced abortion, young Ethiopian women are nevertheless sexually active and induced abortions are still sought and performed, with the potential for grave physical harm and social stigmatization. This paper examines young unmarried Ethiopian womens narratives of abortion decision-making. In particular, it identifies and explores the operations of a particular discursive shape from within in such narratives, here described as The tale of the hearts. Analysing The tale of the hearts as a decision-making resource, it is argued, allows us to explore the particular, local, historical and cultural character of Ethiopian womens abortion decision-making dilemmas and the culturally available resources contributing to their resolution.

Being Anally Penetrated: Erotic Inhibitions, Improvizations and Transformations

Young gay men may both desire and fear, even dread, the act of being penetrated anally. In Norwegian culture today, these men not infrequently associate this act with a loss of dignity and manhood. Closely connected to this, the act of being anally penetrated has the power to shape or define the young mans sense of self. Young gay Norwegian men have, however, developed or adopted strategies for gaining experience and experiencing pleasure in emotionally satisfying, culturally transformative and physiologically safe ways. Hence, and examination of these strategies seems especially worthwhile. The empirical data underlying this examination were gathered through a qualitative study among young gay men in Norway (1994-1996).

Same-Sex Practicing Men in Tanzania from 1860 to 2010

This article offers a review of published texts describing sexual relations between men in Tanzania in the period 1860–2010. It explores ways in which men who have sex with men have been named and understood; describes the sexual and social roles associated with differing same-sex identities and subjectivities; tracks politics, policies, and sociocultural expressions relating to sex between men; and explores the ways in which men’s same-sex sexual practices have been responded to in the context of health and HIV. Among the impressions emerging from the historical record is that sex between men is not (and has not been) uncommon in Tanzania; that a significant conceptual distinction exists between men who are anally receptive and men who penetrate anally; and that there has been a range of views on, and opinions about, same-sex relations within the wider society. There is evidence that same-sex practicing men in Tanzania have been affected by HIV at least since 1982, with one seroprevalence study indicating that the burden of HIV among men who have sex with men was quite disproportionate as far back as 2007. However, while men who have sex with men have been defined as a “vulnerable population” with respect to HIV in national frameworks since 2003, this had not led to any significant amount of targeted HIV prevention work being reported by either local or international actors by 2010.

Situating Condoms in Sexual Lives: Experiences of Same-sex-Attracted men in Tanzania

ABSTRACT. This article examines ways in which same-sex-attracted men in Dar es Salaam perceive, seek, and enact sexual pleasure, and the roles that use and nonuse of condoms play in the lived sexual lives in which such pleasure is sought and created. It also identifies several HIV risk-minimizing strategies that same-sex practicing men are employing in their sexual relations, including but not limited to condom use. The article draws on conversations and interviews conducted during 15 months of ethnographic fieldwork with and among a diverse group of same-sex-attracted men in 2008 and 2009.

Qualitative Research Methods

This chapter offers an introduction to qualitative research methods, with particular emphasis on qualitative interviewing and participant observation. The chapter starts with a discussion of issues pertaining to qualitative research methods in general, pointing out that exploration is central in most qualitative research and discussing the consequences this has on the planning and conduct of qualitative studies. Thereafter, a detailed description of theoretical and practical aspects of qualitative interviewing and participant observation is presented, followed by a discussion of qualitative data analysis and issues pertaining to the portability, applicability, and quality of qualitative research.

The role of substance use and morality in violent crime - a qualitative study among imprisoned individuals in opioid maintenance treatment

BackgroundOpioid maintenance treatment (OMT) is regarded as a crime control measure. Yet, some individuals are charged with violent criminal offenses while enrolled in OMT. This article aims to generate nuanced knowledge about violent crime among a group of imprisoned, OMT-enrolled individuals by exploring their understandings of the role of substances in violent crime prior to and during OMT, moral values related to violent crime, and post-crime processing of their moral transgressions.MethodsTwenty-eight semi-structured interviews were undertaken among 12 OMT-enrolled prisoners. The interviews were audio recorded and transcribed verbatim. An exploratory, thematic analysis was carried out with a reflexive and interactive approach.FindingsPrior to OMT, substances and, in particular, high-dose benzodiazepines were deliberately used to induce ‘antisocial selves’ capable of transgressing individual moral codes and performing non-violent and violent criminal acts, mainly to support costly heroin use. During OMT, impulsive and uncontrolled substance use just prior to the violent acts that the participants were imprisoned for was reported. Yet, to conduct a (violent) criminal act does not necessarily imply that one is without moral principles. The study participants maintain moral standards, engage in complex moral negotiations, and struggle to reconcile their moral transgressions. Benzodiazepines were also used to reduce memories of and alleviate the guilt associated with having committed violent crimes.ConclusionsSubstances are used to transgress moral codes prior to committing and to neutralize the shame and guilt experienced after having committed violent crimes. Being simultaneously enrolled in OMT and imprisoned for a (violent) crime might evoke feelings of ‘double’ shame and guilt for both the criminal behavior prior to treatment and the actual case(s) one is imprisoned for while in OMT. Treatment providers should identify individuals with histories of violent behavior and, together with them, explore concrete episodes of violence and their emotional reactions. Particular attention should be given to potential relationships between substance use and violence and treatment approaches tailored accordingly. What appears as severe antisocial personality disorder may be partly explained by substance use.