Cecilia Van Hollen

HIV/AIDS and the Gendering of Stigma in Tamil Nadu, South India

Drawing on the seminal theoretical work on stigma by Goffman, this article analyzes stigma through the lens of Parker and Aggleton, who call for the joining of Goffman and Foucault to better grasp relationships among stigma, power and social inequality. Studies on the social impact of HIV/AIDS globally have demonstrated that women tend to be blamed for the spread of HIV/AIDS, and as a result, HIV-positive women face greater stigma and discrimination than HIV-positive men. Based on ethnographic research among 50 HIV-positive women in South India in 2002–2003 and 2004, my research supports this standard argument. However, my findings suggest that the gendering of stigma and discrimination is more complex and context specific. The gendering of stigma varies depending on the social context of private versus public spheres. The tendency to stigmatize women is due in part to cultural constructions of gendered bodies and not only to a gendered double standard of sexual morality, as has been previously reported. Even when a cultural argument about women’s wayward sexuality is evoked, this rhetoric must be understood in part as a strategy to mask economically motivated responses, rather simply being attributed to sexist ideology per se.

Navigating HIV, Pregnancy, and Childbearing in South India: Pragmatics and Constraints in Women's Decision Making

The initial approaches to the AIDS epidemic in the 1980s were based on an essentially biomedical conception thus dissociating the disease from social relations. In the 1990s new approaches placed the health and illness process within the context of social cultural political and economic systems allowing this issue to become central to the struggle for human rights of people living with HIV. Hence this epidemic offers the opportunity for in-depth reflections and networking in struggles for citizenship and social change. In the last two decades the womens movement and especially the feminist one has worked in this field with educational actions and also by producing knowledge. They seek to understand the meaning and above all the impact of the AIDS epidemic on women particularly those who live in poverty. Resulting from these experiences feminist analyses bring forward new perceptions about the exercise of human rights in the framework of the AIDS. (authors)Based on ethnographic research conducted in 2004 and 2002–3, this article examines how poor women living with HIV in Tamilnadu, India navigate decisions about pregnancy and birth, and demonstrates that these decisions are influenced by a complex web of sociocultural factors. I argue that these decisions are informed by: 1) institutional interests of the state, NGOs, and international aid donors; 2). cultural constructions of gender and of the self; 3). Christian-based organizations; and 4). support group organizations, known as “networks” for people living with HIV/AIDS. Childbearing decisions emerged through a synthesis of coexisting structures and discourses which sometimes converged at the same conclusion despite differences in their underlying logics. I argue that the discourse of “positive living” fostered by the networks provided women with a framework for making reproductive decisions that was enabling. The article highlights how women pragmatically negotiated these various factors as they engaged in reproductive decision-making.

Moving targets: Routine IUD insertion in maternity wards in Tamil Nadu, India

Abstract In 1995, nurses and doctors in many of the public maternity wards in the state of Tamil Nadu in India were routinely inserting IUDsimmediately following childbirth and abortions, as part of the target-orientated family planning policy. This practice, sometimes carried out unbeknownst to women or against their will, has received little public attention. Tamil Nadus success in reaching state targets for TUD acceptance far exceeded those of all other states and territories in India. This paper reports on an ethnographic study in 1995 of Tamil Nadu womens experience of routine IUD insertion and why health workers considered the policy necessary. Based on information from a follow-up visit in 1997, it describes how the change in national and state policy in 1996 to a target-free approach, with local determination of needs, is being implemented, but only in some hospitals and by some health workers. Reproductive health policy in India has been dominated by family planning and driven by numerical targets for a long time; it will take more time to assess the effects of the new policy.

Extending Theory, Rupturing Boundaries: Reproduction, Health, and Medicine Beyond North-South Binaries

In his 1930 short story “Mantra” (Premchand 2012), Indian writer Munshi Premchand tells the story of Dr. Chadha, a medical doctor, and Bhagat, a poor old man revered locally as a shaman who can cure snakebites. Tragically, Bhagat’s only son dies after Dr. Chadha, on his way to golf, refuses to see the young patient. Premchand’s narrative establishes Dr. Chadha as a privileged physician, trying to make it to tee off in time and callously disregarding a poor illiterate villager.

Handle with Care: Rethinking the Rights versus Culture Dichotomy in Cancer Disclosure in India

Medical practitioners, bioethicists, psychologists, and anthropologists have debated whether it is ethical to disclose or withhold information from patients about cancer diagnoses. This debate is framed as pitting universal individual human rights against cultural pluralism. The rights-based argument asserts that people have a right to information about their own health to make the best decisions about their treatment. The cultural variation argument suggests that in some cultural contexts there is a perception that information about ones cancer diagnosis may cause more harm than good due to the psychological trauma this may cause. Based on ethnographic research with cancer patients in India, I argue that both sides of this debate overemphasize the importance of the content of the information that may be disclosed or withheld and underestimate the central ways in which the act of disclosing or withholding information is evaluated as a symbol of care of paramount concern to patients.

Analysis of Social Science Research Into Cancer Care in Low- and Middle-Income Countries: Improving Global Cancer Control Through Greater Interdisciplinary Research

This analysis lays a framework for greater collaboration between the cancer community and social scientists in both research and policy. We argue that the growing cancer burden that low- and middle-income countries face is raising social, political, and economic challenges of global cancer that require interdisciplinary research beyond the traditional biomedical-clinical nexus. First, we briefly review some of the most important existing social science studies that have addressed cancer in low- and middle-income countries, including the main methods, approaches, and findings of this research. Second, we give an overview of recent interdisciplinary collaborations between social scientists and oncologists and demonstrate how qualitative research can help us to understand the distinct challenges of cancer care in low- and middle-income settings. Finally, we identify key areas for future collaboration and suggest possible paths forward for cancer research and policy that involve social science.