César Ernesto Abadía-Barrero

Machismo, public health and sexuality-related stigma in Cartagena.

This paper reports on an ethnographic study in Cartagena, Colombia. Over a seven-month fieldwork period, 35 men and 35 women between 15 and 60 years of age discussed the social context of HIV/AIDS through in-depth interviews, life histories and drawing. Participants considered the transgression of traditional gender roles as prescribed by machismo a major risk factor for HIV infection. In addition, they integrated public-health concepts of risk groups with these long-standing constructions of gender roles and sexuality-related stigma to create the notion of ‘AIDS carriers’. The bricolage between machismo, public health and sexuality-related stigma that participants created and consequent preventive measures (based on an avoidance of sex with people identified as ‘AIDS carriers’) was a dynamic process in which participants were aware that changes in this particular interpretation of risk were necessary to confront the local epidemic.

Crianças vivendo com HIV e Casas de Apoio em São Paulo: cultura, experiências e contexto domiciliar

Este artigo, baseado em pesquisa na area da Antropologia Medica, pretende analisar alguns fatores culturais que influem no desenvolvimento de criancas e adolescentes vivendo com HIV em casas de apoio. Existem semelhancas e diferencas nos padroes de criacao de cada instituicao e, em consequencia, no desenvolvimento individual e social das criancas e adolescentes. Uma semelhanca marcante e que a melhora na qualidade de vida e o aumento da sobrevida (com muitos virando adolescentes) parece ter-se convertido em um problema para os adultos que cuidam deles. Minha intencao e explicar como este problema deve-se, em grande parte, as ideias e ao imaginario do que a crianca com Aids no Brasil representa. Essas ideias sao culturalmente construidas e estao em sincronia com as categorias e discussoes modernas sobre crianca, desenvolvimento e respostas sociais moralmente aceitaveis. O desenvolvimento de criancas e adolescentes vivendo com HIV/Aids questiona as ditas categorias ameacando, inclusive, os padroes de criacao estabelecidos pelos adultos e as estruturas das instituicoes.

The transformation of the value of life: dispossession as torture

Workers at the oldest maternity hospital in Colombia experienced the privatization of health care and the flexibilization of their labor. Drawing on their experience, I illustrate how neoliberalism transforms the value of life. This transformation occurs first in terms of its moral worth: the worth of life changes over time, as people and public hospitals are stigmatized as the ‘living memory’ of the old. Second, the hospital buildings, the land on which they sit, and the roles of workers within the hospital are all transformed. Both similarities and differences emerge between a type of systemic or chronic violence that is inherent to the capitalist system and modern practices of torture. Examining how capitalist forces transform the value of life opens up new fields of inquiry to study links between critical political economy and subjectivity.

Structural actions toward HIV/AIDS prevention in Cartagena, Colombia: a qualitative study

OBJECTIVE To obtain a thorough understanding of the complexity and dynamics of the social determination of HIV infection among inhabitants of Cartagena, Colombia, as well as their views on necessary actions and priorities. METHODS In a five-year ethnography of HIV/AIDS in collaboration with 96 citizens of Cartagena, different methods and data collection techniques were used. Through 40 in-depth interviews and 30 life histories of inhabitants, the scenario of HIV vulnerability was summarized in a diagram. This diagram was evaluated and complemented through group discussions with key representatives of local governmental and nongovernmental organizations and with people who were interested in the epidemic or affected by it. RESULTS The diagram illustrates the dynamic and complex interrelationships among structural factors (i.e., social determinants) of HIV infection, such as machismo; lack of work, money, and social services; local dynamics of the performance of the state; and international dynamics of the sexual tourism industry. On the basis of the diagram, groups of key representatives proposed prioritizing structural actions such as reducing socioeconomic inequalities and providing access to health care and education. CONCLUSIONS The social determinants displayed in the diagram relate to historic power forces that have shaped vulnerable scenarios in Cartagena. Collaboration between participants and researchers generates conceptual frameworks that make it possible to understand and manage the complexity of HIVs social determination. This way of understanding effectively connects local inequalities with international flows of power such as sexual tourism and makes evident the strengths and limitations of current approaches to HIV prevention.

Neoliberal Justice and the Transformation of the Moral: The Privatization of the Right to Health Care in Colombia

Neoliberal reforms have transformed the legislative scope and everyday dynamics around the right to health care from welfare state social contracts to insurance markets administered by transnational financial capital. This article presents experiences of health care-seeking treatment, judicial rulings about the right to health care, and market-based health care legislation in Colombia. When insurance companies deny services, citizens petition the judiciary to issue a writ affirming their right to health care. The judiciary evaluates the finances of all relevant parties to rule whether a service should be provided and who should be responsible for the costs. A 2011 law claimed that citizens who demand, physicians who prescribe, and judges who grant uncovered services use the systems limited economic resources and undermine the states capacity to expand coverage to the poor. This article shows how the consolidation of neoliberal ideology in health care requires the transformation of moral values around life.

Children living with HIV and Support Homes in São Paulo: culture, experiences and housing context

Este artigo, baseado em pesquisa na area da Antropologia Medica, pretende analisar alguns fatores culturais que influem no desenvolvimento de criancas e adolescentes vivendo com HIV em casas de apoio. Existem semelhancas e diferencas nos padroes de criacao de cada instituicao e, em consequencia, no desenvolvimento individual e social das criancas e adolescentes. Uma semelhanca marcante e que a melhora na qualidade de vida e o aumento da sobrevida (com muitos virando adolescentes) parece ter-se convertido em um problema para os adultos que cuidam deles. Minha intencao e explicar como este problema deve-se, em grande parte, as ideias e ao imaginario do que a crianca com Aids no Brasil representa. Essas ideias sao culturalmente construidas e estao em sincronia com as categorias e discussoes modernas sobre crianca, desenvolvimento e respostas sociais moralmente aceitaveis. O desenvolvimento de criancas e adolescentes vivendo com HIV/Aids questiona as ditas categorias ameacando, inclusive, os padroes de criacao estabelecidos pelos adultos e as estruturas das instituicoes.

Care and consumption: A Latin American social medicine's conceptual framework to comprehend oral health inequalities.

ABSTRACT This article offers a conceptual framework that arises out of the Latin American Social Medicine/Collective Health (LASM/CH) tradition to comprehend inequalities in oral health. We conducted a dialogue between the LASM/CH proposal called social determination of health (in particular one of its nuclear categories ‘ways of living together’) and studies that address social inequalities and oral health. This dialogue allowed us to redefine oral health–disease–treatment as a process that either promotes or harms well-being and is modulated by different ways of living together where not only patients and professionals, but also governments, supranational bodies, and national and international markets represented by food, pharmaceutical, insurance, personal care, and cosmetic companies interact. The article proposes the cycle particular–consumption care/institutional–consumption care as the construct that allows investigators to think about how ways of living together relate to oral health inequalities. ‘Particular–consumption care’ includes ways and possibilities to access healthy foods and practice protective hygienic measures. ‘Institutional–consumption care’ refers to institutional responses related to supply, access to services, capabilities for resolution, and pedagogical practices.

Niños que viven con VIH Y Casas de Apoyo en San Pablo: Cultura, experiencias y contexto domiciliar

Este artigo, baseado em pesquisa na area da Antropologia Medica, pretende analisar alguns fatores culturais que influem no desenvolvimento de criancas e adolescentes vivendo com HIV em casas de apoio. Existem semelhancas e diferencas nos padroes de criacao de cada instituicao e, em consequencia, no desenvolvimento individual e social das criancas e adolescentes. Uma semelhanca marcante e que a melhora na qualidade de vida e o aumento da sobrevida (com muitos virando adolescentes) parece ter-se convertido em um problema para os adultos que cuidam deles. Minha intencao e explicar como este problema deve-se, em grande parte, as ideias e ao imaginario do que a crianca com Aids no Brasil representa. Essas ideias sao culturalmente construidas e estao em sincronia com as categorias e discussoes modernas sobre crianca, desenvolvimento e respostas sociais moralmente aceitaveis. O desenvolvimento de criancas e adolescentes vivendo com HIV/Aids questiona as ditas categorias ameacando, inclusive, os padroes de criacao estabelecidos pelos adultos e as estruturas das instituicoes.