Eirik Saethre

Nutrition, Economics and Food Distribution in an Australian Aboriginal Community

For many years, high rates of morbidity and mortality among the Aboriginal population of Australia have been a major concern of researchers, healthcare professionals, government and Aboriginal people themselves. Despite a great deal of work, Aboriginal health continues to lag behind that of non-Aboriginal people. Overall, the many strategies aimed at improving Aboriginal health have not been able to effect lasting or substantial changes. To demonstrate the barriers to improving general Aboriginal health, it is useful to examine one factor that is thought to contribute significantly to poor health: nutrition. Many health professionals feel that one of the best methods for improving Aboriginal health is to improve nutrition. One blueprint for achieving this goal is to discourage Aboriginal people from eating food from the shop and takeaway store, and to encourage them, instead, to consume more food hunted or gathered from the bush. If such a change in eating habits could be achieved, it appears that both Aboriginal nutrition and general health would be improved. Regardless of the messages of healthcare providers and Aboriginal leaders, however, many Aboriginal people continue to eat foods high in fat and sugar, despite being aware of the health risks associated with this behaviour. Lajamanu is representative of many Aboriginal communities in the Northern Territory of Australia and, as a result, provides an important insight into issues relating to Aboriginal health. The community lies approximately 900 kilometres from both Darwin and Alice Springs, on the northern edge of the Tanami Desert in the Katherine region. Lajamanu has a population of around 800, the great majority of whom are Warlpiri-speaking Aboriginal people. Approximately 40 non-Aboriginal people live in the community, working as service providers; for example, as nurses, tradespeople, accountants, school teachers and managers. In 1996, I approached the community regarding the possibility of conducting in-depth research there for my PhD, and was given approval to begin investigating local ideas of health. From 1996 to 1999, I lived in Lajamanu and have made trips back to the community since that time.

Gelling medical knowledge: innovative pharmaceuticals, experience, and perceptions of efficacy

As new pharmaceutical products to combat the acquisition of HIV are produced, their clinical efficacy is determined through large-scale clinical trials. Trial participants, however, also independently evaluate the effectiveness of these technologies. During a phase III microbicide clinical trial in Johannesburg, South Africa, female participants acknowledged that although the gel had not yet been clinically proven to be efficacious, they believed that it was capable of healing infections, cleansing the vagina, increasing fertility, and preventing HIV. These responses were informed by experiences of gel use coupled with ideas regarding the flow of bodily fluids and the removal of dirt for bodily cleanliness and the maintenance of health. Examining participant responses to the gel provides insight into the relationship between knowledge and experience when utilizing previously unfamiliar biotechnologies.

Rumours about blood and reimbursements in a microbicide gel trial

A rumour that emerged during a microbicide gel trial tells the tale of clinic staff purchasing trial participants’ blood. This paper documents the rumour and explores its divergent interpretations and meanings in relation to the context of the trial and the social and economic setting at two of the trial sites (Soweto and Orange Farm) in South Africa. The article is based on qualitative research conducted during the Microbicides Development Programme (MDP) 301 trial to evaluate a microbicide vaginal gel for HIV prevention in women. The research incorporated in-depth interviews with female trial participants and their male partners, focus group discussions with male and female community members, and participant observation in the trial clinic and community setting at the two sites. The article analyses the different perspectives among the clinic staff, community and trial participants in terms of which the rumour about the exchange of blood for cash is seen as: 1) the result of ignorance of the clinical trial procedures; 2) the exploitation of poor and vulnerable women; 3) an example of young womens desire for material gain; and 4) a reciprocal exchange of ‘clean blood’ for cash between women trial participants and the health services. We suggest that the rumours about selling blood verbalise notions of gender and morality while also providing an appraisal of the behaviour of young women and a critique of social relationships between foreign researchers and local participants. Through stories about the clinical trial procedures and its potential reimbursements, the participants were creating and reconfiguring social relationships. Ultimately, rumours are one way in which foreign enterprises such as a clinical trial are rendered local.

A tale of two "cultures": HIV risk narratives in South Africa.

There has been a tendency for many researchers and health professionals examining HIV transmission in South Africa to focus on explanations that specifically implicate culture as a primary vector affecting the prevalence of high-risk sexual behavior, such as multiple partners, unprotected sex, and dry sex. In contrast, the residents of Orange Farm, a former informal settlement south of Soweto, portray culture as seldom, if ever, motivating actions that are associated with HIV transmission or prevention in the community. Comparing and contrasting these differing conceptions, we comment critically on the use of ideas regarding culture in explanations addressing the HIV/AIDS pandemic in sub-Saharan Africa.

Malicious Whites, Greedy Women, and Virtuous Volunteers

As clinical trial research increasingly permeates sub-Saharan Africa, tales of purposeful HIV infection, blood theft, and other harmful outcomes are widely reported by participants and community members. Examining responses to the Microbicide Development Programme 301-a randomized, double-blind, placebo-controlled microbicide trial-we investigate the ways in which these accounts embed medical research within postcolonial contexts. We explore three popular narratives circulating around the Johannesburg trial site: malicious whites killing participants and selling their blood, greedy women enrolling in the trial solely for financial gain, and virtuous volunteers attempting to ensure their health and aid others through trial participation. We argue that trial participants and community members transform medical research into a meaningful tool that alternately affirms, debates, and challenges contemporary social relations.

Adherence and the Lie in a HIV Prevention Clinical Trial

ABSTRACT The lie has been presented as a performance that protects identities against moral judgment in the context of power imbalances. We explore this assertion from the perspective of a pre-exposure prophylaxis trial to prevent HIV for African women in South Africa, in which context biological evidence of widespread lying about product adherence was produced, resulting in a moral discourse that opposed altruistic and selfish motivations. In this article, we seek to understand the meaning of the lie from the perspective of women trial participants. Seeing the trial as representing a hopeful future, and perfect adherence as sustaining their investment in this, participants recited scripted accounts of adherence and performed the role of the perfect adherer, while identifying other participants as dishonest. Given that clinical trials create moral orders and adherence is key to this, we argue that women embraced the apparatus of the clinical trial to assert their moral subjectivities.

Medical interactions, complaints, and the construction of Aboriginality in remote Australia

In remote Australian Aboriginal communities, medical interactions between non-Aboriginal nurses and Aboriginal patients often use health narratives to enact and contest social identities. Nursing staff complain that Aboriginal patients do not comply with their prescribed medication nor attend the clinic appropriately. Nurses often blame these behaviours on irresponsibility and laziness. Conversely, Aboriginal people complain that nursing staff are racist and state that foods and medicines from the bush are more efficacious than biomedical treatment. Through medical interactions and discourse, non-Aboriginal and Aboriginal residents seek to circumscribe and challenge notions of Aboriginality.

UFOs, Otherness, and Belonging: Identity in Remote Aboriginal Australia

UFO beliefs exist around the world yet they have been almost exclusively analysed within the context of urban American society. This article seeks to understand the ways in which people from differing social and cultural backgrounds also engage in UFO narratives. In a remote Aboriginal desert community in Central Australia, descriptions of UFOs merge popular and media portrayals of extraterrestrials with elements and themes found in local Aboriginal cosmology. Consequently, Aboriginal narratives regarding extraterrestrial beings are able to both reflect the local social environment of race relations and affirm Aboriginal identity.