Emily A. Wentzell

Bad Bedfellows: Disability Sex Rights and Viagra

The disability rights movement grounds material critiques of the treatment of people with disabilities in a social constructionist perspective, locating disability in the social rather than physical realm, and demedicalizing the concept of disability. However, this conceptualization is threatened by the medicalization of nonnormative erections as the biomedical pathology erectile dysfunction (ED). Although use of medical treatments for ED can have positive outcomes for individuals, the medical communitys tendency to include sexual difference in the rubric of disability threatens to remedicalize that category. Furthermore, medicalized conceptions of ED often serve to refocus sexuality around phallocentric, normative sex acts and gender roles, undoing the deconstructive work of disability sex studies. Finally, although aging Western populations targeted for ED treatment represent potentially expanded bases for disability movement activism, the pathologizing of nonnormative sexuality may have the power to instead focus this group on individualistic use of medical interventions geared toward “normalcy.”

Marketing Silence, Public Health Stigma and the Discourse of Risky Gay Viagra Use in the US

This article analyzes the rise and fall of a public health ‘fact’ in the US: the assertion that gay men’s Viagra use is inherently recreational and increases STD risk. Extending the science studies argument that drug development and marketing entail the construction of new publics, this article shows how strategic drug marketing silences can also constitute new populations of users. It shows how Viagra marketing’s silence about gay users, which facilitated legitimization of the drug as an aid for companionate heterosexuality, created a cultural space for the development of health discourse about gay men as illegitimate, recreational and risky Viagra users. Using Susan Leigh Star’s concepts of ‘simplification’ and ‘complexification’, this article traces the construction and deployment of this public health fact, as well as its subsequent contestation. Using an arena analysis approach, this article demonstrates how marketing discourse and public health fact-making came together in the case of gay Viagra use to refresh long-standing and politically harmful American cultural associations between gay sex and sickness.

Perceptions and Experiences of Human Papillomavirus (HPV) Infection and Testing among Low-Income Mexican Women.

Background HPV infection causes cervical cancer, a major contributor to morbidity and mortality among low-income Mexican women. Human papillomavirus (HPV) DNA testing is now a primary screening strategy in Mexico’s early cervical cancer detection program (ECDP). Research on Mexican women’s perceptions of HPV and testing is necessary for establishing culturally appropriate protocols and educational materials. Here, we explore perceptions about HPV and HPV-related risk factors among low-income Mexican ECDP participants. Methods We conducted semi-structured interviews with 24 ECDP participants from two primary care health clinics in Michoacán state, Mexico. Interviews addressed women’s understandings of and experiences with HPV and HPV testing. Analysis was inductive and guided by the Health Belief Model with a focus on gender. Results Women’s confusion about HPV and HPV screening caused emotional distress. They understood HPV to be a serious disease that would always cause severe symptoms, often characterizing it as analogous to HIV or inevitably carcinogenic. Women also attributed it to men’s sexual behaviors, specifically infidelity and poor hygiene. Women described both sexes’ desire for sex as natural but understood men’s negative practices of masculinity, like infidelity, as the causes of women’s HPV infection. Some women believed dirty public bathrooms or heredity could also cause HPV transmission. Conclusions These results are consistent with prior findings that geographically and economically diverse populations lack clear understandings of the nature, causes, or symptoms of HPV, even among those receiving HPV testing. Our findings also reveal that local cultural discourse relating to masculinity, along with failure to provide sufficient education to low-income and indigenous-language speaking patients, exacerbate women’s negative emotions surrounding HPV testing. While negative emotions did not deter women from seeking testing, they could be ameliorated with better health education and communication.

Medical anthropology at the intersections : histories, activisms, and futures

Acknowledgments vii Introduction: Medical Anthropology at the Intersections / Marcia C. Inhorn and Emily A. Wentzell 1 Part I. Histories 1. Grafting Together Medical Anthropology, Feminism, and Technoscience / Emily Martin 23 2. Getting at Anthropology through Medical History: Notes on the Consumption of Chinese Embryos and Fetuses in the Western Imagination / Lynn M. Morgan 41 3. Making Peasants Protestant and Other Projects: Medical Anthropology and Its Global Condition / Lawrence Cohen 65 Part II. Queries 4. That Obscure Object of Global Health / Didier Fassin 95 5. Medical Anthropology and Mental Health: Five Questions for the Next Fifty Years / Arthur Kleinman 116 6. From Genetics to Postgenomics and the Discovery of the New Social Body / Margaret Lock 129 Part III. Activisms 7. Anthropology and the Study of Disability Worlds / Rayna Rapp and Faye Ginsburg 163 8. Medical Anthropology and Public Policy: Using Research to Change the World from What It Is to What We Believe it Should Be / Merrill Singer 183 9. Critical Intersections and Engagements: Gender, Sexuality, Health, and Rights in Medical Anthropology / Richard Parker 206 Notes 239 References 251 Contributors 307 Index 313

Generational Differences in Mexican Men’s Ideas of Age-Appropriate Sex and Viagra Use

Mexican men of different generations, exposed to different cultural ideas about sex, manliness and marriage, often hold divergent ideas about how men’s sexuality should change over the life course. Based on 250 interviews with male urology patients at an urban Mexican hospital, this article reveals differences in self-identified older and younger men’s ideas of age-appropriate sexuality and pursuit of sexual health interventions. Older men frequently expected youthful promiscuity to give way to a family-focused older age and saw decreasing erectile function as a ‘‘natural’’ embodiment of this shift. Conversely, younger men who strove to be different than their once-womanizing fathers often saw decreased erectile function as a relationship-threatening medical problem appropriate for erectile dysfunction (ED) treatment. Despite the fact that ED drugs may facilitate sexual penetration that could be associated with ‘‘macho’’ sexuality, they were viewed most positively by younger study participants seeking to avoid machismo by pursuing affective marital sex.

How Did Erectile Dysfunction Become “Natural”? A Review of the Critical Social Scientific Literature on Medical Treatment for Male Sexual Dysfunction

This article reviews the multidisciplinary social science literature assessing the social consequences of medical treatment for male sexual dysfunction. This literature applies medicalization theory and social constructionist approaches to gender to assert that Euro-American cultural ideals of masculinity and sexuality, as well as ageism and ableism, determine which sexual changes and experiences get defined as “dysfunction” and shape the marketing and use of medical treatments for those changes. These medical responses assuage the suffering of men who become unable to meet cultural ideals for sexuality but in the process make reductive norms for male sexuality seem biologically natural. In addition, the critical social science research suggests that an economic logic underlies the process of redefining diversity and change in men’s sexual function as medical pathology. However, comparative qualitative data on men’s and their sexual partners’ experiences of sexuality and aging across world regions suggest that people do not universally accept the narrow ideals of male sexuality embedded in medical discourse regarding men’s sexual dysfunction. The diversity in people’s sexual desires across the life course and their responses to sexual function change highlight the cultural nature of medical definitions of sexual dysfunction.

‘I help her, she helps me:’ Mexican men performing masculinity through transactional sex

Prior research shows that people assert diverse, context-dependent identities through ‘transactional sex’. Focusing on an urban Mexican setting where both companionate partnering and virility are valued, I examine how older, working-class men experiencing erectile difficulty performed masculinity through exchange-mediated liaisons they viewed as friendships dependent on charitable giving rather than prostitution. Contextualizing their experiences with comparative data from a broader study of men’s experiences with erectile difficulty, I argue that the nature of these relationships enabled men to perform the responsibility and virility locally identified with good masculinity, despite life and health problems that threatened their abilities to do so.

Understanding Factors that Influence Health Care Utilization Among Mixtec and Zapotec Women in a Farmworker Community in California

This paper examines health care utilization among indigenous immigrants from Oaxaca, Mexico, who have settled in a farmworker community in southern California. In 2016, two trained Spanish-Mixteco and Spanish-Zapoteco bi-lingual interviewers conducted in-depth interviews with 44 indigenous women residing in Oxnard, California on issues that affect health care utilization. Interviews were conducted in Mixteco, Zapoteco and Spanish and were coded to identify structural, cultural, and provider-related barriers to health care utilization. Five bi-lingual Spanish-Mixteco indigenous interpreters employed at local clinics were also interviewed. Many women reported lack of health insurance, inability to pay, language barriers, long waiting times, rushed encounters with providers, and seeking western medical care only after home remedies did not work. However, several women were able to access routine health care services, often with support from indigenous interpreters employed at clinics. Interviews with five interpreters found that they provided assistance with interpretation during medical encounters and appointment making. They also educated patients about upcoming exams, identified low-cost services and insurance programs available to patients, assisted with paperwork and occasionally educated physicians on behalf of their patients. In addition to addressing barriers to health care access our findings suggest the importance of identifying and leveraging community assets, such as indigenous navigators, when developing programs for such underserved communities. Our findings can inform best practice in settings that provide health care to indigenous populations and may also apply to settings that provide health care to other immigrant communities that have very limited familiarity and contact with western health care.

Performing piety in sexual health research: gender, health and evangelical Christianities in a Mexican human papillomavirus (HPV) study

ABSTRACT Recent research suggests that health surveillance experiences like clinical trial participation might have unanticipated social consequences. I investigate how evangelical Christians participating in longitudinal, observational sexual health research incorporate that long-term medical surveillance into their religious practice. This exploratory research focuses on Mexican Cristianos’ participation in the Cuernavaca arm of the multinational ‘Human Papillomavirus in Men’ (‘HIM’) study, which tested men for the common and usually asymptomatic sexually transmitted infection human papillomavirus (HPV) over time. I draw on interviews with heterosexual male research participants and their female partners throughout their medical research involvement, and data from church-based participant observation, to understand how couples framed the HIM study as an arena for performing piety. I argue that evangelical understandings of piety as moral practice encouraged participants to view long-term sexual health surveillance as assistance for living out the health, gender, and marital behaviors promoted by their congregations. This finding suggests that health research designers and ethics committees should consider the health and social outcomes of research participants’ agentive incorporation of religious observance into study protocols.

Chronic conditions, fluid states: Chronicity and the anthropology of illness

This book is an important and timely intervention into the biomedical discourse about the rise of ‘chronic’ disease, which powerfully shapes clinical care and public health intervention today. In a concise yet wide-ranging introduction, the editors document and challenge the naturalisation of the biomedical notion of chronic disease. They, and the volume’s contributors, argue that medical definitions of chronic disease as the binary opposite of ‘acute’ sickness, attributable to lifestyle factors and biological predisposition, and following a set ‘natural history’, obscure both key causes and the lived reality of chronic illness. Asserting that the chronic/acute dichotomy lacks meaning in a context where the course of disease depends more on the accessibility of treatment than the diagnosis itself, the contributors aim to bring the key role of longterm problems not normally associated with chronic disease into discussions of its causes and treatment. This volume’s goals are both ambitious and important. The contributors aim to contextualise chronicity, revealing that chronic conditions of poverty, social inequality and lack of access to resources contribute as much to cases of chronic disease as do commonly discussed ‘lifestyle’ factors like sedentism and diet. They also challenge the assumption that ‘chronic’ equals static, using ethnographic examples to highlight differences in the lived experience of illness over time, both among and within individual cases. In doing so, this book furthers medical anthropological conversations about the role that disjunction plays in the long-term experience of illness, but also looks beyond the field of anthropology. It is positioned to start a conversation with biomedicine about the nature of ‘the chronic’ that can reconfigure the boundaries drawn around the causes of long-term disease, and the assumptions about the ways people live it out over time, that shape and sometimes hamper treatment. A key strength of this book is its inclusion of diverse ethnographic examples. Contributors draw on fieldwork done around the world, in both wealthy and poor countries, with people experiencing awide range of illnesses. The ethnographic data are often quite rich and provide an engaging and readable grounding for the high-level theoretical interventions that the authors seek to make in the discourse surrounding chronic disease. The book also has a clear and well-conceived structure. It begins with an exploration of the notion of chronicity itself, followed by a section that highlights the role that gender plays in chronic illness and concluding with a section that describes and critiques the intersections between chronic illness and biomedicine. The first section is both readable and theoretically sophisticated, providing alternative notions of chronicity that will inform readers’ experience of the subsequent Global Public Health Vol. 7, No. 3, March 2012, 315 316