James Gillett

Lay constructions of HIV and complementary therapy use

This study examines the meanings that individuals with HIV attach to their use of complementary therapies. A qualitative analysis of 66 interviews completed between 1993 and 1998 showed that complementary therapies represent different things for these individuals--a health maintenance strategy, a healing strategy, an alternative to Western medicine, a way of mitigating the side-effects of drug therapies, a strategy for maximizing quality of life, a coping strategy, and a form of political resistance. We found that the meanings individuals ascribe to complementary therapies and the benefits they expect to derive from them are not idiosyncratic, but linked to social characteristics--sexuality, ethnocultural background, gender--and to beliefs about health and illness, values and experiences. We found as well that these meanings are neither mutually exclusive nor fixed. The therapies often appeal to individuals on different levels and their appeal may change over time.

Bodywork as a moral imperative: some critical notes on health and fitness.

Abstract This paper provides a critique of the processes by which health and fitness have moved forward on the cultural agenda. It is argued that the development and promotion of cultural beliefs about health, while often well intended, flow from and help reproduce structures of inequality and relations of dominance. It is also suggested that the health and fitness movement incorporates a moral imperative which has consequences for class and gender relations. Our analysis demystifies some of the taken-for-granted assumptions underlying popular beliefs about the relationship between exercise, fitness, and health. We conclude by challenging some of the orthodoxies surrounding current social pressures to pursue ascetic lifestyles.

Equine athletes and interspecies sport

This article draws on a range of sociological literature including studies of sport, subculture, interspecies relationships and animal advocacy to understand the social processes that have contributed to the horse being defined as an athlete in equestrian sports. Using a combination of qualitative interviews and archival analysis, we identify trends in the equine industry that have provided the foundation for the emergence of a new type of equine athlete – the sport pony – in the context of late modern societies. We conclude by arguing that the popularity of the sport pony is a reflection of a general trend within the equine industry placing value on athleticism and esthetics.

Internet Web Logs as Cultural Resistance: A Study of the SARS Arts Project

This article examines an Internet project — sarsart.org — that features digital artworks created in response to the severe acute respiratory syndrome (SARS) outbreak in spring 2003. Qualitative methods including archival research, semiotic analysis, and interviews are used to examine the emergence and substance of this Internet project. The analysis identifies ways in which contributions by artists and bloggers (i.e., individuals with their own Internet site or Web log) contest institutional representations of SARS. The site challenges the representation of the outbreak on three levels: portrayals of citizens affected by SARS, portrayals of health professionals, and portrayals of the risk and panic associated with the outbreak. The argument is made that Internet projects such as sarsart.org can increase the capacity for cultural resistance by creating greater opportunities for the expression of political opposition to institutional authority.

The Challenges of Institutionalization for AIDS Media Activism

Since the early 1980s, AIDS activists have developed their own alternative media projects in order to mobilize those infected and affected, challenge misconceptions regarding the disease, provide practical and useful information, and transform power structures which inhibit an effective response to the HIV/AIDS pandemic. In this article I examine several challenges for AIDS media activists arising from an expanded institutional response to the HIV/AIDS epidemic. First is the challenge posed by pressures to professionalize media projects for people with HIV/AIDS. The second challenge is the need to adapt the role of media projects as providers of information in relation to those institutional resources that are available to people with HIV/AIDS. Third is the challenge of overcoming the marginality of alternative media projects in order to effectively reach out to and inform people with HIV/AIDS and in order to continue to work toward transforming the meaning of HIV/AIDS. To conclude, I address the relevancy of AIDS specific struggles with institutionalization for media activism more broadly. This analysis provides insight into the dialectic between activists using media to challenge and transform the meaning of social problems and institutional forces of incorporation and containment exercised by the state, medicine, and the mass media.

Capitation and Primary Care in Canada: Financial Incentives and the Evolution of Health Service Organizations

Alternative approaches to the funding, organization, and delivery of primary care have been the subject of ongoing discussion and debate in many industrialized nations for many years. One common recommendation has been to use capitation, as opposed to fee-for-service, as the payment method for physicians. In this study the authors use data from interviews with physicians and Ministry of Health officials to trace the evolution of Ontarios Health Service Organization (HSO) program, the only program of capitation-funded physician care in Canada. The program has developed in three phases: formation in the early 1970s, expansion in the late 1970s and throughout the 1980s, and restructuring in the 1990s. The analysis focuses on the perceptions and actions of policymakers and physicians who became involved with the program at different points in its evolution, and identifies how they perceived and responded to the financial incentives that were introduced to promote the program. This case study allows an examination of the shifting objectives, communications, perceptions, and responses of policymakers and stakeholders in changing contexts over a period of more than 20 years. The long history of the HSO program provides the opportunity to examine the factors that can cause financial incentives to go awry. The authors suggest how this case study offers lessons for financial incentive policymaking.

The relationship between HIV seroconversion illness, HIV test interval and time to AIDS in a seroconverter cohort.

Seroconversion illness is known to be associated with more rapid HIV disease progression. However, symptoms are often subjective and prone to recall bias. We describe symptoms reported as seroconversion illness and examine the relationship between illness, HIV test interval (time between antibody-negative and anibody-positive test dates) and the effect of both on time to AIDS from seroconversion. We used a Cox model, adjusting for age, sex, exposure group and year of estimated seroconversion. Of 1820 individuals, information on seroconversion illness was available for 1244 of whom 423 (34%) reported symptomatic seroconversion. Persons with a short test interval (< or = 2 months) were significantly more likely to report an illness than people with a longer interval (OR 6.76, 95% CI 4.75-9.62). Time to AIDS was significantly faster (P = 0.01) in those with a short test interval. The HIV test interval is a useful replacement for information on seroconversion illness in studies of HIV disease progression.

How People With HIV/AIDS Manage and Assess Their Use of Complementary Therapies: A Qualitative Analysis

The objective of this article is to provide a qualitative analysis of the practical concerns that people with HIV/AIDS have with regard to their use of complementary therapies. In-depth semistructured interviews were conducted with a diverse range of people with HIV/AIDS (N = 46). An inductive grounded approach was used to collect and analyze the data. There were five central concerns: (a) selecting which therapies to use, (b) judging which therapies work, (c) combining Western medicine with complementary therapies, (d) assessing the safety of complementary therapies, and (e) dealing with the barriers to the use of complementary therapies. A better understanding of the practical dimensions of complementary therapy use highlights the treatment and care issues that people with HIV/AIDS face and offers insights into the role that nurses might play in addressing some of these issues.

What Do People Living With HIV/AIDS Expect From Their Physicians? Professional Expertise and the Doctor-Patient Relationship

This qualitative study identifies the types of professional expertise that physicians are seen to possess in clinical encounters from the perspective of people living with HIV/AIDS (PLWHA). Respondents looked to their physicians for expert knowledge in 3 key areas: medical/clinical; legal/statutory; and ethical/moral. Physicians were seen to be authorities in each of these areas and their judgments, though not always agreed with, were taken seriously and influenced the health care decisions made by PLWHA. The authority that comes with professional expertise in each of the areas identified was experienced both positively and negatively by PLWHA. Understanding the expectations of patients in the medical encounter can assist physicians in providing optimal care in the management of HIV/AIDS.

Women in Equestrian Polo: Cultural Capital and Sport Trajectories

A significant development in sport over the last century is the greater involvement of women resulting from transformations in the gender order. Studies in the sociology of sport document the gradual decline of sport as a male preserve. Equestrian sport is an interesting yet complex case with regard to gender equity and participation among women. There are, however, equestrian events that are slower to respond to pressures for greater gender equity, the prime example being polo. Theoretically, we use the work of Bourdieu to conceptualize the relationship between material and cultural factors in both presenting opportunities and barriers to the participation of women in polo. Our chapter examines the shifting gender dynamics within equestrian polo in Canada. Consistent within equestrian sport in North America, women have a long history of participation in polo even though the sport is and has been primarily dominated by men. Lately, though, as in the case of sport in general, polo has undergone a transformation as participation among women in polo has increased and women have taken on more active and prominent positions in the sport. Given this recent trend, the purpose of our analysis is to better understand what it means for women who are playing polo, the challenges they face, and their influence on the sport generally.