Robert A. Rubinstein

Structural Violence and Racial Disparity in HIV Transmission

Abstract Among women of color in the United States, infection with the human immunodeficiency virus (HIV) is rising. Most of the research on this topic, however, has focused on individual-level risk factors, which do not fully explain racial or ethnic differences in infection rates. This article uses structural violence as a conceptual framework to examine ecological-level risk factors leading to disparate rates of heterosexually transmitted HIV among women of color in Syracuse, New York. Three ecological pathways to disproportionate infection are discussed: community rates of infection, concurrent partnerships, and increased vulnerability. The discussion of the pathways considers the following macro-level risk factors: disproportionate incarceration rates of African American men, residential segregation, gang turf, constraints on access to sexually transmitted disease services, an African American sex ratio in which women outnumber men, social norms stigmatizing homosexuality, and commercial sales of douching products. The authors argue that health care providers and policy analysts must address ecological-level risk factors for HIV transmission in underserved communities.

Judging the Other: Responding to Traditional Female Genital Surgeries

Traditional female genital circumcision, or female genital mutilation, performed upon women in some non-Western cultures has provoked considerable international controversy since the late 1970s. Western feminists, physicians, and ethicists condemn such practice. Having made moral judgement against female genital mutilation, however, what is the next step? There is clearly an impasse between cultural relativism on the one hand and universalism on the other. Those at the forefront of the debate on female genital mutilation must learn to work respectfully with, instead of independently of, local resources for cultural self-examination and change. The authors discuss cultural relativism and moral universalism; female circumcision in sections on epidemiology, health effects, and culture, religion, and social change; the debate historically; the response of Arab and African women; and moving beyond the impasse.

AN EVALUATION OF THE VALIDITY OF THE DIAGNOSTIC CATEGORY OF ATTENTION DEFICIT DISORDER

Attention Deficit Disorder (ADD) replaced Hyperkinetic Reaction of Childhood as a category in DSM-III. This study evaluates the validity of the new terminology by determining whether clinical diagnoses of ADD could be predicted from scores on a number of widely used psychometric and behavioral instruments. Results suggest that ADD is an inadequately specified category. Some implications of this finding are considered.

Intervention and culture: An anthropological approach to peace operations

Culture is increasingly an important consideration in peace operations. Efforts to ameliorate culture-based difficulties between organizations participating in missions and between mission elements and local populations are proliferating. These focus on providing guidance about what to expect and how to act toward individuals from other cultural groups. This article shows that such advice is insufficient for understanding how culture affects peacekeeping. A general framework is presented for linking cultural elements to a deeper symbolic level from which peacekeeping derives its legitimacy, standing, and authority. The importance of the root metaphor of the United Nations as an institution for creating a world in which national interests and cut-throat geopolitical power relations are trumped by collective action is explicated. Peacekeeping is shown to be linked to this root metaphor through a number of behavioral inversions. When those inversions are not part of a peacekeeping mission, the entire instrument of peacekeeping is destabilized.

Cultural Aspects of Peacekeeping: Notes on the Substance of Symbols

In 1957, following the truce which ended the Suez War, the United Nations deployed its first peacekeeping force to monitor the separation of Egyptian and Israeli troops in Gaza and in the Sinai. On the first evening that the United Nations Emergency Force (UNEF) was deployed in Gaza, UNEF troops sprayed with machinegun fire a minaret from which a muezzin was calling the faithful to prayer. The UNEF soldiers, not understanding Arabic or Islam, had mistaken this as a call for civil disobedience.1 Ten years later UNEF withdrew from Gaza and the Sinai at the behest of the Egyptian President Nasser. This withdrawal was a key factor leading to the June 1967 Arab-Israeli War and was widely cited as evidence of the failure of the United Nations’ foray into the field of peacekeeping. Further, it set off a continuing debate about what Nasser’s statements and actions really meant, underscoring the importance of cultural questions to the establishment and success of peacekeeping.2

Culture, International Affairs, and Multilateral Peacekeeping: Confusing Process and Pattern

that is embodied in, and results from, their daily experience. This is the culture of international affairs. Further, this cultural context supports particular ways of thinking about culture, which, in turn, affect the way community members approach the social and cultural aspects of their own work. The conceptions of culture used by the international affairs community circumscribe the role of culture in international affairs. The culture of international affairs and the

Analogy and Mysticism and the Structure of Culture [and Comments and Reply]

Examples are drawn from the cultures of China, Africa, Tibet and Japan, and the Navaho in support of a model for human cognitive processing which assumes that a major component of the rules for calculating human behavior is resident outside the individual in the symbolic artifacts of culture. An Appositional Transformation Operator (ATO) is specified that can relate semantic concepts and patterns of behavior by analogy. The ATO is shown to work with great computational efficiency for verbal and visual analogies. The I Ching, a philosophical divination mechanism of classical Chinese culture, is shown to be constructed on the basis of an ATO logic. The existence of such an ATO divination system throughout much of Africa is also discussed, as well as the apparent encoding of ATO structures in the iconic imagery of Buddhism and of Navaho sand painting. This analysis is intended as part of a cross-cultural validation of a theory which posits that ATOs are the basis for human calculation of behavior by analogy and for perception and use of metaphor.

Towards a Public Health Approach to Bioethics

Abstract: In this paper we examine the central commitments of bioethical enquiry and reasoning from a public health perspective. We argue that a core element of American national culture is individualism, which resonates in scholarly and popular debates. Our contention is that the habitus of bioethical debate is in large measure animated by an overriding concern with the individual, and the resulting social practice of the community has been to downplay the importance and legitimacy of group‐level health care dilemmas. This paper calls for re‐focusing of bioethics by employing a public health perspective, which would include a population focus, evidence‐based research topics, and engagement of the ethical dilemmas that arise from decisions concerning prevention. Racial and ethnic health disparities throughout the life span of a population in central New York State are used to illustrate the need for a public health focus in bioethics.

IDENTIFYING PSYCHOSOCIAL DISORDERS IN CHILDREN: ON INTEGRATING EPIDEMIOLOGICAL AND ANTHROPOLOGICAL UNDERSTANDINGS

The development of a more satisfactory understanding of psychosocial disorders in children depends upon the successful combination of medical anthropological and epidemiological information. In this paper we describe one way this can be done. Our approach is to focus first on the level of the logic of inquiry, and only secondarily on the use of specific methods.

The Trauma Response Team: a Community Intervention for Gang Violence

While violent crime has decreased in many cities in the USA, gang-related violence remains a serious problem in impoverished inner city neighborhoods. In Syracuse, New York, gang-related murders and gun shots have topped other New York state cities. Residents of the high-murder neighborhoods suffer trauma similar to those living in civil conflict zones. The Trauma Response Team was established in 2010, in collaboration with the Police Department, health care institutions, and emergency response teams and with the research support of Syracuse University faculty. Since its inception, gang-related homicides and gun shots have decreased in the most severely affected census tracts.