Tim Allen

UNDERSTANDING ALICE: UGANDA'S HOLY SPIRIT MOVEMENT IN CONTEXT

This article examines the Holy Spirit movement of Alice Lakwena, which emerged i n Uganda between 1987 and 1989. The popular account of Alice, as told in the Western media especially, ignored die social and historical contexts which are essential to understanding die forces which gave rise to her and her following. The spirit possession revealed by Alice Lakwena took forms which were familiar t o the people of this part of Uganda, aldiough die political and social dislocations of the late 1980s were significant in shaping her actions and in determining the full range of issues with which her spiritualism came to be associated. This can be seen by examining die actions of Alice herself, but also by recognising diat odier spirit mediums were active in the region at die same time. Spirit mediums helped to establish a degree of social accountability in a world where die state had largely lost its credibility and collapsed and where witchcraft and sorcery were widely believed to be die most common causes of mortality. These spirit mediums were influenced by Christian conceptions of morality: it was partly because spirit divination had become closely associated widi die Catholic Church diat Alice and odier mediums were able to marshal such large followings and to appeal to such a broad spectrum of society. The case of Alice Lakwena is fascinating and informative not because of its novelty but because of its mixture of old and new forms, its continuities with die past and widi wider social processes, and its responses to new social traumas.

AIDS AND EVIDENCE: INTEROGATING SOME UGANDAN MYTHS

Uganda is invoked as a metaphor for a host of arguments and insights about HIV/AIDS. However, much of what has been asserted about the country is not based on the available evidence. This paper reviews findings by epidemiologists and anthropologists, and draws on the authors experiences of researching in the country since the early 1980s. It comments on various myths about HIV/AIDS in Uganda, including myths about the origin and dissemination of the disease, about the links between HIV/AIDS and war, and about declining rates of infection. It shows that much less is known about Uganda than is commonly supposed, and it offers some alternative hypotheses for interpreting HIV prevalence and incidence data. In particular it draws attention to the importance of mechanisms for social compliance. It concludes by raising concerns about the current enthusiasm for provision of anti-retroviral drugs.

The ‘Other Diseases’ of the Millennium Development Goals: rhetoric and reality of free drug distribution to cure the poor's parasites

Abstract The sixth MDG aims ‘to combat HIV/AIDS, TB, malaria and other diseases’. The residual category of ‘other diseases’ has become the focus of intense interest, partly because it has provided an opportunity to increase resources for the control of the mostly parasitic ‘neglected tropical diseases’ (NTDs). Intense lobbying has secured large amounts of funding from donors, as well as generous donations of medicines from the major drug companies. A massive programme is now underway to treat the parasites of the poor in Africa via integrated vertical interventions of mass drug administration in endemic areas. The approach has been hailed as remarkably effective, with claims that there is now a real prospect of complete control and, for some NTDs, even elimination. However, a closer look at evaluation and research data reveals that much less is known about what is being achieved than is suggested. Competition between implementing organisations is leading to potentially counterproductive exaggerations about treatment coverage. Detailed local-level research in Uganda and Tanzania shows that actual rates of drug take-up among target populations are often lower than is necessary to effectively control the diseases, and that methods of drug distribution may even lead to active resistance to treatment. If current trends are not corrected, declining rates of NTD infection will not be sustained. Much more rigorous and effective monitoring is essential.

Will increased funding for neglected tropical diseases really make poverty history

www.thelancet.com Vol 379 March 24, 2012 1097 Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ interviewed in the highly endemic areas in which we have researched are unaware of the link between the disease and mosquitoes and, at best, have a very limited understanding of the rationale for mass treatment. They ask why people with no visible symptoms should take tablets and why many of those with symptoms take the tablets but seem not to be cured. Similar confusions occur with respect to schisto somiasis. It is hardly surprising that rumours circulate about the real purpose of the drugs. In 2008, there were protests against distributions in various parts of Tanzania, and one of our doctoral students, who was observing treatment for schistosomiasis in schools near Morogoro, was attacked by an angry crowd. Parents had become convinced that the tablets had been sent to poison their children. She had to be rescued by armed police. Elsewhere, teachers involved in handing out tablets were severely beaten. Many of those involved in implementing MDA programmes are aware of these kinds of issue, but they are reluctant to discuss them too openly or revise policies. Others have set them aside as insignifi cant. A few passionate advocates of MDA have even gone so far as to misrepresent arguments and insights that we and others have made in an eff ort to discredit them, occasionally using highly emotive language in the process. Raising problems with MDA does not mean that we are opposed to NTD treatment—far from it. But we are concerned by the way in which competition for multimillion-dollar grants is closing off debate and restricting critical analysis of what is actually occurring on the ground. The situation is not helped by the fact that intense pressures are placed on institutions responsible for designing, administering, and monitoring MDA programmes to set overly optimistic targets and timelines at the expense of engaging with local realities. Similarly unhelpful is the confl ation in medical Will increased funding for neglected tropical diseases really make poverty history?

WILL MASS DRUG ADMINISTRATION ELIMINATE LYMPHATIC FILARIASIS? EVIDENCE FROM NORTHERN COASTAL TANZANIA

Summary This article documents understandings and responses to mass drug administration (MDA) for the treatment and prevention of lymphatic filariasis among adults and children in northern coastal Tanzania from 2004 to 2011. Assessment of village-level distribution registers, combined with self-reported drug uptake surveys of adults, participant observation and interviews, revealed that at study sites in Pangani and Muheza districts the uptake of drugs was persistently low. The majority of people living at these highly endemic locations either did not receive or actively rejected free treatment. A combination of social, economic and political reasons explain the low uptake of drugs. These include a fear of treatment (attributable, in part, to a lack of trust in international aid and a questioning of the motives behind the distribution); divergence between biomedical and local understandings of lymphatic filariasis; and limited and ineffective communication about the rationale for mass treatment. Other contributory factors are the reliance upon volunteers for distribution within villages and, in some locations, strained relationships between different groups of people within villages as well as between local leaders and government officials. The article also highlights a disjuncture between self-reported uptake of drugs by adults at a village level and the higher uptake of drugs recorded in official reports. The latter informs claims that elimination will be a possibility by 2020. This gives voice to a broader problem: there is considerable pressure for those implementing MDA to report positive results. The very real challenges of making MDA work are pushed to one side – adding to a rhetoric of success at the expense of engaging with local realities. It is vital to address the kind of issues raised in this article if current attempts to eliminate lymphatic filariasis in mainland coastal Tanzania are to achieve their goal.

De-Politicizing Parasites: Reflections on Attempts to Control the Control of Neglected Tropical Diseases

Large amounts of funding are being allocated to the control of neglected tropical diseases. Strategies primarily rely on the mass distribution of drugs to adults and children living in endemic areas. The approach is presented as morally appropriate, technically effective, and context-free. Drawing on research undertaken in East Africa, we discuss ways in which normative ideas about global health programs are used to set aside social and biological evidence. In particular, there is a tendency to ignore local details, including information about actual drug take up. Ferguson’s ‘anti-politics’ thesis is a useful starting point for analyzing why this happens, but is overly deterministic. Anti-politics discourse about healing the suffering poor may shape thinking and help explain cognitive dissonance. However, use of such discourse is also a means of strategically promoting vested interests and securing funding. Whatever the underlying motivations, rhetoric and realities are conflated, with potentially counterproductive consequences.

Border parasites: schistosomiasis control among Uganda's fisherfolk

Abstract It is recognized that the control of schistosomisais in Uganda requires a focus on fisherfolk. Large numbers suffer from this water-borne parasitic disease; notably along the shores of lakes Albert and Victoria and along the River Nile. Since 2004, a policy has been adopted of providing drugs, free of charge, to all those at risk. The strategy has been reported to be successful, but closer investigation reveals serious problems. This paper draws upon long-term research undertaken at three locations in northwestern and southeastern Uganda. It highlights consequences of not engaging with the day to day realities of fisherfolk livelihoods; attributable, in part, to the fact that so many fisherfolk live and work in places located at the countrys international borders, and to a related tendency to treat them as “feckless” and “ungovernable”. Endeavours to roll out treatment end up being haphazard, erratic and location-specific. In some places, concerted efforts have been made to treat fisherfolk; but there is no effective monitoring, and it is difficult to gauge what proportion have actually swallowed the tablets. In other places, fisherfolk are, in practice, largely ignored, or are actively harassed in ways that make treatment almost impossible. At all sites, the current reliance upon resident “community” drug distributors or staff based at static clinics and schools was found to be flawed.

Conflicts and compromises?: experiences of doing anthropology at the interface of public policy

VOLUME ONE Preface: The Association of Social Anthropologists of the UK and the Commonwealth - John Gledhill and James Fairhead Foreword: Thinking Anthropologically, About British Social Anthropology - John L. Comaroff and Jean Comaroff Introduction: Flying Theory, Grounded Method - Richard Fardon PART ONE: INTERFACES - Edited by Cris Shore and Richard A. Wilson Introduction: Anthropologys Interdisciplinary Connections - Cris Shore and Richard A. Wilson Anthropology and Linguistics - Alessandro Duranti Anthropology and Psychology - Christina Toren Anthropology of Biomedicine and Bioscience - Sarah Franklin Anthropology and Art - Arnd Schneider Anthropology, Media and Cultural Studies - Kevin Latham Anthropology and Public Policy - Cris Shore Anthropology and Law - Sally Engle Merry Anthropology and History - Jane K. Cowan Anthropology and Archaeology - Julian Thomas Anthropology, Economics and Development Studies - Keith Hart Anthropology and the Political - Jennifer Curtis and Jonathan Spencer Anthropology and Religious Studies - Martin Mills Anthropology and Museums - Brian Durrans Anthropology and Gender Studies - Henrietta L. Moore Anthropology and the Postcolonial - Richard Werbner Anthropology and Literature - C.W. Watson PART TWO: PLACES - Edited by Mark Nuttall Introduction: Place, Region, Culture, History: From Area Studies to a Globalized World - Mark Nuttall The Circumpolar North: Locating the Arctic and Sub-Arctic - Mark Nuttall Replacing Europe - Sarah Green Retroversion, Introversion, Extraversion: Three Aspects of African Anthropology - David Pratten Refiguring the Anthropology of the Middle East and North Africa - Glenn Bowman Southwest and Central Asia: Comparison, Integration or Beyond? - Magnus Marsden South Asia: Intimacy and Identities, Politics and Poverty - Patricia Jeffery and Roger Jeffery Modernization and its Aftermath: The Anthropology of Japan - D.P. Martinez The Emerging Socio-Cultural Anthropology of Emerging China - J.S. Eades Archipelagic Southeast Asia - Roy Ellen Australasian Contrasts - Nicolas Peterson, Don Gardner and James Urry Australia - Nicolas Peterson Melanesia - Don Gardner New Zealand/Aotearoa - James Urry Two Indigenous Americas - Kathleen Lowrey and Pauline Turner Strong North America - Pauline Turner Strong South America - Kathleen Lowrey North and Latin American National Societies from a Continental Perspective - John Gledhill and Peter Wade Migration and Other Forms of Movement - Vered Amit The Cosmopolitan World - Nigel Rapport The Indigenous World - Robert K. Hitchcock and Maria Sapignoli VOLUME TWO PART THREE: METHODS - Edited by the late Olivia Harris and Veronica Strang Introduction: Issues of Method - Richard Fardon and Veronica Strang Fieldwork Since the 1980s: Total Immersion and its Discontents - Janet Carsten Between Routine and Rupture: The Archive as Field Event - Tristan Platt The Role of Language in Ethnographic Method - Susan Gal The Ethnographic Interview in an Age of Globalization - Joshua Barker Interpreting Texts and Performances - Karin Barber Blurred Visions: Reflecting Visual Anthropology - Rupert Cox and Christopher Wright Artefacts in Anthropology - Liana Chua and Amiria Salmond Knowledge and Experimental Practice: A Dialogue Between Anthropology and Science and Technology Studies - Penelope Harvey Twenty-first Century Ethics for Audited Anthropologists - Nayanika Mookherjee Ethics Out of the Ordinary - Michael Lambek Researching Zones of Conflict and War - Paul Richards Conflicts and Compromises? Experiences of Doing Anthropology at the Interface of Public Policy - Tim Allen and Melissa Parker From Participant-Observation to Participant-Collaboration: Some Observations on Participatory-cum-Collaborative Approaches - Paul Sillitoe Comparative Methods in Socio-Cultural Anthropology Today - Andre Gingrich PART FOUR: FUTURES - Edited by Trevor H.J. Marchand Introduction: Anthropologies to Come - Trevor H.J. Marchand Section 4.1: Neo-Darwinism, Biology and the Brain Sciences Anthropology and Neo-Darwinism - Robin I.M. Dunbar Cognition, Evolution and the Future of Social Anthropology - Harvey Whitehouse Neuroanthropology - Greg Downey Knowledge in Hand: Explorations of Brain, Hand and Tool - Trevor H.J. Marchand Section 4.2: After Development: Environment, Food, Energy, Disaster Environment and Society: Political Ecologies and Moral Futures - James Fairhead and Melissa Leach Anthropological Encounters with Economic Development and Biodiversity Conservation - Laura M. Rival New Directions in the Anthropology of Food - Jakob A. Klein, Johan Pottier and Harry G. West Water, Land and Territory - Veronica Strang The Anthropology of Disaster Aftermath - Edward Simpson Section 4.3: Demographics, Health and the Transforming Body Demographies in Flux - Sophie Day New Medical Anthropology - Helen Lambert The Anthropology of Drugs - Axel Klein Transforming Bodies: The Embodiment of Sexual and Gender Difference - Andrea Cornwall Section 4.4: New Technologies and Materialities New Materials and New Technologies: Science, Design and the Challenge to Anthropology - Susanne K chler Anthropology and Emerging Technologies: Science, Subject and Symbiosis - Ron Eglash From Media Anthropology to the Anthropology of Mediation - Dominic Boyer Anthropology in the New Millennium - Christopher Pinney Afterword: A Last Word on Futures - Marilyn StrathernVOLUME ONE Preface: The Association of Social Anthropologists of the UK and the Commonwealth - John Gledhill and James Fairhead Foreword: Thinking Anthropologically, About British Social Anthropology - John L. Comaroff and Jean Comaroff Introduction: Flying Theory, Grounded Method - Richard Fardon PART ONE: INTERFACES - Edited by Cris Shore and Richard A. Wilson Introduction: Anthropologys Interdisciplinary Connections - Cris Shore and Richard A. Wilson Anthropology and Linguistics - Alessandro Duranti Anthropology and Psychology - Christina Toren Anthropology of Biomedicine and Bioscience - Sarah Franklin Anthropology and Art - Arnd Schneider Anthropology, Media and Cultural Studies - Kevin Latham Anthropology and Public Policy - Cris Shore Anthropology and Law - Sally Engle Merry Anthropology and History - Jane K. Cowan Anthropology and Archaeology - Julian Thomas Anthropology, Economics and Development Studies - Keith Hart Anthropology and the Political - Jennifer Curtis and Jonathan Spencer Anthropology and Religious Studies - Martin Mills Anthropology and Museums - Brian Durrans Anthropology and Gender Studies - Henrietta L. Moore Anthropology and the Postcolonial - Richard Werbner Anthropology and Literature - C.W. Watson PART TWO: PLACES - Edited by Mark Nuttall Introduction: Place, Region, Culture, History: From Area Studies to a Globalized World - Mark Nuttall The Circumpolar North: Locating the Arctic and Sub-Arctic - Mark Nuttall Replacing Europe - Sarah Green Retroversion, Introversion, Extraversion: Three Aspects of African Anthropology - David Pratten Refiguring the Anthropology of the Middle East and North Africa - Glenn Bowman Southwest and Central Asia: Comparison, Integration or Beyond? - Magnus Marsden South Asia: Intimacy and Identities, Politics and Poverty - Patricia Jeffery and Roger Jeffery Modernization and its Aftermath: The Anthropology of Japan - D.P. Martinez The Emerging Socio-Cultural Anthropology of Emerging China - J.S. Eades Archipelagic Southeast Asia - Roy Ellen Australasian Contrasts - Nicolas Peterson, Don Gardner and James Urry Australia - Nicolas Peterson Melanesia - Don Gardner New Zealand/Aotearoa - James Urry Two Indigenous Americas - Kathleen Lowrey and Pauline Turner Strong North America - Pauline Turner Strong South America - Kathleen Lowrey North and Latin American National Societies from a Continental Perspective - John Gledhill and Peter Wade Migration and Other Forms of Movement - Vered Amit The Cosmopolitan World - Nigel Rapport The Indigenous World - Robert K. Hitchcock and Maria Sapignoli VOLUME TWO PART THREE: METHODS - Edited by the late Olivia Harris and Veronica Strang Introduction: Issues of Method - Richard Fardon and Veronica Strang Fieldwork Since the 1980s: Total Immersion and its Discontents - Janet Carsten Between Routine and Rupture: The Archive as Field Event - Tristan Platt The Role of Language in Ethnographic Method - Susan Gal The Ethnographic Interview in an Age of Globalization - Joshua Barker Interpreting Texts and Performances - Karin Barber Blurred Visions: Reflecting Visual Anthropology - Rupert Cox and Christopher Wright Artefacts in Anthropology - Liana Chua and Amiria Salmond Knowledge and Experimental Practice: A Dialogue Between Anthropology and Science and Technology Studies - Penelope Harvey Twenty-first Century Ethics for Audited Anthropologists - Nayanika Mookherjee Ethics Out of the Ordinary - Michael Lambek Researching Zones of Conflict and War - Paul Richards Conflicts and Compromises? Experiences of Doing Anthropology at the Interface of Public Policy - Tim Allen and Melissa Parker From Participant-Observation to Participant-Collaboration: Some Observations on Participatory-cum-Collaborative Approaches - Paul Sillitoe Comparative Methods in Socio-Cultural Anthropology Today - Andre Gingrich PART FOUR: FUTURES - Edited by Trevor H.J. Marchand Introduction: Anthropologies to Come - Trevor H.J. Marchand Section 4.1: Neo-Darwinism, Biology and the Brain Sciences Anthropology and Neo-Darwinism - Robin I.M. Dunbar Cognition, Evolution and the Future of Social Anthropology - Harvey Whitehouse Neuroanthropology - Greg Downey Knowledge in Hand: Explorations of Brain, Hand and Tool - Trevor H.J. Marchand Section 4.2: After Development: Environment, Food, Energy, Disaster Environment and Society: Political Ecologies and Moral Futures - James Fairhead and Melissa Leach Anthropological Encounters with Economic Development and Biodiversity Conservation - Laura M. Rival New Directions in the Anthropology of Food - Jakob A. Klein, Johan Pottier and Harry G. West Water, Land and Territory - Veronica Strang The Anthropology of Disaster Aftermath - Edward Simpson Section 4.3: Demographics, Health and the Transforming Body Demographies in Flux - Sophie Day New Medical Anthropology - Helen Lambert The Anthropology of Drugs - Axel Klein Transforming Bodies: The Embodiment of Sexual and Gender Difference - Andrea Cornwall Section 4.4: New Technologies and Materialities New Materials and New Technologies: Science, Design and the Challenge to Anthropology - Susanne K chler Anthropology and Emerging Technologies: Science, Subject and Symbiosis - Ron Eglash From Media Anthropology to the Anthropology of Mediation - Dominic Boyer Anthropology in the New Millennium - Christopher Pinney Afterword: A Last Word on Futures - Marilyn Strathern

Witchcraft, Sexuality and HIV/AIDS among the Azande of Sudan

Abstract The Azande of Ezo county, southern Sudan consider HIV/AIDS to be their worst health problem. Although there have been few confirmed cases, there is ongoing migration from neighbouring countries that are thought to have high prevalence. There are also more locally specific reasons for concern. Zande fears about HIV/AIDS relate to understandings of witchcraft. Witches, like HIV positive people, may look like everyone else, but are secretly killing those around them. Some individuals, who know they are HIV positive, demonstrate that they are moral persons by being open about it. They are active in providing information about the epidemic, and associate their activities with the Christian churches. Their efforts, and those of local religious and political leaders, have contributed to awareness about modes of transmission associated with sexual intercourse and contamination with infected blood. However, accepting such messages does not necessarily contradict witchcraft causality. Also, without knowing who are secretly positive, almost anyone is suspect. Advice about stopping sexual intercourse is viewed as untenable or worse, because sexuality and procreation are fundamental to life. A minority is enthusiastic about the use of condoms; but most people have had no personal experience of them and oppose their introduction. It is unclear why HIV/AIDS controls cannot be like those for other diseases, such as sleeping sickness. Support is expressed for testing facilities, and for clinical treatment. In addition, there are requests for all positive people to be publicly identified and concentrated in one place.

Introduction: why don't HIV|AIDS policies work?

This ‘policy arena’ offers some responses to the above question and indicates ways forward. The authors originally presented their papers at a workshop held at the London School of Economics in March 2004. James Putzel draws on evidence from Uganda, Senegal and Malawi to interrogate problems that have arisen with the national AIDS commissions favoured by the World Bank; Tim Allen and Suzette Heald compare and contrast responses to the pandemic in Uganda and Botswana; Heather Zhang describes the situation in China; Ken Shadlen looks at issues involved in securing access to drugs, and Tony Barnett comments on how HIV/AIDS data should inform action. Here, I do not attempt to summarise the various arguments they make, but provide a brief critical overview of global HIV/AIDS policy. In so doing I point forward to many of the issues that are addressed in more detail in the pages that follow. The HIV/AIDS pandemic has raised policy dilemmas of a magnitude that are yet to be fully recognized or understood. There seems to be remarkably little appreciation of the scale of the problem in India or (as Zhang demonstrates) in China. Even in those parts of Africa where HIV/AIDS has already become the main cause of adult mortality, governmental responses sometimes lack a sense of urgency or purpose. In South Africa the national government has infamously remained in denial about the situation, and until recently has done almost nothing. Yet before too much blame is apportioned to South African politicians, it is important to note that in neighbouring Botswana the government acted, but with no apparent effect (a point addressed by Allen and Heald). Given the continuing rise in rates of infection and mortality, it would be fair to conclude that HIV/ AIDS public health policies have been seriously inadequate. It is important to note at the outset that the failures in HIV/AIDS policy have been selective. Certain measures have proved to be very effective, but they have mostly been implemented among relatively affluent people or among people living in affluent countries. For recipients of these policies, the risk of infection by HIV/AIDS has been largely contained or reduced, and for most of those infected it has become a condition of chronic morbidity, rather than imminent mortality. For various reasons the application of these policies to poor countries has been very limited, and AIDS-related mortality has become a telling and shocking indicator of economic deprivation.