Brief comment: Disclosure and silence among HIV activists in Zanzibar

by Gideon Lasco, MD, MSc

"The desire to live a normal life demands silences in particular social contexts"  - "Faidha gani? What’s the point: HIV and the logics of (non)-disclosure among young activists in Zanzibar by Eileen Moyer

In the advent of antiretroviral therapies in Zanzibar, what are the challenges that are faced by young activists with HIV as they 'live positively'? In this article, Eileen Moyer identifies disclosure and non-disclosure as an important issue for these individuals. Responding to the notion that non-disclosure is a response to stigma, she draws on the life of a couple - Miki and Zainab – to make the point that more is at stake in the ‘silence’ of people living with HIV. This is in spite of the global assumption that disclosure is good and disclosure is a way to flight stigma (p. 68) that the activists themselves ‘subscribe’ to – but Moyer recasts this subscription as more of acquiescence (p. 70).

Moyer points out that "the desire to live a normal life" is a key struggle for people living with HIV, and spends a good part of the article illustrating what a ‘normal life’ means. Components of a normal life she identifies include “marriage, family relations, work and child bearing” (p. 73). Disclosure disrupts these components in many ways. For instance, she cites an informant who says that “informing a loved one of one’s HIV status still brings pain” and she narrates issues of trust and mistrust in Miki and Zainab’s marriage that has to do with their respective (non)-disclosures.

In a sense, there is ‘performativity’ in having HIV/AIDS: disclosure has a (disruptive) social impact even if people already have previous assumptions of what an individual’s HIV status is. Thus, the global discourses on the importance of disclosure notwithstanding, it is understandable that for people living with HIV, there is no point  - Faidha gani  - in disclosure, when what is demanded of them is silence.

What I find interesting in this article is that there is so much at stake in individuals’ notion of what constitutes a ‘normal’ or acceptable life. When Alex Edmonds speaks of a ‘necessary’ vanity in Brazil, he is also drawing on norms of beauty – a ‘particular standard of living’ that makes plastic surgery socially acceptable in Brazil. But with HIV and plastic surgery being both recent phenomena, how do we the chart the genesis – and the evolution – of these ‘normatives’? How does ‘normal’ change? This I believe is an important and enduring question for medical anthropologists as we reconfigure our lenses to deal with both illness and wellness; both suffering and ‘desire’ and as we confront new medical technologies and challenges.

REFERENCES

Edmonds, Alexander. (2011). A ‘Necessary Vanity’. New York Times, August 13, 2011 Available: http://opinionator.blogs.nytimes.com/2011/08/13/a-necessary-vanity/?_r=0 Accessed 6 Nov 2013

Moyer, E. (2012). Faidha gani? What's the point: HIV and the logics of (non)-disclosure among young activists in Zanzibar. Culture, health & sexuality, 14(sup1), S67-S79.

Brief comment: Efficacy in the hands of clinical trial participants

by Gideon Lasco, MD, MSc

"...it is not only medical professionals who are determining the efficacy of these pharmaceuticals. So too are the individuals enrolled in the trial. Any pharmaceutical or medical product will most likely only be used if people consider it to be effective and appropriate." - Gelling medical knowledge: innovative pharmaceuticals, experience, and perceptions of efficacy (Saethre and Stadler, 2009) 

In their paper, Saethre and Stadler (2009) give voice to participants in a clinical trial of a vaginal microbicidal gel in South Africa, saying that these participants and their partners ascribe various parameters to the gel independently of and prior to the establishment of the gel’s effects by the scientists, and regardless of what they were actually getting – the gel itself or a placebo. These parameters, they suggest, draw on local notions of gynecology and physiology, as well as their own ‘felt’ experiences of using the gel.

Theoretically, there is nothing new in this concept of efficacy that has been conceptualized and applied in various settings (Etkin, 1988; Tan, 1999; Nicther, 1995 to name a few examples). As Whyte, van der Geest, and Hardon note: "In real life, efficacies are assessed not by pharmacologists but by social actors." However, the innovativeness of this paper lies in its application of notions of efficacy to clinical trials, which are interesting because they are the site of first contact between novel products and lay individuals. In a more applied and collaborative research, Pool (2011) looks at clinical trials as ‘cultural trials’, asserting the importance not just of controlled measurements but also what the patients feel about the drug in evaluating new pharmaceuticals. Montgomery and Pool (2011) echo the same rationale, essentially calling for ‘representation’ in the process of developing drugs for prevention.

The benefits of this ethnographic voice in making drugs ‘better’ make me reflect on the role of anthropologists in the pharmaceutical industry in general, mindful of the underlying political economy. What guideposts do anthropologists have in this kind of work? How do we draw the line between the anthropology of pharmaceuticals and anthropology for pharmaceuticals?

Amsterdam
October 2013

The two waves of sociocultural evolutionism in anthropological thought

by Gideon Lasco, MD, MSc

Social evolutionism (also cultural evolution or social evolution), in the context of society and culture, is the view that societies progress from one stage of development to another, and that culture is an adaptation; a survival strategy at the level of the species. In the history of anthropological thought, this idea gained currency twice, in two similar but distinct forms. The first, which we now term as unilineal or classical evolutionism, developed during the 1870s-1890s, amid much interest in Darwinian philosophy, espoused by Edward Tylor and Lewis Morgan. The second, neoevolutionism, was espoused by Leslie White, Julian Steward, Marvin Harris and others in the middle of the 20th century and to some extent remains influential in contemporary anthropological thought via cultural ecology.

The first wave of evolutionism came during a time when Western thinkers were seeking to explain social changes, heavily influenced by the rapid transformations that were occurring in their society at the time. Industrialization and technological advances were supporting larger cities which in turn created unprecedented social conditions – incidentally also inspiring Marx and Engels to craft their own explanations that eventually led to another evolutionary perspective: historical materialism. The colonial enterprise also introduced Western thinkers to what they conceived as ‘primitive societies’, giving rise to archaeological and ethnographic endeavors and subsequently, comparative studies, which was what Tylor and Morgan engaged in.

The epistemological context at the time was a heavily positivistic one, which held that in the same way that there are natural laws that describe biology, chemistry, and physics, similar laws can also be found for societies. Thus when Darwin’s theory of evolution among organisms spread in the intellectual world, social scientists were inspired to look at similar processes among societies. It was not unprecedented to examine societies in terms of processes. The Scottsh economist Adam Smith did the same one century earlier, offering four stages of social development. The contribution of Edward Tylor was to offer various cultures to support a view of evolution – a comparative method - claiming that cultures follow distinct phases of development, using various features such as religion as markers of that development, much as biological evolutionists would look at bipedalism or mammary glands.

Lewis Morgan developed a similar view, holding that features of culture like kinship, system of government, and concept of property can be used to measure different societies’ stage of development. By adopting a unilineal view of evolution, classical evolutionists assumed that “primitive cultures” such as the tribes in Australia – the site of Morgan’s fieldwork – were in an earlier stage of development.

Classical evolutionism was criticized as unsupported by ethnographic data, vigorously attacked by likes of Franz Boas, but the view that ‘culture’ is an adaptation to the environment, and Morgan’s view that material considerations are the driver of cultural change was resurrected in another generation. The important distinction between this new generation and the old evolutionism, however, was that most of them did not believe that cultures have to pass through the same stages of evolution. Instead, each culture takes a different course depending on its environment. Moreover, instead of the comparative method, they used empirical approaches. Gone were the ‘conjectural histories’ as Radcliffe-Brown described the classical evolutionists of old. Harris, for instance, used calculations of energy efficiency in analysing India’s ‘sacred cow’. Leslie White even placed energy consumptiom as a measure of cultural development.

Eventually, neoevolutionists’ focus on material culture and technology would influence latter-day cultural ecologists.

REFERENCES

Harris, M. (2001). The rise of anthropological theory: A history of theories of culture. AltaMira Press.

Stocking, G. W. (1968). Race, culture, and evolution: Essays in the history of anthropology. University of Chicago Press.

Social media and the 2016 elections

by Gideon Lasco

How exactly will social media shape the upcoming elections?

It was US president Barack Obama who demonstrated the usefulness of social media in 2008, when his campaign used Facebook to penetrate young people’s social networks and encourage them to vote. Two years later when Noynoy Aquino ran for president, social media was not as big in the Philippines: in mid-2010, there were only 10 million Facebook users in the country, compared to 40 million today.

The 2013 elections did attract the attention of netizens - remember the Nancy Binay memes - but it was a mid-term election, sans the fanfare that usually accompanies the vote to determine the highest office in the land. With the presidency at stake, 2016 is promising to become the most “trending" of Philippine elections. Here are some ways social media is making its mark:

A more participative platform
Social media is a platform for candidates and voters alike to engage in the political process in a more direct way. Through their fan pages, candidates can directly share their thoughts and photos without being filtered by traditional media. As Mar Roxas learned in his “happy anniversary” faux pas (a topic I addressed in “Social media advice for Mar Roxas”; PDI 09/15/2015), social media engagement has its pitfalls - but it can also be a rewarding way to connect with voters, especially the youth.

Voters, for their part, through their posts, comments, and annotated “shares”, can influence their social networks - a hypothesis that has received support from a 2012 study published in Nature, which demonstrated that what Facebook users see in their “news feeds” can affect their voting patterns. While others have argued that it has only amplified partisanship (i.e. we only read and share the articles we agree with), it has undeniably made the public more involved and aware of what’s happening.

Aside from expressing ideas, the direct access to (and by) the public can be a tool for change - as showed by the anti-pork “Million People March” in 2013, largely organised through social media. Though the “million people” did not materialise, it nonetheless offered a glimpse of what social media can enable.

(Mis)information wars
Websites and Facebook pages can easily be set up, and made to look like respectable news outlets, while subtly espousing an political agenda. Of course, already-established websites and blogs are not immune from the influence of politics and can also contribute to misinformation.

Sometimes, the truth will be sacrificed for the sake of virality. Articles will go for the shareable, the scandalous, the dramatic. They will follow the format of articles guaranteed to attraction your attention (i.e. “Ten reasons not to vote for Binay” or “The shocking truth about Grace Poe”).

But social media can also offer a venue for people to fact check the information they’re overloaded with. In the US, websites like FactCheck.Org are fulfilling this role, and their articles are widely shared in traditional and social media.

Cyber-‘hakot’ and online vote buying
As of this writing, Binay has 230,000 Twitter followers, Roxas has 505,000; Grace Poe has 45,200. In an age when influence is measured by the number of followers you have on social media, expect this numbers game to be closely watched - and contested. Through paid-for “sponsored posts” in Facebook and Twitter - and with the help of online entrepreneurs who “sell” likes and followers - candidates can appear more influential, more famous, and yes, more vote-worthy (everybody loves a winner).

It is not just “likes” and “follows”; even comments can be manufactured or “planted”. One study showed that 1/3 of all customer reviews and comments online are fake, and it won’t be surprising if the same can be said of political comments.

These, of course, are old political tricks, the logical extensions of the “hakot” crowds and actual vote buying employed in traditional politics. But they also raise issues of legality and transparency:  can the COMELEC keep track of campaign expenditures online, and monitor cyberspace for violations?

Will Facebook ‘likes’ translate to votes?
Ultimately, it will be the actual votes, not Facebook ‘likes’ - or Twitter ‘favorites’ - that will matter (that is, of course, assuming that vote buying isn’t a factor). Though it is projected that 60% of Filipinos will have access to the Internet by 2016, it will not be representative of the population: the poor and those living in rural areas will be underrepresented. Thus social media sentiment - or online surveys, for that matter - cannot be taken to be the voice of the nation.

But social media itself can increase voter turnout  by turning the elections into a social, shareable, fashionable activity - a phenomenon that some scholars call “digital peer pressure”. In the same 2012 study I cited above, another key finding was that people were more likely to vote if they saw a message showing their Facebook friends had voted.

How else will social media affect the elections? Will an ingenious campaign jingle, “break the Internet”? Will a YouTube video or a tell-all blog post, revealing a hitherto unseen side of a candidate, go viral days before the elections and affect his or her chances? Because of its relative novelty - and the ever-changing world of Philippine politics - it is unwise to make further predictions.

All we can say at this point is that social media will definitely be a key battleground where the elections will be fought.