Epidemics, interzones and biosocial change: Retroviruses and biologies of globalisation in West Africa.
详细信息
文摘
Despite impressive advances in biomedical science, the resurgence of infectious diseases poses an emerging threat to global public health. These developments underscore the importance of considering the relationship between biological and social change. This dissertation uses the epicentre of the HIV epidemic in West Africa---Abidjan, Cote-d'Ivoire---as a case study to show how epidemics are "crystallizations" of local biological and social factors. The Abidjan epidemic is accounted for in terms of the city's sexual modernity, rather than the common view that migration and prostitution explain the proportions the epidemic took there early on. This view supports recent epidemiological work demonstrating the importance of networks rather than behaviour in determining the scope of HIV epidemics. This sexual modernity has a complex genealogy that stretches back through the modernisation drive of the postcolonial state to colonial practices of government, including colonial strategies for containing tropical diseases, which shaped how Africans engaged with the modern world. As a result, sexuality became an important strategy for self-fashioning. With the advent of the economic crisis of the 1980s, sexuality became increasingly permeable to economic relations. Likewise, with the crisis, the city's therapeutic economy, heavily weighted towards the consumption of biomedicines, shifted resort for illness from the public health sector to the informal economy. This may have led to inappropriate treatment of sexually transmitted infections and increased re-use of needles, fuelling the epidemic further. Contemporary efforts to address the epidemic demonstrate how "bio-social" crystallizations can further effect social and biological change. The interface between local groups and international organisations is a site where transnational discourses of "empowerment" of people with AIDS, predicated on a western model of "self-help," encounter the local reality of poverty and illness. In this site, conceptualised as an "interzone," access to transnational resources is traded for, and translated into, local knowledge. This work of translation and exchange entangles actors in complex "moral economies," or relations of obligation and reciprocity, resulting in hybrid forms of social relations that are used to access resources. Effective biomedical treatments for HIV, available since 1996, have remained largely inaccessible in Africa because of their cost. Consequently, these "moral economies" determine access to these biological treatments. This has resulted in biological changes, such as visibly improved health and the emergence of drug-resistant viral strains. These changes in turn impact on social relations, as the inequality of access fuels competition within groups and both local and international activism for access to treatment. These bio-social changes occur in these "interzones," suggesting that these sites may drive bio-social change much in the way evolution is accelerated in ecological transition zones.