HBHE 516 Final Exam flashcards Flashcards

Terms Definitions
What are the central tenets of neoliberalism as described in lecture?
Deregulation (“disembed capital from its constraints”)
Commodification (“bring all human action into the domain of the market”)
Dismantling of the Keynsian welfare state: reducing and privatizing social services. Also, making availability contingent rather than universal.
An emphasis on “personal responsibility” that ‘naturalizes’ and justifies inequality
Individualism vs. Collectivism

What are some characteristics of neoliberal policy?
Embrace privatization, marketization and deregulation. Consider the “free market” as the most efficient way to produce and distribute resources and services.

Describe the uses and misuses of sexual culture.
“Sexual culture” intended to break down division between sex as an INDIVIDUAL biological process separable from a COLLECTIVE
Main contribution: Anthropologists argued sex (both meaning and practice) highly variable, and HIV prevention must take this into consideration In this context, notions of different “sexual cultures” were often misused (by both anthropologists and non-anthropologists)
Misuses: Explanations decontextualized “sexual practices” and stereotyped local sexualities Implicit racism in the metaphors used in public health created (rational) reactions against Western biomedicine, impeding an effective public health response to AIDS
Describe anthropological critiques of public health discourse that were presented in lecture on HIV/AIDS
The “Risk group” as stigmatizing: focus on risk groups: reinforces stigma; encourages “othering”; implies that those “outside” category are not at risk
The autonomous individual: Biomedical models incorporate assumptions about health resulting from individually chosen lifestyles; reinforces individual responsibility and blame for HIV infection
Define the concept of “double stigma”
The idea that people living with HIV/AIDS often have to contend with both the stimga of being gay and the stigma of being infected.
Describe and critique the uses of gender and gender vulnerability in HIV/AIDS research.
1. Gender & socialization: Learned powerlessness or submissiveness in relation to men (including in sex)
2. Gender & economy: Women more disempowered in terms of economic resources and work
3. Gender & reproduction: women valued in household production and family reproduction The deficits model of gender and power: emphasis on “vulnerability” produces the notion that women are powerless This may neglect how women’s values and beliefs affect HIV risk (e.g., Sobo’s “benefits of unsafe sex”) May depict men as abusive at best or “intentional infecters” at worst
Describe Green’s study of traditional healer incorporation in HIV prevention
·         •Attempt to find intersection between indigenous and biomedical constructions of STIs

·         •Project extends PHC work

·         •“Khoma” (polluting material) intersects with viral transmission model (condom use)

·         •Workshops sought to train healers using indigenous term
    Program briefly replicated and now defunct
Lingering questions: What impact did it have? 

How effective was condom promotion?
What potential consequences of using indigenous constructions to promote HIV behavior change?

What are some gaps in current AIDS research that anthropologists can fill?

•          Institutional ethnography of ARV scale-up, vaccine, and other RTC trials

–        Effects of circumcision campaigns

–        Global Politics of pharmaceuticalization of AIDS

–        Schoepf: “Institutions have become quasi-states”

•          Studies of “aging” and mental health among long-term survivors of HIV

•          Studies of changing stigma as AIDS becomes a more common chronic disease

•          Filling the gap in multi-level theoretical approaches

–        Coates et al: “The theories guiding most interventions are essentially cognitive and individualistic and do not address the fact that HIV transmission is a social event.”

–        Growing recognition of need for structural approaches, but few actual models

–        Such projects require concepts and methods not typical in most PH approaches, and call for anthropological involvement
•          Few full-length ethnographic treatments of AIDS in specific locations



Describe Coates’ concept of highly active HIV Prevention
A method of HIV prevention that works at the intersection of behavioral change, treatment, biomedical strategies and social justice and human rights issues
Describe Paiva et al’s findings regarding the reproductive intentions of HIV positive men and women in Brazil.
—N= 533 women and 206 (het. & bi) men, HIV+ —Desire to have children (in this sample) was more frequent among men than among women and it was reported by 27.9% of participants (50.1% of men versus 19.2% of women).
  —Male gender, younger age (17-24, OR 6.1), having no children (OR 8.4), and being in a heterosexual partnership were independently associated with desire to have children.
  —The childless as well as the youngest should be regarded as groups to be particularly targeted in RH.  
Describe the benefits of integrating HIV/AIDS and Reproductive Health programs described by Berer et al 
One of the main arguments in support of theintegration of more sexual and reproductive health services is that it will improve women’s health by encouraging greater use of services. That is why family planning and maternal and hild health (MCH) services were and still are onsidered highly appropriate for integration with each other: the same women need both at different moments in their reproductive lives.
Describe the methodologies that Padilla uses in Carribean Pleasure Industries
Mixed-methods approach in which survey results are interpreted in the context of ethnographic knowledge while ethnographic data is interpreted in light of survery information.
Benefits to this approach:
Interpret survey results as another form of ethnographic data
 Statistics can provide suggestive trends, but interpretation requires ethnographic / contextual info
You ask: “Why might my sample have responded to this question in this way?” à need ethno. data for answer
What are some implications of Padilla’s findings for HIV prevention?
Programs should connect global, political economic factors to local practices and identities

Programs should incorporate the issues of the economic migration
Work to target the right populations and emphasize the right things.

Conside the issues of stigma when developing a program.

How can you recruit for an HIV prevention program specifically targeting self-identified heterosexual men who engage in sex with men How would you recommend developing an HIV prevention program for this particular population? Are there others that you would include in the prevention programs?

How does Padilla's ethnography present a political economy of sexuality?
In the way that it shows how the economy of sex in the DR is based largely on the politics and economy. For example, policies that focus on developing tourist areas at the expense of the rest of the nation require those who want jobs to move to these areas but that sex work is, for some, one of the few viable means of making a living.
Articulate four common motivations for population control
•       Humanitarian view: Reductions in family size will benefit the health of women and children. •       Malthusian argument: 19th Century Demographer who predicted exponential population growth/doomsday scenario. Concern about who is reproducing (eugenics). •       Environmental Concern: Summit in Rio emphasized global deforestation and toxic waste build up. •       Economic concerns: Addressing poverty by controlling fertility. BUT, why not the other way around?                  
Contrast reproductive health and population control
Reproductive health: •       Sought to resist Population Control assumptions and  fertility-focused reductionism •       Adhered to more holistic / inclusive approach to RH

-“The ability of women to live through the reproductive years and beyond with reproductive choice, dignity and successful childbearing and to be free of gynecological disease and risk.”
-Unification of various programs under one umbrella (e.g., family planning, STIs, Maternal mortality, Child Survival, abortion, menstruation, sexuality, etc.)
Describe the various actors (see the Lane article) that shaped the transition from population control to reproductive health.
University-based demographers and social scientists

Activist groups (e.g., women’s org’s)

Research organizations
Non-governmental organizations

Private philanthropies

 Government agencies

Multilateral agencies
Articulate anthropological critiques of population control
Metaphor of control normalizes coercion

Polices do not create user demand or “user pull”

Can lead to ethical violations
Rights of individuals less important than goals  of population control.

Whose fertility is controlled? Right to reproduce is stratified by race, class etc.

Define the concept of stratified reproduction
Stratified reproduction is a term originally coined by Shellee Colen in her classic 1986 study of West Indian nannies and their (female) employers in New York City, which found inequalities of race, class, gender, culture, and legal status played out on a social field that was both domestic and transnational. Colen elaborated the term in her later work to describe situations in which women perform physical and social reproductive labor structured by economic, political, and social forces and differentiated unequally across hierarchies of class, race, ethnicity, gender, and place in a global economy (Colen 1995). Many feminist social scientists since the 1980s have adopted stratified reproduction as a theoretical framework within which to examine a variety of issues relevant to the intersections of reproduction and stratification. The term stratified reproduction implicitly acknowledges both the sexual politics and the political economy of reproduction. In this way it derives from, and elaborates on, second-wave feminist concerns with removing childbearing (biological reproduction) and domestic labor (social reproduction) from the realm of the “natural” and placing them squarely under critical, social scientific analysis.
Articulate Sargent and Browner’s central thesis
“Reproduction lies at the heart of a culture’s representation of itself; it is in large measure through imagining reproduction that individuals families and social groups conceive the future toward which they aspire for themselves and the next generation”
Be able to describe the central argument put forth by Foley about family planning interventions in Senegal.
"The limitations on Senegalese women’s reproductive choices have little to do with a lack of legal protections for an individual woman’s body or bodily autonomy.  Rather, the restrictions stem from widely held cultural norms and gendered economic relationships that together limit many women’s primary socio-economic strategy to high parity within marital unions”
What are some of the constraints on reproductive choice that Foley describes?
1. Bodies as economic resources - women use their bodies for security
2. Proscriptions against premartial sex - taboo against premarital sex results in lack of reproductive health information among unmarried women
3. Mother worship - strong desire to begin reproducing immediately upon marriage, competition between co-wives for status
What are some conflicts between the agenda put forth at the Cairo conference, and the ways that reproductive health is/was practiced?
•Cairo International Conference on Population and Development emphasized permitting individuals to achieve their reproductive intentions (emphasis on individual reproductive rights)

•Policies have been ineffective in lowering fertility in West Africa, where women face strong pronatalist norms regarding high fertility

•          Policy-makers’ interest in fertility reduction conflicts with the empowerment and “self-determination” philosophy of Cairo

•          High FP investments have little effect in places such as Senegal (esp. in marriage)

•          Foley: The policies and philosophy of USAID programs miss the mark entirely

–        They assume that the primary barriers to contraceptive use are access and quality


Why is it important to think about gender and economy in family planning?
Because men and women have different reproductive "goals" as well as different risks to consider. Also, women are generally less economicaly stable than men and must take that into account when making reproductive choices.
Describe the key methodological approaches and findings from the Cote d’Ivoire study.
•          Used semi-structured interviews and focus groups to study cultural context of FP •          Key informants guided subject selection of policy-makers, FP providers, consumers •          Interview instruments “back-translated” and then validated / pretested •          Analysis: Codebook development, transcript coding / recoding, write-up

•          Corporate family structure –        Extended family unit valorized, despite recent growth in constraints on size –        Desire to maintain solidarity despite change –        Fosterage and resource sharing w/ family influence FP choices •          Quality of FP service, education = priorities •          Gender and resources –        Children as “anchors” for established men –        Marriage requires male financial success     
Describe the use of codebooks in ethnographic research.
•          Short code names (mnemonics) and definitions –        E.g., “HIVFEARS” = Expresses fear or anxiety related to HIV/AIDS •          Definition of inclusion –        E.g., Includes fear of getting HIV for self or others; also includes fear of people with AIDS •          Definition of exclusion criteria –        E.g., Excludes any statement about fears related to passing HIV to others, in the case that participant is HIV-positive (See code FEARTRANS)  
What are the different kinds of governance that women in Ecuador encounter/confront?
Define biopower and its relationship to Dr. Roberts’ work in Ecuador.
Two kinds of biopower:

Anatamopolitics - the movement away from coercive power and toward focusing on individual behavior (habits, intimate individual behaviors)
Biopolitics - with the rise of nations, there are groups of people whose lives you need to manage (vaccination campaigns, trying to get people to reproduce "properly")  and the beginning of eugenics
Contrast the concepts of biopower and sovreign power.
Up until the 15-1600s most power was in the form of "sovereign power" meaning "do this or I'll kill you." Biopower arises when life becomes less precarious and we can make people live rather than just make them die. (Agrarian revolution.)
Describe the construction of citizenship and its relationship to health care in Ecuador.
In Ecuador, essentially nobody wants to be a "citizen" because it means you are devalued. If you have money, you can bypass the state in things like healthcare and security.
Define the gender paradox 
Paradox = if inequality shapes health, women should have worse health outcomes (longevity, morbidity, mortality), yet men often more at risk:
What are the various hypotheses/explanations for the gender paradox?
Courtney (1998): Men’s elevated risks due to the fact that males in U.S. with traditional beliefs about manhood more likely to:

–        Failure to adopt health-promoting behaviors

–        Propensity to engage in risky behaviors

–        Beliefs about manhood

–        Attitudes concerning vulnerability

–        Limited knowledge about health

Describe 3 dominant approaches to men’s health that were described in lecture.
1. Sex role theory: how masculine socialization influences men’s health
2. “Masculinities and health”: examines gender hierarchies among masculinities         3. Masculinity and the body: Examining biocultural bases of men’s health (bodily functioning; technologies of the body; the body politic)

Define Robert Brannon’s 4 components of the male role.
•          No Sissy Stuff: The need to be different from women (and, implicitly, homosexuals) •          The Big Wheel: The need to be superior to others •          The Sturdy Oak: The need to be independent and self-reliant •          Give ‘em hell: The need to be more powerful than others (through aggression)  
Describe Connell’s masculinities hierarchy.
1. Hegemonic masculinity: the prevailing, most lauded, idealized, and valorized form of masculinity in an historical setting

2.Complicit masculinity
A term associated with R. W. Connell’s writings on the gender hierarchy in society. Complicit masculinity is embodied by the many men in society who do not themselves live up to the ideal of hegemonic masculinity, yet benefit from its dominant position in the patriarchal order.

3. Marginal masculinity

4. Subordinate masculinity - homosexuality, transgendered...
Describe and critique the two models of ‘integration’ described by Inhorn and Dudgeon
1. “Women’s Rights and Men’s Responsibilities”

•          Sees men as primarily the “problem”

•          Seeks to achieve reproductive health equity by targeting services to women (and often excluding men)

•          “Interventions that exclude men may do less to achieve reproductive health equity than those that include them”

•          Problems with this approach

•          Assumes that one individual’s rights are separable from another’s

•          Neglects the possibility of co-existing reproductive rights for men and women in relation to one another

•          Avoids questions about men’s rights in relation to women: e.g., the right to influence women’s pregnancy? The right to have multiple partners?

2. The “Men as Partners” approach:

•          Focuses on men insofar as they are involved in the reproductive decision-making of their partners

•          Assumes heterosexual monogamy and fidelity

•          Problems with this approach

•          Neglects men’s involvement in their own reproductive / sexual decisions outside of partnerships (extramarital), or the non-reproductive dimensions

Describe Guttman’s concept of “globalized female contraceptive culture”
•          Promoted by international industries and media

•          Assumes women are primary consumers and users of contraceptives (no “oferta sistematica” for men)

•          Entirely neglects men as actual users (e.g., vasectomy rarely taught in schools)

•          Constrains the utilization of services by men in local contexts (problematizing “cultural barriers” like “machismo”)

Descibe Guttman’s findings regarding male vasectomy in Mexico
•          Question: How do Mexican men decide to have vasectomy?

–        Some men sensitive to women’s suffering: “you’ve already suffered…with the kids…”

–        “I try to help my wife a little in family planning”

–        Women’s empowerment with husbands

•          “Just think about what it’s like to have kids!”

•          Emphasizing simplicity of vasectomy as ”la cortadita”

•          “It’s your turn to suffer a little”

–        Men influencing other men:

•          “It’s no big deal”

Describe 8 arenas of constraint that Inhorn presents.
1. Class and the fact that the cost of these technologies is high influences the degree to which they can access these resources and it informs their decisions as to whether or not to engage in it, and how many times. It also has many influences on quality of care, the relationship to the provider.   2. Access to knowledge - influenced by class because people have educational opportunities that are correlated to class status so they have varying levels of access to information about ARTs   3. Access to technologies - rich go to private clinics where different types of therapies are available (including ability to access Europe and the US) , middle class often only have money for one trial   4. Religious constraints - what ART can be used (such as using a third party as part of the process)   5. The suffering body, stigma and gender (such as male infertility being ignored so it falls on women)   6. The religious framework means that there is no accountability because if the IVF procedure doesn't succeed, it was "god's will" and not because of a poor quality of care
Describe the concept of “local moral worlds”.
Local moral worlds occur at the intersection of instituion (religious or otherwise), family, social network and community.
Describe the methodological strengths and limitations of Inhorn's ethnographic work.
Inhorn has a tendency to contrast "The West" with "The Middle East" while ignoring local differences within a culture.


Methodological limitations - she tries to simplify language and tends to be less anthropological (questionable sweeping statements) and presumes an audience that is Western
What key arguments does Scheper Hughes articulate through her description of Angel Babies?
•          “Death without weeping” suggests angel baby beliefs socialize people to understand death differently: “Angel-baby beliefs not only ‘console’ [mourners], they shape and determine the way that death is experienced”

•          Mothers are socialized into “resignation” toward infants <1; they are not merely “coping” with an underlying (“natural”) grief

•          Question: Do all people feel the same fundamental grief but are obliged to mask it? Does S-H suggest socialized parental “neglect” by mothers?

What are the implications of Scheper-Hughes work for selective primary health care interventions such as ORT?
If a woman thinks she has an "Angel Baby" that is not meant to live, it is more difficult to convince her to try ORT or other interventions to save a child she thinks is hopeless.
Describe the TIPS process and its use in the Indonesian Family Nutrition Improvement program
Step 1: Fieldwork –        Site visits, rapport-building, observation of “natural” tasks –        Uses skills of ethnography and qual interviewing, but with a specific behavioral and applied task
  Step 2: Negotiation –        Regular visits involving “teaching” and “providing options” for change –        Continued observation of trial behaviors and conversations about “what works” and why –        Ends in the “trainee” selecting one of the options for behavior change  
Step 3: Analysis –        Asks questions of observational data: •          How many mothers (etc.) had each particular problem or situation? •          How many accepted which improved behaviors? •          What were the most effective motivations? •          What was their experience and success during the trial? •          What modifications in the suggestions did they make and why?  •          Who in the family and community influenced their behavior? •          What were the main barriers they had to overcome and how did they do this? •          What were their perceived benefits; and what is their intention to continue the new practice(s)?  
Step 4: –        Create recommendations, considering: •          Training needs •          Costs •          Expertise
Important concepts for success in Indonesia:
•          “Pleasing” the family •          Parental aspirations for the future •          Desirable balance in physical and psychological development (e.g., ‘greed’) •          Concerns of costs and time •          Mix of traditional and modern concepts of child care •          Need to emphasize larger quantities of food not “bad”    
Describe the concept of the “cabinet” that Snow describes and its relationship to “concurrency” of partners among youth in South Africa.
Young females in SA describe having "cabinet members". For example, there's the minister of finance (finances nice clothes, eating at fancy restaurant, etc.), minister of housing (pays rent).
How is this "cabinet" of South African women connected to larger structural processes?
This cabinet is connected to the larger structure of society because the women depend on their "cabinet members" in order to get by. If they had access to education and then to well-paying jobs, perhaps they wouldn't need them. This relates to PH because they are having intercourse with all the men, increasing the incidence of STIs. However, it seems the solution is not a "public health" one, but more of economic development. It reminds me of Paul Farmer's structural violence concept.
Describe the 5 strategies of HIV risk reduction that Warren presents.
1. EVERYBODY must delay sexual debut2. Promotional campaign to convince people that there is something very special about having sex with someone their own age3. Concurrency (multiple relationships that overlap) must stop (concurrency was created by financial needs, but has become a normative culture)4. Absolute prevention of vertical transmission (the passing of HIV from mother to unborn child)
5. Prevent late latent infections (people who don't know they are positive and live a long time without knowing)
Describe the major findings of Warren’s qualitative study.
These behaviors are the primary risk factors for HIVB infection:
1. Having many sex partners in a lifetime
2. Having concurrent partners
3. Having sex soon after meeting someone
4. Having one-night stands
5. Having more than one partner in the same month
6. Having overlapping partnerships
7. Having a "main" partner as well as other partners
Prevention messages should focus on:
1. Limiting sexual partners
2. Always using condoms
3. Knowing your HIV status
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