Circumcise or Circumvent: The Colonization of the Epidemiology of HIV/AIDS Research
Ann Hale, University of Sydney
The dominant paradigm informing HIV/AIDS preventive strategies and research has maintained a near exclusive focus on the sexual transmission of HIV infection. In this paper, I argue that this paradigm which was derived from a Western discourse originating predominantly in the United States is inadequate to account for HIV/AIDS transmission in developing countries where escalating HIV rates inevitably occur in countries that lack basic health infrastructure (clean water, sterile procedures, and adequate blood screening). Concomitant with poor health infrastructure is more often an indigenous mode of healing where an injection is the preferred health intervention. In these countries, the consequence is widespread use of non-sterile injections that at times of rapid HIV infection pose a comparable risk of HIV infection to that of intravenous drug use. Based on field work I carried out in Chiang Mai, Thailand, in 1996-97, which focused as much on policy makers and researchers as it focused on those who were researched, I document how failure to account for non-sterile needle use as a substantial mode of HIV/AIDS transmission confounded important research findings, in Thailand, at that time. In the current context, I examine the corporate response to the epidemic in Africa suggesting that this same omission is likely to have influenced the results of the clinical trials that informed the World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS (UNAIDS) recommendation in March 2007 that male circumcision should be introduced internationally as an important intervention to reduce HIV transmission in the developing world.
