Anthropology speaks to medicine: the case HIV/AIDS in Africa

INTRODUCTION It is exceedingly rare for medical doctors and anthropologists to sit down and exchange ideas, even about an issue as important as the global HIV/AIDS epidemic. Does that mean that anthropologists have no knowledge of value to add to the epidemiological and biomedical understanding of the epidemic? This paper asserts that, despite the general neglect of anthropology by the biomedical and public health sciences, anthropology as a discipline has contributed valuable concrete knowledge that has enriched the epidemiological and biomedical understanding of the HIV/AIDS epidemic. The paper argues that two schools of competing anthropological thought have contributed to this knowledge base. The first school is comprised of what will be called traditional anthropologists. These are classically trained anthropologists who see their role as adding socio-cultural depth to biomedical and epidemiological understandings of the HIV/AIDS epidemic. The second school stands for anthropological change. This group of political economy (PE) anthropologists argues that anthropology's 'special understanding' of society is not of primary relevance to understanding HIV/AIDS, as it is the political and economic structure in which individuals act that shapes their behaviour. This school proposes structural violence, the notion that societal structures such as racism, sexism and inequality cause direct and indirect harm to individuals, as the principal perspective for understanding HIV/AIDS1. The paper examines anthropology's contribution to our understanding of HIV/AIDS and sexuality, gender, risk groups, and behaviour change strategies. The paper argues that while the PE anthropologists provide an extremely valuable perspective, their approach does not capitalize on anthropology's comparative advantage (a rich understanding of the local cultural context) and therefore risks ignoring an important level of anthropological analysis the local culture. Thus both types of anthropological knowledge have contributed to our understanding of HIV/AIDS, and without this knowledge, clinicians and public health practitioners would lack our current nuanced understanding of the epidemic. The focus of the paper is on the HIV/AIDS epidemic in sub-Saharan Africa specifically as Africa is home to 64 percent of all people living with HIV (1). While UNAIDS asserts that "[t]here is no such thing as the 'African' epidemic'" because there is a tremendous diversity across the continent in patterns of HIV infection, there are nonetheless certain commonalities found across sub-Saharan Africa (2). First, both aggregate prevalence and incidence are the highest in the world, with profound human and socio-economic ramifications. Second, despite recent strides forward, treatment rates remain the lowest in the world, with an estimated treatment coverage of fifteen percent (1). Third, the epidemic occurs alongside a number of macro-level social shocks such as wars, macroeconomic crises, other infectious disease epidemics, and high levels of political instability (3, 4, 5, 6).