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22 Oct 2014
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Infections and Inequalities Chapter 4
-Paul Farmer discuses a conference he went to where the topic was Aids
-noticed that the general feeling and emotion was “accusation”, accusing the Haitians of
having rituals like the transfer of flood and secretion from person to person
>“Women have been known to introduce menstrual blood into the food and drink of
their partners to prevent them from ‘straying.
-working through the problem of AIDS in Haiti, he found a new “biosocial” perspective.
-critical epidemiology had the power to show a great deal about a new infectious disease.
- Local (in Haiti) interpretations of AIDS often hinged on allegations of sorcery
-not a matter of physical or political geography, but of moral geography. A geography of
blame
>Social responses to the new disease, like the disease itself, linked Haiti’s rural
Central Plateau to the city of Port-au-Prince and, beyond that, to the United States.
-in the US, AIDS was embedded in a framework of blame and accusations
-early in the AIDS pandemic, many Haitians fell ill with opportunistic infections of the
new syndrome
>some of the affected lived in urban Haiti, others had migrated to US and Canada
>unlike the other patients being diagnosed with AIDS in the US, these Haitian
immigrants denied homosexual activity or intravenous drug use
-wide range or theories came up to explain the epidemiology and origin of AIDS
-e.x in dec 1982, a physician said that it was an epidemic Haitian virus that was brought
back to the homosexual population in the US
>this theory was echoed by other physicians as well
-in North America and Europe, other scientists said it was linked to voodoo practices.
-The persistence of these theories represents, in fact, a systematic misreading of existing
epidemiologic and ethnographic data
-link b/w AIDS and Haiti resonated within a North American folk model of Haitians
-Farmer’s interest in AIDS in Haiti mandated research on the island.
-HIV affected Haiti not only indirectly through the prejudices of North American
scientists, employers, landlords and tourists but also directly through the ravages of a
fatal malady
-most chroniclers of the AIDS pandemic agree that awareness of the new syndrome
began to emerge in California in 1981
-likely first AIDS related case of Kaposi’s sarcoma, in Haiti in June 1979
-dermatologist who diagnosed the first case posed the following question: was the cancer
of long-standing and unappreciated importance in Haiti, or was it new to the country?
-research presented at AMH’s conference showed that a new state of immunodeficiency
was striking inc numbers of young adults in urban Haiti, especially men
-there were differences between the epidemics in US and Haiti
>researchers noted that a smaller proportion of Haitian AIDS patients had
Pneumocytsis carinii pneumonia. This was the most common opportunistic infection in
North Americans with AIDS
-tuberculosis was soon seen to be the most common presenting illness among Haitians
with AIDS
-mean survival after diagnosis was greater than a year in the US, survival was less than 6
months in Haitian patients.
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