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Bevan I, Bauld L, Street A. Who We Test For: Aligning Relational and Public Health Responsibilities in COVID-19 Testing in Scotland. Med Anthropol 2024; 43:277-294. [PMID: 38713821 PMCID: PMC11104742 DOI: 10.1080/01459740.2024.2349514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
COVID-19 testing programs in the UK often called on people to test to "protect others." In this article we explore motivations to test and the relationships to "others" involved in an asymptomatic testing program at a Scottish university. We show that participants engaged with testing as a relational technology, through which they navigated multiple overlapping responsibilities to kin, colleagues, flatmates, strangers, and to more diffuse publics. We argue that the success of testing as a technique of governance depends not only on the production of disciplined selves, but also on the program's capacity to align interpersonal and public scales of responsibility.
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Affiliation(s)
- Imogen Bevan
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Linda Bauld
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Alice Street
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
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Kyweluk MA. Quantifying fertility? Direct-to-consumer ovarian reserve testing and the new (in)fertility pipeline. Soc Sci Med 2019; 245:112697. [PMID: 31786460 DOI: 10.1016/j.socscimed.2019.112697] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022]
Abstract
Frequently branded the "egg timer" or "biological clock test," anti-Müllerian hormone (AMH) testing for women is becoming widely available in the United States (US) through online, direct-to-consumer (DTC) testing services. The level of AMH in the blood reflects the remaining egg supply or "ovarian reserve"-a potential fertility indicator. AMH level is primarily used as a diagnostic tool prior to ovarian stimulation for in vitro fertilization (IVF) or oocyte cryopreservation (OC; i.e., egg freezing). This article describes the first ethnographic research on DTC ovarian reserve testing in the US, with a recruited sample of 21 participants interested in pursuing testing who consented to participant observation and semi-structured interviews. Fieldwork took place from January 2018 to July 2018 in Chicago, Illinois. Ethnographic cases explore how experiences with ovarian reserve testing are shaped by relationship status, sexual orientation, socioeconomic status, racial/ethnic identity, and medical insurance coverage. Thematic analysis suggests that DTC ovarian reserve testing is a unique means of investigating fertility; participants felt empowered by receiving testing outside of traditional medical contexts. It was an alternative tool for family planning, particularly for LGBTQ + individuals and single women. However, participants experienced varying degrees of certainty about test results and the appropriate next steps to take to confirm fertility status, preserve fertility, or conceive, thus suggesting that DTC testing may confound reproductive decision-making. I argue that DTC ovarian reserve testing is a new tool in a larger medical and social project to mitigate anticipated future infertility and is an entry point into what I term the new (in)fertility pipeline encouraging entanglement with reproductive technologies across the lifespan. Due to its low cost and widespread availability, DTC ovarian reserve testing reaches a broader demographic, encourages testing across diverse identities and backgrounds, and increases awareness of more advanced assisted reproductive technology (ART), including egg freezing.
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Affiliation(s)
- Moira A Kyweluk
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Perelman School of Medicine, 423 Guardian Drive, Blockley Hall, Philadelphia, PA 19104-4884, USA.
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Mora C, Monteiro S, Moreira COF. Institutional context and VCT practitioner narratives: possibilities and limitations for HIV prevention in Rio de Janeiro, Brazil. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2017; 17:31. [PMID: 29202754 PMCID: PMC5715632 DOI: 10.1186/s12914-017-0139-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 11/21/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Voluntary Counseling and Testing (VCT) is an HIV prevention strategy that promotes the principles of confidentiality and informed consent. International research has highlighted VCT counselors' isolation from service planning and the contradictions they negotiate between local values and global testing recommendations. In Brazil, studies have identified many limitations, including counselors' difficulties to implement a vulnerability approach to HIV prevention as recommended in the country's national guidelines. These studies, however, have not considered the particularities of the institutional contexts where counselors work. This research addresses these gaps in the VCT literature by exploring how VCT services are organized and how counselors perceive and perform their practices in the state of Rio de Janeiro, Brazil. METHODS This is a case study of VCT services in the state of Rio de Janeiro. The research design included individual structured interviews with seven VCT service coordinators and twenty individual semi-structured interviews with VCT counselors. Participants were sampled according to gender, undergraduate degree and work trajectory to capture a diverse range counselor narratives. RESULTS The VCT services were relatively homogenous in terms of functioning and had a similar restricted roll of activities including individual counseling and occasional external prevention activities with groups vulnerable to HIV. All VCT services reported reductions in staff size. Some counselors used dialogical practices to build trust, guarantee confidentiality and adjust their practices in accordance with their clients' values and practices. Others emphasized imperative messages or focused on risk and individual responsibility. Connections between how counselors perceive their practices and the organization of their work environment were observed. CONCLUSIONS Due to the importance of counseling as a prevention strategy we recommend rethinking the relationship between counselors' practices and the organization of VCT services. The challenges brought about by the expansion of "test and treat" programs globally and other social and symbolic aspects of the HIV epidemic, such as gender inequalities, must also be taken into account. Further reflection is also needed on the relationship between counseling guidelines and practices within the vulnerability approach to HIV prevention.
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Affiliation(s)
- Claudia Mora
- State University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Abstract
Papua New Guinean nurses work in a sociomedical system in which cultural and linguistic diversity are matters of pressing concern. Using data drawn from ethnographic research with PNG nursing students, I show how nursing education socializes nurses to take stances toward language and communication that impact their care practices. I argue that nurses' use of language is shaped by their ethical commitments as educated Christians and indigenous concerns about the links between language, emotion, and health. In a resource-poor setting where health workers risk blame for structural inequalities, this "ethical metapragmatics" is an important but neglected facet of care work.
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Affiliation(s)
- Barbara Andersen
- a School of People, Environment and Planning , Massey University , Auckland , New Zealand
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Praspaliauskiene R. Enveloped Lives: Practicing Health and Care in Lithuania. Med Anthropol Q 2016; 30:582-598. [DOI: 10.1111/maq.12291] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/03/2016] [Accepted: 03/10/2016] [Indexed: 11/30/2022]
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Valle CGD. Biosocial Activism, Identities and Citizenship: Making up 'people living with HIV and AIDS' in Brazil. VIBRANT: VIRTUAL BRAZILIAN ANTHROPOLOGY 2015. [DOI: 10.1590/1809-43412015v12n2p027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract This article discusses how Brazilian AIDS activism has emerged and been reconfigured over the last 25 years. I analyze how societal forms were created and particular problems emerged in a specific context affected by the AIDS epidemic. Based on ethnographic research in concrete contexts in Brazil, I follow the ways by which people have united around various ideas and practices related to life, health and illness, morality and politics. People affected by the epidemic were engaged in sociality, identity formation and the definition of a wide range of health, political and judicial demands, which take a particular biosocial activism as their main form of collective mobilization. My main aim is to reflect, therefore, on the formation of particular biosocial worlds, socialities, collectivities and identities related to specific modes of subjectification surrounding life and death, biomedicine and biotechnologies, politics and citizenship.
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Fiereck KJ. Cultural conundrums: the ethics of epidemiology and the problems of population in implementing pre-exposure prophylaxis. Dev World Bioeth 2015; 15:27-39. [PMID: 24373050 PMCID: PMC4067472 DOI: 10.1111/dewb.12034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The impending implementation of pre-exposure prophylaxis (PrEP) has prompted complicated bioethical and public health ethics concerns regarding the moral distribution of antiretroviral medications (ARVs) to ostensibly healthy populations as a form of HIV prevention when millions of HIV-positive people still lack access to ARVs globally. This manuscript argues that these questions are, in part, concerns over the ethics of the knowledge production practices of epidemiology. Questions of distribution, and their attendant cost-benefit calculations, will rely on a number of presupposed, and therefore, normatively cultural assumptions within the science of epidemiology specifically regarding the ability of epidemiologic surveillance to produce accurate maps of HIV throughout national populations. Specifically, ethical questions around PrEP will focus on who should receive ARVs given the fact that global demand will far exceed supply. Given that sexual transmission is one of the main modes of HIV transmission, these questions of 'who' are inextricably linked to knowledge about sexual personhood. As a result, the ethics of epidemiology, and how the epidemiology of HIV in particular conceives, classifies and constructs sexual populations will become a critical point of reflection and contestation for bioethicists, health activists, physicians, nurses, and researchers in the multi-disciplinary field of global health. This paper examines how cultural conundrums within the fields of bioethics and public health ethics are directly implicated within the ethics of PrEP, by analyzing the problems of population inaugurated by the construction of the men who have sex with men (MSM) epidemiologic category in the specific national context of South Africa.
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Affiliation(s)
- Kirk J. Fiereck
- Department of Sociomedical Sciences, Columbia University, New York City, New York, 10032, United States, Phone: 212-305-5656
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Seligman R, Mendenhall E, Valdovinos MD, Fernandez A, Jacobs EA. Self-care and Subjectivity among Mexican Diabetes Patients in the United States. Med Anthropol Q 2014; 29:61-79. [DOI: 10.1111/maq.12107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Rebecca Seligman
- Department of Anthropology and Institute for Policy Research; Northwestern University
| | - Emily Mendenhall
- Science, Technology, and International Affairs Program; Edmund A. Walsh School of Foreign Service; Georgetown University
| | | | - Alicia Fernandez
- Division of General Internal Medicine; San Francisco General Hospital
| | - Elizabeth A. Jacobs
- Division of General Internal Medicine & Health Innovation Program; University of Wisconsin-Madison School of Medicine and Public Health
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Abstract
Over the past two decades, molecular technologies have transformed the landscape of cancer diagnosis, treatment and disease surveillance. However, although the effects of these technologies in the areas of primary and secondary cancer prevention have been the focus of growing study, their role in tertiary prevention remains largely unexamined. Treating this topic as a problematic to be conceptually explored rather than empirically demonstrated, this article focuses on the molecularisation of tertiary prevention, especially the growing use of molecular biomarkers to monitor disease recurrence. Taking a semiotic approach, I speculate on the potential meanings of molecular biomarkers for people living with and beyond cancer and suggest the meanings of these technologies may differ in important ways for those on both sides of the risk divide: that is, those 'at risk' for cancer and those living with realised risk. Although molecular biomarkers may intensify a sense of 'measured vulnerability', by indexing cancer's presence they may also prove reassuring. Moreover, as an invisible but ostensibly 'transparent' sign, in some contexts they appear to enable cancer survivors to challenge biomedical decision making. In the light of recent oncological debates about the value of these biomarkers in tertiary prevention, I conclude by suggesting that signs can never be reduced to their 'objective' biomedical denotation in spite of professional attempts to expunge meaning and value from care.
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Affiliation(s)
- Kirsten Bell
- Department of Anthropology, University of British Columbia , 6303 NW Marine Dr, Vancouver, BC V6 T 1Z3, Canada . E-mail:
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Soares PDS, Brandão ER. O aconselhamento e a testagem anti-HIV como estratégia preventiva: uma revisão da literatura internacional, 1999-2011. SAUDE E SOCIEDADE 2012. [DOI: 10.1590/s0104-12902012000400013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Com base em revisão bibliográfica discute-se a literatura produzida nos anos de 1999 a 2011, no campo da saúde coletiva, sobre uma importante estratégia de prevenção da transmissão do HIV: o aconselhamento e testagem anti-HIV. O artigo realiza um balanço da literatura internacional, analisando criticamente os aspectos mais assinalados pela comunidade científica, apontando divergências e convergências entre os estudos e identificando lacunas que possam estimular o desenvolvimento de novas pesquisas neste campo temático. Como resultado, evidenciou-se que os processos de decisão de realizar um teste e a experiência da testagem são discutidos na literatura com abordagens fragmentadas, sejam de ordem individual ou institucional. Para compreender diversas dimensões implicadas na adoção de uma prática preventiva como o teste HIV, é preciso contemplar indicadores sociais tais como gênero, religião, identidade sexual, raça/cor, e relacioná-los às políticas públicas e à operacionalização dos serviços de saúde. O uso expressivo do conceito de risco (aliado às categorias de grupo, comportamento, percepção) e de escalas quantitativas para aferir a percepção individual do risco como uma barreira para a realização do teste ilustra o foco excessivo sobre uma dimensão individual e parcial do problema.
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Norris A, Jackson A, Khoshnood K. Exploring the Ethics of Observational Research: The Case of an HIV Study in Tanzania. AJOB PRIMARY RESEARCH 2012; 3:30-39. [PMID: 24069546 PMCID: PMC3779918 DOI: 10.1080/21507716.2012.714836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Observational studies have generally been viewed as incurring minimal risk to participants, resulting in fewer ethical obligations for investigators than intervention studies. In 2004, the lead author (AN) carried out an observational study measuring sexual behavior and the prevalence of HIV, syphilis, and herpes simplex virus type 2 (HSV-2), among Tanzanian agricultural plantation residents (results reported elsewhere). This article uses an ethical lens to consider the consequences of the observational study and explore what, if any, effects it had on participants and their community. METHODS Using a case study approach, we critically examine three core principles of research ethics-respect for persons/autonomy; beneficence/nonmaleficence; and distributive justice-as manifested in the 2004 observational study. We base our findings on three sources: discussions with plantation residents following presentations of observational research findings; in-depth interviews with key informants; and researcher observations. RESULTS The observational research team was found to have ensured confidentiality and noncoercive recruitment. Ironically, maintenance of confidentiality and voluntary participation led some participants to doubt study results. Receiving HIV test results was important for participants and contributed to changing community norms about HIV testing. CONCLUSIONS Observational studies may act like de facto intervention studies and thus incur obligations similar to those of intervention studies. We found that ensuring respect for persons may have compromised the principles of beneficence and distributive justice. While in theory these three ethical principles have equal moral force, in practice, researchers may have to prioritize one over the others. Careful community engagement is necessary to promote well-considered ethical decisions.
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Solomon H. Affective journeys: the emotional structuring of medical tourism in India. Anthropol Med 2011; 18:105-18. [DOI: 10.1080/13648470.2010.525878] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Oliveira MICD, Silva KSD, Gomes Junior SC, Fonseca VM. Resultado do teste rápido anti-HIV após o parto: uma ameaça à amamentação ao nascimento. Rev Saude Publica 2010; 44:60-9. [DOI: 10.1590/s0034-89102010000100007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 07/07/2009] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar fatores associados à não-amamentação na primeira hora de vida, sobretudo a influência do momento do resultado do teste rápido anti-HIV. MÉTODOS: Estudo de coorte, sendo o ponto inicial a submissão ao teste rápido e o final a primeira mamada do bebê. A população estudada incluiu 944 parturientes submetidas ao teste rápido anti-HIV, com resultado negativo, em 2006, nos cinco hospitais amigos da criança do Sistema de Gestação de Alto Risco no município do Rio de Janeiro, RJ. Entrevistadoras treinadas obtiveram dados do laboratório e do prontuário e no pós-parto aplicaram questionário para entrevista às mães. O modelo multinível foi adotado para analisar a influência de características sociodemográficas, de assistência pré-natal e ao parto sobre a não-amamentação na primeira hora de vida. RESULTADOS: Dentre as participantes, apenas 15,6% receberam seu resultado antes do parto, 30,8% depois do parto e 53,6% ainda desconheciam o resultado ao ser entrevistada. A prevalência de não-amamentação na primeira hora de vida foi de 52,5% (IC 95%: 49,3;55,8). Após ajuste, o recebimento do resultado do teste rápido após o parto dobrou o risco da não-amamentação na primeira hora de vida (RR=2,06; IC 95%: 1,55;2,75). Outros fatores de risco foram: cor não branca, renda materna de um salário mínimo ou menos, parto cesáreo, mãe não querer amamentar o bebê ao nascimento e mãe referir que a equipe hospitalar não a escutava. O desconhecimento da realização do teste rápido anti-HIV pela mãe se mostrou como fator de proteção. CONCLUSÕES: O principal fator de risco para a não-amamentação na primeira hora de vida foi o recebimento do resultado do teste rápido após o parto. O teste anti-HIV deve ser amplamente disponibilizado no pré-natal e o teste rápido deve ser realizado sob indicação, na admissão, com busca ativa e pronta comunicação do resultado à mulher.
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Affiliation(s)
- João Biehl
- Department of Anthropology, Princeton University, Princeton, New Jersey 08544; ,
| | - Amy Moran-Thomas
- Department of Anthropology, Princeton University, Princeton, New Jersey 08544; ,
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Life of the mind: The interface of psychopharmaceuticals, domestic economies, and social abandonment. AMERICAN ETHNOLOGIST 2008. [DOI: 10.1525/ae.2004.31.4.475] [Citation(s) in RCA: 168] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Obermeyer CM, Osborn M. The utilization of testing and counseling for HIV: a review of the social and behavioral evidence. Am J Public Health 2007; 97:1762-74. [PMID: 17761565 PMCID: PMC1994175 DOI: 10.2105/ajph.2006.096263] [Citation(s) in RCA: 263] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2006] [Indexed: 01/31/2023]
Abstract
Against the background of debates about expanding HIV testing and counseling, we summarize the evidence on the social and behavioral dimension of testing and its implications for programs. The discrepancy between acceptance of testing and returning for results and the difficulties of disclosure are examined in light of research on risk perceptions and the influence of gender and stigma. We also summarize the evidence on the provision of testing and counseling, the implementation of practices regarding confidentiality and consent, and the results of interventions. We demonstrate that social factors have a considerable impact on testing, show that the services linked to testing are key determinants of utilization, and consider the implications of these findings for HIV testing programs.
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Edmonds A. ?The poor have the right to be beautiful?: cosmetic surgery in neoliberal Brazil. JOURNAL OF THE ROYAL ANTHROPOLOGICAL INSTITUTE 2007. [DOI: 10.1111/j.1467-9655.2007.00427.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Van Hollen C. Navigating HIV, pregnancy, and childbearing in South India: pragmatics and constraints in women's decision making. Med Anthropol 2007; 26:7-52. [PMID: 17365636 DOI: 10.1080/01459740601021186] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Based on ethnographic research conducted in 2004 and 2002-3, this article examines how poor women living with HIV in Tamilnadu, India navigate decisions about pregnancy and birth, and demonstrates that these decisions are influenced by a complex web of sociocultural factors. I argue that these decisions are informed by: 1) institutional interests of the state, NGOs, and international aid donors; 2). cultural constructions of gender and of the self; 3). Christian-based organizations; and 4). support group organizations, known as "networks" for people living with HIV/AIDS. Childbearing decisions emerged through a synthesis of coexisting structures and discourses which sometimes converged at the same conclusion despite differences in their underlying logics. I argue that the discourse of "positive living" fostered by the networks provided women with a framework for making reproductive decisions that was enabling. The article highlights how women pragmatically negotiated these various factors as they engaged in reproductive decision-making.
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Abstract
The intensive entertainment infrastructure of Las Vegas is overlaid with a robust therapeutic network for those who become addicted to its technologies. Although the objectives of gambling machines and addiction therapeutics are seemingly at odds--the first work to encourage play, the second to stop it--both gear their interventions around a model of the self as a continuum of behavioral potentials that can be externally modulated. For compulsive gamblers implicated in this circuit of modulation, pharmaceutical drugs that have been prescribed to dampen cravings for machine play sometimes function as intensifiers of its effects. Caught in an intractable play between technologies of harm and technologies of care, recovering gambling addicts are challenged to assemble a technical array through which they can maintain balance; health itself, for these individuals, becomes a state of managed dependency. This essay explores the shifting terms and changing stakes of subjectivity and health in the contemporary United States by way of ethnographic research on compulsive gamblers who live and work in Las Vegas. The analysis draws on interviews with gamblers as well as on observations in local self-help groups, directed group therapy sessions, and chat rooms of Internet recovery Web sites.
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Affiliation(s)
- Natasha Dow Schüll
- Program in Science, Technology, and Society, Massachusetts Institute of Technology, Building E51-185, 77 Massachusetts Avenue, Cambridge, 02139, USA.
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Kaufman SR, Russ AJ, Shim JK. Aged bodies and kinship matters: The ethical field of kidney transplant. AMERICAN ETHNOLOGIST 2006; 33:81-99. [PMID: 18461150 PMCID: PMC2373268 DOI: 10.1525/ae.2006.33.1.81] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The number of kidneys transplanted to people over age 70, both from living and cadaver donors, has increased steadily in the past two decades in the United States. Live kidney donation, on the rise for all age groups, opens up new dimensions of intergenerational relationship and medical responsibility when the transfer of organs is from younger to older people. There is little public knowledge or discussion of this phenomenon, in which the site of ethical judgment and activism about longevity and mortality is one's regard for the body of another and the substance of the body itself is ground for moral consideration about how kinship is "done." The clinic, patient, and patient's family together shape a bond between biological identity and human worth, a demand for an old age marked by somatic pliability and renewability, and a claim of responsibility that merges the "right to live" and "making live." Live kidney transplantation joins genetic, reproductive, and pharmacological forms of social participation as one more technique linking ethics to intervention and the understanding of the arc of human life to clinical opportunity and consumption. Significant in this example is the medicocultural scripting of transplant choice that becomes a high-stakes obligation in which the long-term impacts on generational relations cannot be foreseen.
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Affiliation(s)
- Sharon R. Kaufman
- Department of Anthropology, History and Social Medicine, Institute for Health and Aging, Box 0646, University of California, San Francisco, CA 94143-0646,
| | - Ann J. Russ
- Institute for Health and Aging, Box 0646, University of California, San Francisco, CA 94143-0646,
| | - Janet K. Shim
- Department of Social and Behavioral Sciences and Institute for Health and Aging, Box 0646, University of California, San Francisco, CA 94143-0646,
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Abstract
This review of recent studies examines the conceptual and methodological tools that are used to understand sexual behavior and HIV. Whereas surveys have provided reliable indicators of behavior, their validity is uncertain, their correlation with biological indicators tenuous, and the explanations they offer limited. Microlevel research has called into question the rationalizing, medically informed, and risk-averse frameworks used in the public health literature on HIV and behavior, but its impact has been limited. Thus, surveys and qualitative research have proceeded along two separate tracks, and this separation has hampered our understanding of sexual behavior. A small but growing number of studies, however, provide examples of less-compartmentalized research that avoids oversimplification. They show that expanding the models that drive research in this area is possible, and that efforts to combine disciplinary perspectives result in deeper understandings of knowledge, risk perceptions, attitudes, and behavioral change.
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Subjects of Speculation: Emergent Life Sciences and Market Logics in the United States and India. AMERICAN ANTHROPOLOGIST 2005. [DOI: 10.1525/aa.2005.107.1.019] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Goldani MZ, Giugliani ERJ, Scanlon T, Rosa H, Castilhos K, Feldens L, Tomkins A. Voluntary HIV counseling and testing during prenatal care in Brazil. Rev Saude Publica 2003; 37:552-8. [PMID: 14569329 DOI: 10.1590/s0034-89102003000500002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: Voluntary HIV counseling and testing are provided to all Brazilian pregnant women with the purpose of reducing mother-to-child HIV transmission. The purpose of the study was to assess characteristics of HIV testing and identify factors associated with HIV counseling and testing. METHODS: A cross-sectional study was carried out comprising 1,658 mothers living in Porto Alegre, Brazil. Biological, reproductive and social variables were obtained from mothers by means of a standardized questionnaire. Being counseling about HIV testing was the dependent variable. Confidence intervals, chi-square test and hierarchical logistic model were used to determine the association between counseling and maternal variables. RESULTS: Of 1,658 mothers interviewed, 1,603 or 96.7% (95% CI: 95.7-97.5) underwent HIV testing, and 51 or 3.1% (95% CI: 2.3-4.0) were not tested. Four (0.2%) refused to undergo testing after counseling. Of 51 women not tested in this study, 30 had undergone the testing previously. Of 1,603 women tested, 630 or 39.3% (95% CI: 36.9-41.7) received counseling, 947 or 59.2% (95% CI: 56.6-61.5) did not, and 26 (1.6%) did not inform. Low income, lack of prenatal care, late beginning of prenatal care, use of rapid testing, and receiving prenatal in the public sector were variables independently associated with a lower probability of getting counseling about HIV testing. CONCLUSIONS: The study findings confirmed the high rate of prenatal HIV testing in Porto Alegre. However, women coming from less privileged social groups were less likely to receive information and benefit from counseling.
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Affiliation(s)
- Marcelo Zubaran Goldani
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
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Rajan KS. Genomic capital: public cultures and market logics of corporate biotechnology. SCIENCE AS CULTURE 2003; 12:87-121. [PMID: 15971369 DOI: 10.1080/0950543032000062272] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Kaushik Sunder Rajan
- John F. Kennedy School of Government, Harvard University, Cambridge, MA 02138, USA.
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