I remember this story from my childhood days. Several people join a person anxiously looking for lost keys. After a while one of them asks how and when the keys were lost. They learn that he had dropped them in another place. So why is he looking for them elsewhere. Because, he says, it was pitch dark there. Here the light is better.
I have been reminded of it in the context of the HIV pandemic that has surprised the public health authorities in Sindh. I wish here to share some of the approaches that have been used across the globe and have enjoyed a degree of success.
The HIV epidemic in Sindh and Balochistan is a result of several factors, not merely an interplay of a retrovirus and an individual’s immune system. The attention of social scientists is likely to be as much of a requirement to restrict it as that of healthcare professionals. The realm of social sciences – especially anthropology, sociology, political science and history – must play their significant part to comprehensively understand the subtle factors: social, cultural, political, economic, historical, and environmental.
Dr Ronald Valdiserri, a deputy health secretary at the HIV/AIDS office of the USA, is reported to have remarked a month prior to his retirement: “The fact that biomedical science has tremendously advanced our ability to counter this epidemic should never be misinterpreted to mean that other components of a comprehensive response to HIV/AIDS are no longer necessary.”
That is to say that proper understanding of a problem is necessary for devising an efficacious strategy to deal with it. The HIV/ADIS problem is a complex one. We need a holistic approach to deal with it.
There are four theoretical lenses that a social sciences’ discipline, particularly the anthropology can employ. These frameworks were used to understand the origin and occurrence of the HIV/AIDS epidemic in Africa.
The first paradigm that studied the phenomenon of the HIV/AIDS was Handmaidens: The Biomedical Paradigm. This framework supported the biomedical research and never challenged it. Due to that overemphasis on the biomedical and individualistic perspectives, it received a criticism. In our case too, dealing with the HIV merely by medical orientations would not resolve the problem completely. It cannot help to cut the problem from the nib.
That weakness gave birth to the second lens, Cultural Experts: The Community Paradigm. This paradigm shifted its focus away from the individual-centric perspectives. Because in the 1980s, it appeared convincingly that the HIV phenomenon was not simple. Thus, it cannot be handled adequately by merely focusing on the individual psychology resulting in changes in sexual patterns. There are social, structural, cultural factors in play. The theoretical stream, as it did in the Africa, can substantially help understand the social and cultural meanings of the pathological reasons such as sex, or sharing of razors. The paradigm can play a vital role in making culturally appropriate prevention programmes.
Proper understanding of a problem is necessary for devising an efficacious strategy to deal with it. The problem of HIV infections is complex. We need a holistic approach
The third paradigm is Political Economists: The Structural Violence. This simultaneously draws on the second paradigm and critiques it, including the first one. The structural violence lens certainly seems an addition to the cultural experts, whilst centring the focus from the local socio-cultural processes, which are responsible for risk of infection, to the global political economy. In simple words, it is broader than the paradigm two, since it focuses on links between the local and the global inequalities. The central figure, Paul Farmer – a physician-turned-medical anthropologist – proposes to situate a crisis in a wider context. He and his colleagues propose a ‘biosocial approach’ to question the chief factors such as sexism and inequality.
The HIV epidemic in our country sits rather well in this paradigm, keeping in view the national situation as well as the global context. For instance, our foreign policy or the recent ongoing IMF deal. What repercussions such international moves bring for our country have thoroughly been studied.
The fourth paradigm can be either a synthesis of the above-mentioned lenses or an altered form of them or a completely new assemblage of diverse paradigms. For example, Arthur Kleinman and his colleagues’ paradigm of ‘social suffering’ that questions how, on one hand, political, economic, and institutional power produces social suffering, and on the other, such power shapes the responses to such issues. It accounts for social suffering as “an assemblage of the human problems that have their origins and consequences in the devastating injuries that social force might in?ict on human experience.”
These are some of the possible frameworks, which can be employed to conduct extensive research on HIV/AIDS, other crises included. We must utilize and shift our research to the next level. Since without proper research, we can do next to nothing, but just waste our resources.
Social disciplines should jump in and encourage their students with an obligation to formulate the projects in the arena of applied research. Related to this, however, is an indispensable factor: the money.
Unfortunately, social sciences in Pakistan, particularly anthropology, remain marginalized. One can clearly draw a line between the natural and social sciences. Quality social science research consumes time and resources. It is however worth it in the end. A lack of funding hinders quality research. High-income countries never ignore social science research in terms of resource allocation no in terms of its importance for building a better society.
Given the gravity of the crises, the HIV/AIDS epidemic included, that have engulfed our country and the scarcity of resources for social science research, the first necessary step is to allocate ample funds to such disciplines for conducting comprehensive research works. The government may also announce independent consultancies. The conclusions of the research should be used to devise effective programmes to tackle the crises assiduously. This will aid to find the lost key, easily and appropriately.
The writer is a PhD scholar at the University of Vienna, Austria. He can be reached at: [email protected]