Map of life expectancy at birth from Global Education Project.

Tuesday, December 09, 2008

Case Study

As readers will have gathered by now, much of my work in public health has concerned HIV. This is partly an accident of timing -- I got into the field in the early 1990s when HIV was the biggest thing going. And I have to admit that HIV exceptionalism -- the perhaps disproportionate amount of funding that goes to HIV-related programs and research -- has helped to keep this particular problem more or less front and center for me. It's certainly not the only focus of my work, and to the extent it is a focus, I think of it as a more broadly instructive example, not a universe unto itself.

But HIV is uniquely instructive, for a medical and public health sociologist. This virus -- a little bit of genetic information that got adrift in the world, a microscopic, mindless, lifeless fragment of chemistry -- brings into sharp relief some of the most important issues in fields as disparate as health promotion and disease prevention, clinical practice, the organization and financing of health systems, and the sociology of science.

A frequently productive intellectual trick is to organize a discussion around a theme that crosses conventional boundaries, so we serendipitously discover linkages and resemblances. For example, a professor might teach a course entitled "Chocolate." Students sign up because they like chocolate, and they end up learning about botany, tropical agriculture, colonialism, African politics and economics, international trade relations, the organization of the food industry, industrial processes, product marketing, and the biology of human sensory perception and psychological reward. These all get fit together to help fill in our picture of the world, and the observed patterns and connections extend far beyond the various meanings of a flavorful bean.

HIV is biologically similar everywhere, but its socially constructed meaning differs radically from place to place, to some extent in a causal dance with the epidemiology but also independently. The sociology of HIV has changed just as much over time, as HIV has transformed the cultures around it, as the epidemic has evolved, and as medical science has changed the nature and context of HIV disease. HIV reveals so much that is central to our interests here, so I'm going to spend some time in the coming days on its story.

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