Sexual Health in India

I chose to look at sexual health in India as my global health problem.  Specifically there is a big issue with the spread of HIV.  One of the issues leading to this problem is the taboo surrounding sexual activity-especially outside of marriage.  This taboo has led to conflict between volunteer agencies trying to promote sexual health and police who believe they are violating laws by educating the lower classes about safe sex and handing out free condoms.  According to Patralekha Chatterjee, “At the heart of the crisis are systems of law and enforcement that remain insensitive to the requirements of the unfolding epidemic and the dangers posed by cultural taboos that impede discussions about sexual health (more than 80% of HIV cases in India are attributed to sexual transmission)”.  Outreach groups who are working specifically with homosexual men are seen as acting unlawfully since homosexual sex is a criminal offence.  Local governments are working to mediate between the larger governments policies and aid groups to find ways to be more sensitive to cultural taboos and help these groups to not be harassed.  The Delhi State AIDS Control Society (DSACS), who is help these aid groups, is also working with police to educate them and “dispel myths about HIV/AIDS”. The origin of this problem goes back to the late nineteenth century when homosexual sex was criminalized.  The origin also lies in the cultural taboos surrounding sexual activity.  If people do not want to talk about it, it is difficult to promote healthy behavior.  The problem of high HIV rates is exacerbated by this cultural taboo and the disconnect between aid groups who are promoting safe sex and the police who are viewing their help as unlawful.  There is also a disconnect in understanding between what is needed to prevent the spread of this epidemic and what is ok to talk about.

One anthropologist working in this area is Dr. Paul Boyce out of University of Sussex.  His work is largely based around understanding the world of men who have sex with men in India and AIDS.  He has also written about why the HIV/AIDS epidemic is still growing despite the global efforts and programs aimed and reducing this epidemic.

http://search.proquest.com.proxy2.cl.msu.edu/docview/199050056/138784F85D633A7DD08/15?accountid=12598

http://www.sussex.ac.uk/anthropology/people/peoplelists/person/285569

HIV and AIDS in Malawi

Currently, approximately one million of the 15 million people living in Malawi are living with HIV. The first case of AIDS in Malawi was reported in 1985 and a short-term response program was enacted. It is argued that these government programs really did little to help, including the creation of the National AIDS Control Programme (NACP) in 1988. However, by 1989, a five-year plan was announced. Politics stunted the tackling of the growing epidemic, and by this time the effects of HIV began to take it’s toll on the economy.

In 2000, another five-year plan was established and the governments efforts in increasing knowledge about the transmission of the disease and it’s prevalence have greatly increased. HIV is most common in urban areas and 60% of cases are female. The disease has had a massive impact on children, who either contracted the disease during birth or have been orphaned by it.

Various programs created by the government and NGOs have been created to combat the disease. This includes volunteer therapy, instruction on mother-to-child transmission, and the distribution of condoms. However, all of these solutions are facing complications such as lack of funding, shortage of supplies, and human resources. In terms of culture, traditional gender inequality puts women at a disadvantage, and the stigma surrounding the disease often hinders treatment.

A medical anthropologist focused on the problem of AIDS in Malawi is Dr. Anat Rosenthal. Rosenthal “has comprehensively studied how both international and local health organizations impact the impoverished communities and villagers”, and the socio-cultural effect AIDS has on those in Africa. She is dedicated to assessing, preventing, and fighting HIV/AIDS outbreaks. Despite the bleakness of her topic, Rosenthal believes she has found her calling and gives lectures that highlight the “very gray” world of health care. She is focused on Malawi because of their staggering HIV rates in comparison to other countries.

Sources:
http://www.avert.org/aids-malawi.htm

http://www.smudailycampus.com/news/medical-anthropologist-promotes-aids-awareness-in-malawi-1.1922507#.UCWX26GPWyg

Sexual Health in India

Sexual health is considered a taboo topic among Indian culture. Sexual health implications are interlinked with social implications as well. Stigmas of sexual activity exist heavily in India, which can lead to further health issues for women due to reluctance to seek treatment resultant from fear of social ramifications.

Some social factors that facilitate the inhumane treatment of women include denial of human rights being evident in Indian populations and the allowance of the state to administer beatings and other forms of punishment to women by police officers. It is apparent the Indian government is not worried about the health of women or rate of infections because they enable women to be viewed in a negative light for sexuality, as it is something that is frowned upon in their culture. In addition, culturally, Indian women are expected to be submissive to their husbands, facilitating even more discrimination.

According to one article,  Tamil Nadu is dealing with an increased infection rate among married women in rural areas. Traditionally in this area, the rate of reproductive tract infections are high, however women often will not visit a clinic for treatment because these sexuality stigmas do exist. Unfortunately, as a result, a significant number of deaths among Indian women in these areas are due to cervical cancer. Another sexual health issue in Indian women is HIV, who are often deserted by their husbands upon contraction of the disease. There was a program implemented to prevent parent to child transmission of HIV by encouraging pregnant women to get tested and to receive antiretroviral therapy so the disease is not spread to their child during birth. However, the program has inadvertently resulted in further stigmatization and discrimination against women. If an Indian woman tests positive for HIV and convinces her husband to get tested, Indian men will more often than not reject the idea they have been the source of the virus and will instead question the wife’s fidelity (1).

Stephen Schensul is an anthropologist that has studied the prevention of HIV and STI’s in Mumbai among married women. He found that sexual health is not a chief concern among families with low incomes that have more dire concerns such as overcrowding in homes and unsanitary water. Since he has started his research, there has been a significant drop in sexually transmitted infections and the extramarital affairs of men through the treatment of clinical care and sustaining knowledge and resources to prevent these infections. Schensul’s project has helped established a women’s health clinic in Mumbai to provide health services to the varied gynecological needs of women (2).

Sources:

1. “Perception of Stigma and Discrimination.” South India AIDS Action Programme. N.p., 2009. Web. 10 Aug. 2012. <http://www.siaapindia.org/resources/publications/perception-of-stigma>.

http://www.siaapindia.org/resources/publications/perception-of-stigma

2. DeFrancesco, Chris. “UConn Today.” UConn Today. N.p., 31 July 2012. Web. 10 Aug. 2012. <http://today.uconn.edu/blog/2012/07/reducing-sexual-risk-in-india/>.

http://today.uconn.edu/blog/2012/07/reducing-sexual-risk-in-india/

HIV in Malawi

The global health problem from my title is HIV, or human immunodeficiency virus, in a country called Malawi, which is in Africa. The website “Avert,” an international charity for HIV and AIDS, discusses many topics, including the prevalence of this disease in Malawi. One main fact that stood out was that approximately one million people have the disease, out of the 15.4 million living in the country. Some other facts from the site include that the first case of HIV was found in 1985, and some contributing factors to the high prevalence of the disease include things like lack of healthcare workers in the area, and lack of access to education about HIV treatment/prevention. HIV is also more common in women of the country, which we are told is most likely due to gender inequalities in economic and social status.

As far as prevention of the disease, the site says that the government has been working on trying to increase awareness and prevention strategies, but the efforts are slow due to the lack of resources. These strategies are funded through donors from all over the world, and includes things like testing for HIV, passing out condoms, and trying to prevent mothers from passing HIV on to their children through breastfeeding.

An example of one anthropologist working in Malawi on this topic is Peggy Bently, who is discussed in the article “Malawi Study May Lead to New Approach to Improve Health and Survival of HIV- Positive Mothers and Their Infants.” Bentley’s main focus in Malawi is the study and improvement of the health of breast- feeding mothers infected with HIV, and the health of their infants. Bentley found that even though breastfeeding can lead to HIV infection of children, “infants are at a greater risk of dying if they are not breastfed rather than if they are, even by an HIV- positive mother.” The focus of the study became giving both mothers, since breastfeeding “increases nutrional demands on mothers,” and infants nutritional supplements to see if their health could be improved. Another key part of the study was to test the efficiency of certain antiretroviral drugs on infants to help combat the passing of HIV during breastfeeding. The findings of this study are still being gathered and interpreted.

Sources:

 

http://www.avert.org/aids-malawi.htm#contentTable3

 

http://www.med.unc.edu/infdis/research/hiv-stds/ban-study/study-descripton

FGM in Sudan

Female genital mutilation is defined by the World Health
Organization as “all procedures that involve partial or total removal of the
external female genitalia, or other injury to the female genital organs for
non-medical reasons. There are serious life threatening complications with
cultural atrocity. These include but are not limited to sever pain, infection,
shock, injury to adjacent organs, broken bones, acute urinary infection,
tetanus, and death. According to Regent’s College, eighty million girls and
women, that are living today, have been subjected to this inhumane procedure.
The number of women who have died from or as result of complications from the
procedure is unknown.

The origins of the practice go as far back as Ancient Egypt.
The factors that facilitate the procedural ideology center around the belief
that female genital mutilation is necessary to raise a girl correctly. Female
genital mutilation, according to followers of the practice, allows women to rid
themselves of all male body parts(clitoris) which allows them to become a
complete woman. The Research, Action and Information Network for the Bodily
Integrity of Women, also known as RAINBO, have been instrumental in attempting
to change the belief system that has been ingrained throughout the country. The
idea that achieving the ultimate level of motherhood is necessary by FGM, has
been the main opposing belief.

The research that I found was conducted by several
physicians. The principal physician was Dr. Almroth. Their research focused on
determining the relationship between FGM and primary infertility. They believed
that infections that occur from FGM could possibly ascend into internal
genitalia. This can cause inflammation and scarring which leads to tubal-factor
infertility. After examining 99 infertile women, almost half of the women fit
into their hypothesis. They concluded that FGM and primary infertility had a
strong positive association. Their research will be another instrumental
component to fighting the current cultural norms in Sudan.

http://www.unicef.org/protection/sudan_29886.html

http://www.bmj.com/highwire/filestream/353202/field_highwire_article_pdf/0

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)67023-7/fulltext

 

 

 

 

Tuberculosis in Russian Prisons

During the 1990’s, after the collapse of the Soviet Union, Russia began to experience a tuberculosis epidemic within their prison system.  During much of the Cold War period the Soviet Union and the United States shared the position of having more people incarcerated than any other country on earth.  In fact, after the fall of the Soviet Union it was found that the Jackson Prison was the largest prison on the planet until the 1980’s when the state divided the prison into smaller prison units due to rioting.  In Russia however things only became worse after the collapse of the Soviet government.  People began to be sentenced to prison for minor infractions and the prison population expanded to an all new high.[1]  Because of prison overcrowding, and reduced funds being spent on the Russian medical system, tuberculosis had taken hold within the prisons.  It was found that one in ten prisoners had active tuberculosis and this number was only going to increase as these prisoners infected other prisoners and possibly even their families after their release.  It can also be said that being sentenced to prison during this time period included the sentence of tuberculosis.

In response to the epidemic The Public Health Institute (PHRI) and Partners in Health (PHI), which was founded and run by Dr. Paul Farmer, established medical facilities within Russia to manage the threat of tuberculosis for both prisoners and the general public.  “Accomplishing this aim required the establishment of collaborative working relationships with a variety of partners in Russia, building a laboratory infrastructure virtually from scratch, training laboratory and medical personnel, implementation of TB control procedures, provision of appropriate first and second line drugs, advocacy to convince TB and governmental leaders to proceed with the program, and a myriad of additional tasks, all taking place in a highly charged political atmosphere.”[2]

The political atmosphere of Russia during this time period made it difficult for westerners to affect change.  Dr. Paul Farmer was forced to meet with many political members of the Russian government and argue the need to treat the people suffering from this disease including the nation’s prisoners.  A colleague of Dr. Farmer who witnessed Farmer’s heated exchanges recollected an argument at “a congenial dinner with a famous personage in public health. By day Paul had been arguing with him. The fight had to do with milk. Paul wanted Russian prisoners with TB to get a glass of milk each day, and the public-health expert didn’t think this was necessary.”[3]  These heated exchanges were common for Dr. Farmer while he attempted to gain a support for the medical centers and tuberculosis treatments.

By 1997 PHRI had successfully established effective tuberculosis controls in Russia for both the civilian and prison population.  The PHRI then turned over management of the program to Dr. Paul Farmer and the PHI.  Because of the efforts of world health organizations such as PHRI and PHI and medical anthropologist and physician Paul Farmer tuberculosis is now controlled and treated within the Russian prison system and the sentence of tuberculosis has also been eliminated from the Russian criminal justice system.


[1] Paul Farmer, “Russia’s Tuberculosis Catastrophe,” Project Syndicate, January 18, 2001, accessed August 9,2012, http://www.project-syndicate.org/commentary/russia-s-tuberculosis-catastrophe.

[2] The Public Health Research Institute Center, “The PHRI/Soros Russian TB Program: Treating MDRTB in Siberian Prisons,” The Public Health Research Center, Accessed August 9, 2012, http://www.phri.org/programs/program_russiantb.asp.

[3] Tracy Kidder, “Paul Farmer Is Revolutionizing Medicine,” The Daily Beast, May 5, 2010, accessed August 9, 2012, http://www.thedailybeast.com/articles/2010/05/06/paul-farmer-is-revolutionizing-medicine.html.

Malnutrition in Nepal

Malnutrition is one of, if not the largest health problem in the world.  It is directly linked to disease, whether as a result or a contributing factor (quite significantly).   There are two main types of malnutrition: protein-energy based malnutrition, which is a lack of enough protein & energy providing food (all basic food groups); and micronutrient deficiency, which is lacking in vitamins & minerals.  Though debated, there is thought to be a third as well: Obesity, because malnutrition is a lack of nutritional value rather than food.  Malnutrition can reduce physical and mental development in children, causing stunting in growth & weight gain, mental retardation & brain damage, and even sight problems (including blindness).  It can also pose danger to women pre & post natal: babies may be low birth-weight (starting out malnourished), a mother may have hard time producing breast milk & it may not have health content if she does, or the mother may not survive. These things are particularly true in developing countries, such as Nepal, given the poverty stricken communities and their lack of adequate water supply and/or food, combined with a lack of education.  Many government programs and NGOs are dedicated to helping with this problem.  For instance, UNICEF, WFP, WHO, and Helen Keller International, all have major programs just in Nepal (some elsewhere as well).  Helen Keller International has set up the Action Against Malnutrition through Agriculture (AAMA) project, to help educate people about proper nutrition and how to provide for this themselves (1).  The United Nations Childrens Fund (UNICEF) and similar aid programs are setting up outposts to reduce travel time for receiving care, educating parents on malnutrition, and are providing people with ‘high-protein packages of food’ for malnourished children.(2) Simillarly, the World Food Programme (WFP), is providing micronutrient powders & fortified blended foods to provide or supplement nutrition in diets.(3)

I found information on several anthropologists that have worked in Nepal, many as medical anthropologists.   However, the research itself was harder to come by.  The research I found to best fit my chosen global issue is from Dr. Linda Stone, a cultural anthropologist, and professor emeritus at Washington State University.  Her research focuses on traditional medicine and religion in Nepal.  She has worked on “development projects in Nepal concerned with the introduction of modern medical options and their integration with local cultural understandings of health and illness.”  She also has worked as a consultant to the World Health Organization, as well as the Food and Agriculture Organization of the United Nations in Nepal. (4)

 

 Sources:

http://www.wfp.org/hunger/malnutrition

http://www.worldhunger.org/articles/Learn/world%20hunger%20facts%202002.htm

1)  http://one.org/blog/2012/05/08/take-action-against-malnutrition-in-nepal/

2)  http://www.soschildrensvillages.org.uk/charity-news/archive/2011/07/fighting-malnutrition-in-nepal

3)  http://www.wfp.org/nutrition/how-wfp-fights-malnutrition

4)   http://libarts.wsu.edu/anthro/Faculty/stone.html

Ebola in Uganda

Ebola is a disease that originated from a river in the Democratic Republic of Congo, which is responsible for the name. If originates from contact with the bodily fluids of an infected animal. Originally, this was how it was transmitted, but human-to-human contact is also responsible for transmission. The ebola virus results in “the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding.” (Ebola Fact Sheet). The fatality rate of the virus is typically around a staggering 50%, and in some cases as high as 90%. There are no known treatments or vaccines for ebola. For these reasons, ebola is a very dangerous epidemic, and it occasionally flares up in Uganda, even as late as 2012.

http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/3644-ebola-outbreak-in-uganda.html

Above is an article linking to a recent outbreak from July. At the time of the article, 14 out of the 20 shown to have ebola died from it. However, they mention that a few tasks force have been dispensed in an attempt to control the outbreak. However, the World Health Organization “does not recommend that any travel or trade restrictions be applied to Uganda.” So, while dangerous, it does not appear to be too dangerous to travelers, simply poor residence around affected regions in Uganda.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033100/

Here is an article written by Barry S Hewlett, a cultural anthropologist. in it, he describes how there was an ebola outbreak in 2000-2001, and how they culture (specifically the Acholi people) dealt with the outbreak. I found his article fascinating because he gave surveys to the population, and will attempt to use their answers so that treatment, or at least outbreak prevention, can be controlled in the future, while still being culturally sensitive to the Acholi people. They believed that the outbreak was caused by a bad spirit, and they had a variety of methods of driving away these spirits, from wearing a dried banana bracelet, to chasing the spirits back to the Nile by loud noise. They also had procedures to sick people so they could get better, such as not dancing and refraining from sexual activity. However, they did share many similar ideas that we find basic, such as isolating those that are affected. Hopefully, by being mindful of the culture of these people, we can still effectively treat or prevent an ebolic outbreak.

Female Genital Mutilation in Sudan

The topic I chose is female genital mutilation in Sudan.  FGM is the term that refers to a variety of procedures that result in the complete or partial removal of the external female genitals.  FGM is also a manner in which men have control over women’s sexual lives. As stated in the article from Landinfo, it is estimated that 89% of North Sudanese women between the ages of 15-49 have been subject to genital mutilation.  Most women are subject to infibulation, which is the most severe.  This involves complete or partial removal of all external sexual organs.  Infibulation only leaves a small hole for urine and menstrual flow.

The origins of FGM are not really known but go back as far as 5th century B.C in Egypt.  Today FGM is a cultural issue.  Some consider it as a rite of passage.  The reasons behind FGM today are to maintain cleanliness of sexual organs, decreasing vaginal secretions that contaminate the female body, abolish sexual desire, and to maintain virginity and prevent promiscuity. Although in America we view FGM as inhumane, many women are in favor of upholding the custom.  In a survey of more than 5,000 women, 79% between the ages of 15-49 were in favor of upholding the custom.

In 1946, Sudan was the first African country to induce legislation against genital mutilation.  The current penal code, however, does not cover genital mutilation.  Its’ provisions on physical injury might cover genital mutilation.  Since this, girls who have not undergone circumcision tend to be ridiculed and looked down upon.  Although there was legislation against genital mutilation, not much enforcement has occurred.  There are only a few examples of practitioners being arrested but that is all the information that is known.

Ellen Gruenbaum is an anthropologist who spent five years in Sudan.  She learned that female circumcision is a strong cultural tradition.  In her book, The Female Circumcision Controversy, she talks about how there is an acceptance and resistance to change.  With the help of Islamic activists, Sudanese health educators, and educated African women there has been social and economic developments.

http://www.upenn.edu/pennpress/book/13443.html

http://www.english.emory.edu/Bahri/FGM.html

www.landinfo.no/asset/764/1/764_1.pdf

 

HIV in Malawi

 After doing some research, the information that gathered was startling. I learned Malawi has one of the highest HIV incident rates in the entire world. In Malawi, AIDS is the leading cause of death. A study in 2003 confirmed the HIV prevalence of the country for adults was at 14%; ages 15-49 years. Malawi’s life expectancy is extremely low. It was interesting to see that young women (ages 15-19) had a rate of four times higher to have AIDS than men of that age group. But, the amount of men who had AIDS in the +30 age group was three times higher than women. There are many factors that contribute to making the HIV/AIDS rates so high. When the epidemic started to escalate, people wouldn’t even mention HIV, because it was such a stigma; which is part of the problem because HIV was being unknowingly passed to other people. After 1994, and political changes were being made to help stop the AIDS epidemic, Malawi faced terrible social and economic problems. Too many people in the country were infected with AIDS; farmers couldn’t work their farm, families couldn’t provide money for food. HIV was one of the leading causes of the food shortage. In 2001, the National AIDS Commission was set up. It provides prevention programs, treatment programs, and support groups.

Dr. Anat Rosenthal is a medical anthropologist working in Africa. She started her work based on women who were living HIV positive in Africa, then spread to Malawi and other parts of the country with HIV/AIDs out breaks. Most of her research she did while in Malawi was focused on how both international and local health organizations impact the impoverished communities and villagers. She says she is very dedicated to the social-cultural work she is doing in Africa.

Sources:

http://www.who.int/hiv/HIVCP_MWI.pdf

http://www.dailyrecord.co.uk/entertainment/celebrity/work-being-done-to-tackle-hiv-1095232

http://www.avert.org/aids-malawi.htm

http://www.smudailycampus.com/news/medical-anthropologist-promotes-aids-awareness-in-malawi-1.1922507