Anthropology of HIV/AIDS

Globally, HIV is considered a complex global pandemic. The devastating effects of HIV/AIDS are profoundly alarming as it continues to be one of the leading causes of deaths in the world. In recent years, it is increasingly realized that HIV is more than just a public health issue. Rather it is a social issue that causes severe development challenges in human history. 

The spread of HIV embraces social inequalities that specifically impact the poor, socially marginalized and vulnerable communities. The socio-political, cultural, economic, historical and psychological factors contributing to HIV/AIDS are equally important to consider while addressing the HIV epidemic in a larger context. Anthropologists are interested in understanding prevailing cultural beliefs, social norms, value systems and local practices that place people at risk of HIV. 

In addition to biomedical and public health sciences, anthropology as a discipline has significant contributions to generate evidence that has greatly enhanced epidemiological and biomedical understanding of HIV epidemic. Apart from this, there is an emerging need to explore the political economy of HIV that shapes people’s behaviors in different socio-political and cultural contexts. The intersecting yet diverse social inequalities and structural barriers have both direct and indirect impacts on people’s nuanced understanding of the HIV epidemic and their access to the services they need. 

The issues of sexuality, gender, risk groups, stigma and discrimination, social and behavior change within and across cultures can be meticulously accessed with an anthropological perspective. In most societies, local knowledge, biosocial processes and cultural influences on patterns of infectious diseases are often neglected. Linking these wider social determinants of HIV is crucial for sustained local responses. 

Moving away from traditional approaches for HIV response, we need a paradigm shift that demands human rights-based, people-centered policies, community-led interventions and resilient health systems. Gender and social inclusion in HIV response is critical as there are differential effects of the epidemic on people who are poor, socially excluded and vulnerable. 

The evidence shows that social vulnerability to HIV is more prominent in specific population groups such as migrants, sex workers, people who use drugs, men having sex with men and transgender communities.  Their social, cultural, legal and economic disadvantages have largely contributed to the high risks of HIV and vulnerabilities. 

From the HIV response perspectives, there are increasing needs of community-led interventions, which are more culturally appropriate. Such interventions are likely to be more effective as community engagement is ensured to create an enabling environment for social and behavior change among the vulnerable groups. In essence, overcoming socio-political, cultural, religious and economic barriers is a key challenge to end the epidemic. 

The cultural understandings of HIV are essentially diverse in different contexts. Anthropological inquiry to growing needs of public awareness of HIV for prevention has made clear emphasis on social and cultural environments where vulnerable groups are realistically experiencing their own livelihoods in their everyday life. Social resilience and adaptive wisdom are critical to cope with the devastating effects of HIV on population groups who are socially excluded and vulnerable in the communities. 

While integrated bio-behavioral surveys and assessments are largely focusing on quantitative research methods and approaches, implementation of ethnographic field research is relatively low. The anthropological approaches will help explore wider inequalities of class, gender and ethnicity in terms of risks and vulnerability to HIV. Therefore, engaging anthropologists in HIV responses is crucial in addressing social concerns from people’s perspectives, designing community-led interventions, undertaking ethnographic field research for evidence-informed policy and strategic actions.   

Given our biological knowledge and the availability of effective medical and behavioral solutions, anthropological perspectives are useful to have greater details of why HIV continues to spread. More importantly, these perspectives aim to explore what impacts does HIV have on human populations. Ethnographic field research collects the stories of local realities and social sufferings experienced by people living with HIV in their everyday life and their choices for healthcare and social services.  

In this context, the basic health belief model developed in the 1950s has been instrumental in obtaining the information related to an individual’s perceived susceptibility, severity, benefits and barriers regarding any threat related to HIV or health conditions or behaviors. The community-led responses require effective representation and meaningful engagement of people living with HIV and other key populations at high risk of HIV infection. 

In all social hierarchies, it is necessary to examine how HIV policies and strategic priorities are shaped by socio-political, economic and cultural contexts in terms of inclusivity, equity and diversity. The disparity between rural and urban, rich and poor has evoked a serious concern in terms of people’s access to prevention, treatment and care services. Unfortunately, the policy responses to ensure the right to healthcare are not sufficiently addressed yet within and across cultures.

At the core, anthropological perspectives offer a broad overview of the social, cultural, political, economic and psychological factors shaping the HIV/AIDS epidemic. The wider determinants of HIV are significantly influencing HIV vulnerability cross-culturally, and the ways in which governments, civil society and development partners are working together for sustained responses in different contexts. Therefore, the new approaches for HIV responses must focus on humanity, dignity and right to health to scale up person-centered HIV care across the communities.

The author is a health policy analyst and has an interest in anthropology