Why and how are diseases like AIDS and tuberculosis associated with poverty and inequality? This study from ‘Current Anthropology’ examines AIDS and tuberculosis in rural Haiti in relation to the social and economic structures in which they are embedded. A syncretic and biosocial anthropology shows how inequality and poverty create differential risk for infection and for adverse outcomes including death. It is important to link such anthropology to epidemiology and to an understanding of differential access to new diagnostic and therapeutic tools.
Any thorough understanding of the modern epidemics of AIDS and tuberculosis in the postcolonial world requires a thorough knowledge of history and political economy. The emergence and persistence of these epidemics in Haiti, where they are the leading causes of young-adult death, is rooted in the enduring effects of European expansion in the New World and in the slavery and racism with which it was associated.
An anthropology of this ‘structural violence’ necessarily draws on history, biology and political economy. It is important to see how the erasure of history and biology constrains an honest assessment of social life.
During the 1980s, the hypotheses circulating in the United States suggested that HIV came to the United States from Africa via Haiti. However, it is clear that the disease spread in the other direction:
- AIDS in Haiti is about proximity rather than distance. It is a tale of ties to the United States, rather than to Africa.
- AIDS in Haiti has far more to do with the pursuit of trade and tourism in a poor country than with social mores of Africans.
- Using trade data to assess the degree of Caribbean basin countries’ dependency on the United States at the time HIV appeared in the region shows that the five countries with the tightest ties to the United States were the five countries with the highest HIV prevalence.
- Cuba is the only country in the region not linked closely to the United States. Not coincidentally, Cuba remains the country with the lowest prevalence of HIV in the Americas.
- AIDS has had, in the span of a single generation, a profound effect on kinship structure.
It is important to understand that the distribution of AIDS and tuberculosis—like that of slavery in earlier times—is ‘historically given and economically driven’. Social inequalities are at the heart of structural violence. Racism, gender inequality, and extreme poverty in the face of affluence are linked to social plans and programmes ranging from slavery to the current quest for unbridled growth. The following points should also be considered:
- While it is not sufficient to change attitudes, attitude change does make other things happen.
- Both money and political will are required to address the problems associated with tuberculosis and AIDS.
- It is important to make therapy accessible to those who need them most, not just to the favoured few. Health-care infrastructure is inadequate in the countries hit hardest by HIV.