Theorizing the Relationship Between HIV/AIDS, Biomedicine, and Culture Using an Urban Indian Setting as a Case Study

Abstract

The biomedical model serves as a grand narrative shaping the dominant discourse on health and illness. The goal of this study is to understand how lay people living with HIV understand meanings of health and how the biomedical narrative enters their subjective interpretations. Findings were derived from in-depth interviews with HIV+ people in India, who had access to modern medicine. While deviations from the biomedical model were found, for the most part, participants reinforced dominant understandings; they were preoccupied with controlling risk, yet struggled to make sense of contradictions between scientific fact and personal experience. The anthropological concept of the ‘‘work of culture’’ is used to understand the loss of alternative cultural frames and the implications of this loss. The past few decades have seen numerous studies examining the experiences and perceptions of people living with HIV/AIDS across different cultures—in particular, those in the non-Western world—with a view toward understanding the various ways in which people make sense of the disease. Nzioka (1996), for example, collected ethnographic data from 29 heterosexual HIV positive patients at treatment clinics in Nairobi to examine how risk is socially constructed against a backdrop of cultural beliefs and how such perceptions inform lay experiences of sex. Findings showed that participants understood HIV/AIDS as a ‘‘normal’’ illness resulting from blood mixtures, which could be cured through decontamination rituals. They also believed that the risk of HIV infection increased with the number of times one had sexual intercourse and the amount of seminal fluid exchanged and that reversing sexual positions may prevent against infection. The author concluded that while people were often misinformed about the cause of the disease, their perceptions were congruous with medical science. In another example, Shefer et al. (2002) conducted focus groups with South African communities; they found that much of the discourse centered on alternative prevention and intervention strategies for sexually transmitted infections