Therapeutic Imaginaries in the Caribbean: Competing Approaches to HIV/AIDS Policy in Cuba and Belize

Abstract

In this article, I put forward a therapeutic imaginaries framework, developed from previous geographic work on therapeutic landscapes. In particular, I briefly trace the history of HIV and HIV policy in these countries, resulting from field work I have conducted in Havana since 1997 and in Belize since 2005. I highlight how therapeutic imaginaries are created and experienced through governmental AIDS policies, and how these strategies in Cuba and Belize influence individuals’ perceptions of the salubriousness of these countries’ natural and built landscapes. These case studies demonstrate how countries in the same region can develop health care policies that represent different biomedical and sociocultural outcomes. For example, Cuba's policies result in the lowest HIV/AIDS prevalence rates in the Caribbean, whereas Belize experiences the second highest rates. On one hand, the Cuban government espouses comprehensive and centralized health care as a political goal. On the other hand, Belize has a health care system characterized by a decentralized knowledge base and a reliance on Cuban medical personnel. I argue that geopolitics, gender dynamics, economic philosophies, and cultural norms intertwine to create differing disease outcomes in these countries. In both cases I emphasize the roles of HIV policies in influencing perceptions (from individual to international) about whether a particular landscape is healthy or diseased. These perceptions inform the relationship among therapeutic landscapes, therapeutic narratives, and therapeutic imaginaries. Although the causes and outcomes of risk, from geopolitical to individual behavior, vary in each context, the importance of places, filtered through these different scales, remains constant.