Global Health Discourse Research Articles

Health-related quality of life and associated factors among children with Transfusion-dependent β-thalassaemia: a cross-sectional study in Guangxi Province

BackgroundTransfusion-dependent β-thalassemia (TDT) is a severe inherited disorder. Without regular treatment, patients with TDT experience complications that can significantly shorten life expectancy and severely impact both their quality of life and that of their families. The condition has attracted significant attention in global health discussions. Due to the challenges of blood supply shortages, the high costs of iron chelation therapy, and hematopoietic stem cell transplantation (HSCT), TDT presents a serious health risk to patients and imposes a substantial burden on families and society. However, research on the health-related quality of life (HRQoL) of thalassemia patients in China remains limited. This study evaluated the factors affecting the HRQoL of these patients, with the goal of developing strategies to improve their quality of life.MethodsIn this cross-sectional study, children with TDT were recruited from five treatment centers in Guangxi, a province with a high prevalence of thalassemia in China. Structured questionnaires were employed to gather relevant data on sociodemographic variables, disease characteristics, treatments, and associated costs. The HRQoL was assessed using the Transfusion-Dependent Quality of Life (TranQoL) questionnaire, with a proxy version for patients aged 0–11 years and a child version for those aged 12–18 years.ResultsThe study included 418 participants, yielding an overall TranQoL score of 60.6 ± 16.3 among thalassemia patients. Multiple linear regression analysis revealed a negative correlation (P < 0.05) between overall TranQoL scores and several factors: increasing patient age, the presence of multiple thalassemia patients within a family, and undergoing HSCT. Conversely, adherence to regular treatment was positively correlated with higher TranQoL scores (P < 0.05).ConclusionThe study demonstrates that HRQoL among Chinese patients with TDT is at a low level. Age, treatment adherence, family support, and socioeconomic status were identified as key determinants influencing HRQoL. It is essential to further enhance and optimize health insurance policies and medical services to support comprehensive treatment strategies for these patients.

Prevalence, Reasons, and Prevention for Drug Related Death After Release from Prisons: A Systematic Review and Meta-analysis

Context: Drug-related mortality is a major concern in public and global health discussions. Objectives: Therefore, the aim of this study was to investigate the prevalence, causes, and prevention of death after individuals are released from prison. Methods: This study was conducted systematically using MeSH keywords with no language or time restrictions. PubMed, Scopus, and Web of Science databases were extensively searched for observational studies from 1980/1/1 to 2023/12/30, following the PRISMA checklist. Fourteen research studies were ultimately included in the systematic review process. The CRD code is CRD42024571756. Results: The two-week period following release, with an 18% prevalence, was identified as the time when most overdose deaths occurred. The leading causes of death included prior heroin use, previous experiences with drug withdrawal, drug injection, and sedative use within six months before death. Compared to other unnatural causes of death, there was an increased risk of fatal drug overdose for individuals who died within the first two months of release. Men had higher death rates from all causes compared to women. Most studies reported that substance abuse treatment during imprisonment and providing take-home naloxone for emergencies protected against mortality from all causes. Conclusions: In conclusion, evidence from these systematic investigations highlights the urgent need for targeted interventions to address substance use disorders and overdose prevention among individuals recently released from prison. Efforts to bridge the gap between incarceration and community reintegration should prioritize comprehensive substance abuse treatment programs to reduce the heightened risk of mortality in this vulnerable population.

“Someone Who Is Going to Preserve Your Surname and Clan Name”: A Sesotho Cultural Perspective on Male Partner Involvement in Maternal and Newborn Care in the Free State, South Africa

In the global public health discourse, involving men in maternal and neonatal health is regarded as crucial for positive outcomes in both health and development. In South Africa, health interventions designed to promote male partner involvement among low-income indigenous populations have been framed within social constructivist notions of masculinities and have produced mixed outcomes. This has necessitated calls to explore alternative approaches, including the need to decolonise men and masculinities studies in Africa. As part of one phase of formative research for a mixed-method project aimed at adapting a male involvement intervention for the context of Sesotho-speaking men and women in the Free State, we applied a multi-site case study research design and collected qualitative data using focus group discussions and key informant interviews. Verbatim-recorded transcripts were translated, transcribed, and thematically analysed with NVIVO 14. The results indicate that customary practices in pregnancy, delivery, and newborn care are not static and vary between families based on belief systems, socioeconomic status, geographical setting (peri-urban/rural), and kinship networks of care. Therefore, these practices and beliefs should be understood, affirmed, and contested within the complex African-centred material and immaterial worldviews on personhood in which they were generated, transmitted, rejected, or adopted. It is recommended that a decolonised approach to male partner involvement in this context must be cognisant of the intersections of racial and gendered power relations, contestations in beliefs and practices, the resilient effect of colonialism on indigenous gender systems, as well as contemporary global entanglements that inform North–South power relations on the best practices in maternal and newborn health in the public health sector in South Africa.

Mental health of the Pacific Island Nation communities: What the rest in the world can contribute to and learn from?

Creating Futures initiative has established a network of mental health professionals, researchers, and community members from the Pacific Island Nations (PIN), Australia, and New Zealand to address the growing challenges of mental health conditions compounded by the climate change crisis. The enormous amount of work done in Global Mental Health can be particularly helpful to improve population-level mental health. However, translation of this evidence base into practice poses several challenges. This perspective paper discusses the role of local culture and health systems context in determining the feasibility and acceptability of implementing and scaling up evidence-based interventions designed in an American-European context. The paper also advocates development (and evaluation) of mental health interventions in the PIN communities particularly and Global South generally and exporting these interventions to the rest of the world. COVID-19 crisis underlined the role of global cooperation as well as national level 'self-reliance'. In this post COVID-19 world, it will be desirable for the mental health community to cooperate and collaborate to scale up evidence-based interventions through rigorous contextualization and at the same time main-stream mental health interventions developed in the Global South by incorporating them in the Global Mental Health discourse.

“We’re Not Lab Rats”: Analysis of Netizens’ Response to BCG Vaccine-Test Proposal Against COVID-19 in Africa

In April 2020, two French scientists proposed Africa as the site for testing a BCG tuberculosis vaccine for treating COVID-19. This sparked social media outrage with some describing the gaffe as a hangover of colonial mentality. This study examined netizens’ interpretation of the faux pas and how the social media activism that followed it shaped the narrative about Africa’s identity. The study found that netizens interpreted the discourse as racism against Africa, colonialism, and a breach of medical ethics. These created an avenue for social media activism by a new generation of African netizens to assert their independence, protect their humanity, and promote the idea of Africa for Africans. The study recommends the need for ethics of care and racial sensitivity in public and global health discourses that have the potential to reopen scars of historical trauma in subjugated populations who may be geographically or socially affected by pandemics.

Factors of Power and Equity: Enhancing Our Health System Resilience Research Frameworks Comment on "Re-evaluating Our Knowledge of Health System Resilience During COVID-19: Lessons From the First Two Years of the Pandemic"

The concept of health system resilience has gained prominence in global health discourse, especially in response to the Ebola and COVID-19 pandemics. This commentary responds to Saulnier and colleagues’ 2022 review, which used the Dimensions of Resilience Governance framework to synthesize of COVID-19 related health system resilience research and explore possible conceptual gaps. The review’s findings reveal elements missing from the original framework which underscore the social nature of health systems. This commentary links the review’s empirical findings to nascent theorization of health systems resilience to develop an adapted Framework for Exploratory Research on Health Systems Resilience. A key contribution of the adapted framework is to make explicit the role of actor power and highlight more clearly the distinctions between: (i) research focused on identifying the capacities needed to enable adaptation; (ii) research focused on the actors whose interests and choices determine which adaptive strategies are used, and (iii) research that assess the outcomes of such strategies.

The discursive process of resemantisation: how global health discourses turned male circumcision into an anti-HIV policy

The discursive process of resemantisation: how global health discourses turned male circumcision into an anti-HIV policy

Sociocultural context of exclusive breastfeeding in Africa: A narrative review.

Although exclusive breastfeeding (EBF) has many benefits, it is not commonly practiced in several countries as a result of context-specific challenges. EBF practice is thus a global health discourse because over 200 million children suffer from malnutrition despite the abundance of human milk. The risk of starvation remains very high among African children with less than 40% of them exclusively breastfed. In Africa, the adoption or nonadherence to EBF is a sociocultural issue. Hence, this narrative review examined the sociocultural context of EBF in the region. PubMed, Google Scholar, and Scopus were searched using keywords related to EBF and Africa. Relevant data from selected studies were synthesized narratively and reported using a structured narrative format. EBF is strongly rooted in every culture and is a culturally determined behavior. Some believe that colostrum is dirty and harmful to newborns and, thus, needs to be purified. Despite the belief that human milk is the best food for babies, mothers often complement human milk with other foods right from birth because of perceived lactation inadequacy. Most African mothers believe in prelacteal feeding to help cleanse the infant's gastrointestinal tract for digestion, quench thirst, flush the bladder and help the mother to rest after childbirth before breastfeeding (BF) is initiated. The role of significant others was equally found important in the decision and duration of BF. The availability of family support (especially from grandmothers and husbands) reportedly encouraged EBF in Africa. The duration and exclusivity of BF in Africa are negatively associated with demographic variables like young age, low level of education, being unmarried, low income, out of employment, and parity (first-time mother). While there have been some efforts and policies to improve EBF, it is important to consider context-specific challenges and sociocultural factors. There is a need for more deliberate efforts to encourage mothers through the implementation of effective best practices concerning EBF in Africa.

Missing in action: a scoping review of gender as the overlooked component in decolonial discourses

IntroductionRace and gender were intimately intertwined aspects of the colonial project, used as key categories of hierarchisation within both colonial and modern societies. As such, true decolonisation is only possible...

Decoding global reproductive health discourse on Reddit: themes, regions, and misinformation challenges.

This study explores dominant themes in global reproductive health discussions on Reddit over a 12-month period (January 2021 to December 2021). We collected and analyzed 50,000 posts and 100,000 comments from key subreddits, including "r/ReproductiveHealth" and "r/Parenting," using Python libraries like PRAW and BeautifulSoup for efficient data collection and preprocessing. Employing tools such as Latent Dirichlet Allocation (LDA) for topic modeling and VADER for sentiment analysis, we identified five major themes: Family Planning and Contraception, Pregnancy and Childbirth, Sexual Education and Awareness, Misinformation and Myths, and Support and Emotional Well-being. Geospatial analysis revealed regional variations, with North America and Europe emphasizing family planning, while Asia and Africa took the lead in discussions on pregnancy and childbirth. Our findings shed light on a global dispersion of misinformation discussions, emphasizing the challenges posed by misinformation in online reproductive health conversations. This research provides a nuanced understanding of prevalent themes and community engagement, contributing valuable insights to the dynamics of reproductive health discussions on Reddit.

Scaling up Surgical Capacity in Kenya: The Kenya Hospital Assessment Tool (K-HAT)

IntroductionAlthough substantial progress has been achieved to bring surgical care to the forefront of global health discussions, a number of low-and middle-income countries are still in the process of developing a National Surgical, Obstetric, and Anesthesia Plan (NSOAP). This paper describes the initial step toward the development of the NSOAP through the creation of the Kenya National Hospital Assessment Tool (K-HAT). MethodsA study protocol was developed by a multisectoral collaborative group that represented the pillars of surgical capacity development in Kenya. The K-HAT was adapted from two World Health Organization (WHO) tools: the Service Availability and Readiness Assessment tool and the Situational Analysis Tool. The survey tool was deployed on Open Data Kit, an open-source electronic encrypted database. This new locally adapted tool was pilot tested in three hospitals in Kenya and subsequently deployed in Level 4 facilities. ResultsEighty-nine questions representing over 800 data points divided into six WHO Health Systems Strengthening sections comprised the K-HAT which was deployed to over 95% of Level 4 hospitals in Kenya. When compared to the WHO Service Availability and Readiness Assessment tool, the K-HAT collected more detailed information. The pilot test team reported that K-HAT was easy to administer, easily understood by the respondents, and that it took approximately 1 hour to collect data from each facility. ConclusionsThe K-HAT collected comprehensive information that can be used to develop Kenya's NSOAP.

COMMUNITY-BASED MENTAL HEALTH INTERVENTIONS IN AFRICA: A REVIEW AND ITS IMPLICATIONS FOR U.S. HEALTHCARE PRACTICES

This study critically examines community-based mental health interventions in Africa and their implications for U.S. healthcare practices. The primary aim was to explore the effectiveness of these interventions and assess their potential integration into the U.S. healthcare framework. The methodology employed was a comprehensive literature review, focusing on recent peer-reviewed articles and reports. This approach facilitated an in-depth analysis of the evolution of mental health care models, the significance of community-based approaches in African contexts, and their relevance to U.S. healthcare systems The findings reveal that African community-based mental health models are distinct in their emphasis on community engagement, integration with traditional practices, and the pivotal role of non-governmental organizations. These elements have contributed significantly to their success and offer valuable insights for U.S. mental health care enhancement. The study also identified key research gaps, providing a foundation for future scholarly work. In conclusion, the study highlights the potential benefits of incorporating African community-based mental health strategies into U.S. practices. The recommendations emphasize the need for economic alignment, sociocultural training in psychiatric education, a coherent value appraisal framework, and policy integration. These strategic suggestions aim to foster a more inclusive, culturally sensitive, and effective mental health care system in the U.S., drawing on the successful experiences from African models. This research contributes significantly to the global mental health discourse, offering a unique perspective on cross-cultural learning and adaptation in mental health care practices.&#x0D; Keywords: Community-Based Mental Health, African Models, U.S. Healthcare, Mental Health Care, Global Mental Health.

The global distribution of oral and maxillofacial surgeons: a mixed-methods study

Despite its role in treating the most dominant non-communicable diseases worldwide, the global workforce of oral and maxillofacial (OM) surgeons is not well-characterized. To address the current deficit in understanding of the global OM surgeon workforce and to elevate oral and maxillofacial surgery (OMS) in the global health discourse, we join other surgical specialties in evaluating global surgical capacity with a descriptive analysis of the distribution of OM surgeons worldwide. A mixed-methods study was implemented using a combination of literature review, in-country contacts, internet searches, and survey data. The survey was distributed globally from January to June 2022. Data regarding OM surgeon workforce estimates were obtained for 104 of 195 United Nations-recognized countries (53.3%). Among countries with available estimates, the median global workforce density was 0.518 OM surgeons per 100,000 population. Twenty-eight countries (26.9%) were reported to have two or fewer OM surgeons. The median OM surgeon workforce density for low-income countries was 0.015 surgeons per 100,000 population, compared to 1.087 surgeons per 100,000 population in high-income countries. low and middle-income countries countries have the least workforce density as well as the least data coverage. More work is needed to better understand the capacity of the global OM surgeon workforce and access to OMS care.

Decolonization Projects

Decolonization Projects

Grammars of Progress and Pathology: A Recursive History of Africa, Cancer, and "Diseases of Civilization".

The phrase "disease of civilization" and concomitant lexicons, such as "pathologies of modernization," frequently surface across public and global health discourses. This is particularly the case within the framework of cancer research in Africa. In this article, the authors trace the emergence of these grammars of progress at the beginning of the twentieth century as a biomedical lens through which to analyze and frame cancer in Africa. Arguing with Ann Stoler for a recursive understanding of colonial and postcolonial history, the authors follow in detail the lexical shifts and recursions across the twentieth century, as these grammars move from diseases of civilization to development and modernization. In tracing these lexical shifts, they place them within the broader understandings of Africa and the African body as an other against which Euro-America frames itself.

Provider implicit and explicit bias in person-centered maternity care: a cross-sectional study with maternity providers in Northern Ghana

BackgroundPerson-centered maternity care (PCMC) has become a priority in the global health discourse on quality of care due to the high prevalence of disrespectful and lack of responsive care during facility-based childbirth. Although PCMC is generally sub-optimal, there are significant disparities. On average, women of low socioeconomic status (SES) tend to receive poorer PCMC than women of higher SES. Yet few studies have explored factors underlying these inequities. In this study, we examined provider implicit and explicit biases that could lead to inequitable PCMC based on SES.MethodsData are from a cross-sectional survey with 150 providers recruited from 19 health facilities in the Upper East region of Ghana from October 2020 to January 2021. Explicit SES bias was assessed using situationally-specific vignettes (low SES and high SES characteristics) on providers’ perceptions of women’s expectations, attitudes, and behaviors. Implicit SES bias was assessed using an Implicit Association Test (IAT) that measures associations between women’s SES characteristics and providers’ perceptions of women as ‘difficult’ or ‘good’. Analysis included descriptive statistics, mixed-model ANOVA, and bivariate and multivariate linear regression.ResultsThe average explicit bias score was 18.1 out of 28 (SD = 3.60) for the low SES woman vignette and 16.9 out of 28 (SD = 3.15) for the high SES woman vignette (p < 0.001), suggesting stronger negative explicit bias towards the lower SES woman. These biases manifested in higher agreement to statements such as the low SES woman in the vignette is not likely to expect providers to introduce themselves and is not likely to understand explanations. The average IAT score was 0.71 (SD = 0.43), indicating a significant bias in associating positive characteristics with high SES women and negative characteristics with low SES women. Providers with higher education had significantly lower explicit bias scores on the low SES vignette than those with less education. Providers in private facilities had higher IAT scores than those in government hospitals.ConclusionsThe findings provide evidence of both implicit and explicit SES bias among maternity providers. These biases need to be addressed in interventions to achieve equity in PCMC and to improve PCMC for all women.

Herbal Medicines &amp; Anxiety Disorders

Anxiety and insomnia are two of the most prevalent mental health conditions and a significant contributor to disability worldwide. We all experience feelings of anxiety, fear, and worry at many point in our lives. These feelings can have a negative impact on every individual’s mental and physical health if they persist for an extended period of time. Clinical anxiety disorders result from this. Anxiety disorders can be treated with a variety of methods and can also be treated with herbal remedies, as this article outlines. In most countries, the lifetime prevalence of panic attacks—a type of anxiety disorder—is between 7-9 percent, and it is only 1% in India. On the other hand, the lifetime prevalence of generalized anxiety disorder is extremely high—it is 8.5% in the general population— according to WHO (2001). 16.6% of people worldwide suffer from anxiety disorders (Somers et al., 2006), and numerous efforts have been made to comprehend the disease's pathophysiology and treatment options. Psychiatric disorders like depression, anxiety, and insomnia are very common and often co-exist with one another. Numerous individuals from all over the world have been affected by these well-known mental health conditions. For the treatment of mental illnesses, herbal formulas and individual herbs are frequently prescribed. The use of herbs to improve health is on the rise as a result of the numerous side effects of western medicine. The study of herbal psychopharmacology has received a lot of attention in recent decades. The literature demonstrated a variety of herbal mechanisms of action, including re-uptake of monoamines, alteration of neuroreceptor binding and channel transporter activity, modulation of neuronal communication, and activation of the hypothalamic-pituitary adrenal axis (HPA). Global health discussions are focusing a lot on traditional herbal remedies. The use of medicinal plants has been the subject of some of the most research in Asia, and a number of Indian regions retain their rural traditions. The purpose of this overview is to highlight the use of wild and cultivated plants in India, specifically as sedatives and for treating insomnia, as well as to collect, analyze, and summarize the pharmacological activity of these plants, as well as clinical and pre-clinical studies on the most cited plants.

COVID-19 vaccine equity in Africa.

The coronavirus disease 2019 (COVID-19) pandemic has dominated global health discourse since early 2020. By early 2021, the unprecedented speed of vaccine development against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by government, academia and industry contributed biotechnological tools to reduce severe COVID-19 infections, hospitalizations and deaths. However, vaccine distribution has not been equitable. We address one element of this challenge, namely the low COVID-19 vaccination rates in African countries, which lag behind higher-income nations. We evaluate key obstacles to initiatives addressing this inequity and emphasize Africa-based research and development as a sustainable solution to ensuring vaccine equity in Africa.

10.H. Round table: Access, equity and the relevance of the Pandemic Treaty: lessons from the COVID-19 response

Abstract Access to medicines, equity and fair pricing have been intensely debated in the context of EU policies and global health priorities for many years prior to the COVID-19 pandemic. To this effect, there have been efforts to develop mechanisms to jointly assess health technologies (HTA Regulation) and to establish cross-border partnerships for price negotiation and procurement. Although TFEU (art.168) is limiting the scope of activities and decisions to be taken at the EU level for public health matters, the Commission has also played an active part in global health discussions in the G20 and in the G7 since 2010, and there is explicit commitment to SDGs, and in particular UHC (SDG3.8) ‘leaving no one behind’ (2019). Indeed, according to its commitments “the EU advocates equitable, universal and high-quality healthcare coverage and promotes fair, effective financing of research to benefit the health of all [and] it is working to ensure that new products are safe, effective, accessible and affordable.” In the context of the COVID-19 pandemic, the EU came together in solidarity within and beyond its borders, including through joint procurement of countermeasures. At the same time, different instruments were developed to combat the pandemic globally, such ACT-Accelerator deploying the diagnostic and medicinal products, including, vaccines, and its COVAX Global Vaccines Facility to scale up production and establish consensus on the international allocation of these products. In this transitional phase, issues that arise are: What is the role of the EU in shaping European public health and global health? What are the fundamental principles enshrined in legislative and non-legislative instruments determining EU policies and actions of global health impact? Is such EU policymaking informed by evidence? Are the necessary interdisciplinary and intersectoral partnerships in place to generate the necessary evidence? Which instruments and mechanisms have been the most efficient and effective in combating the COVID-19 pandemic? Are they relevant for future pandemics and for increasing preparedness and resilience? What has been the role and contribution of the EU in these initiatives? What are the values and fundamental principles determining EU action and policy, and to what degree are EU policies evidence-informed? Will the EU's efforts be determined by G20 decision-making, interests and priorities? Each panel member will briefly (5 min) present work conducted to inform European public health and global health policies. The panel will then discuss EU public health and global health policies, assessing the extent to which they are evidence-informed and the degree to which they reflect the fundamental principles of the Union. There will be two rounds of questions/statements, the first elucidating the role of the EU, the second examining it in the context of the COVID-19 pandemic and future pandemics, incl. in the context of the development of the Pandemic Treaty. Key messages • Sound governance, transparency and implementation monitoring is required for all instruments and mechanisms to combat the COVID-19 pandemic and ones, with due consideration to sustainability and UHC. • The EU’s role in global health needs to be strengthened via interdisciplinary and intersectoral collaboration for evidence-informed policies, and in a manner consistent with EU fundamental principles. Speakers/Panellists Dimitra Lingri National Organization for Health Care Services Provision, Athens, Greece Rosa Castro European Public Health Alliance, Brussels, Belgium Tom Buis Wemos, Amsterdam, Netherlands Aurelie Mahalatchimy UMR DICE CERIC &amp; EAHL Interest Group on Supranational Biolaw, Aix-en-Provence, France

Commodities of Care: The Business of HIV Testing in China by Elsa L. Fan

Reviewed by: Commodities of Care: The Business of HIV Testing in China by Elsa L. Fan Aaron Su Elsa L. Fan. Commodities of Care: The Business of HIV Testing in China. Minneapolis: University of Minnesota Press, 2021. 216 pp. When strategies to streamline global health resources result in narrow, magic-bullet testing solutions, what meaningful interventions and social relations are enacted or foreclosed? Resonating with contemporary debates around the limits of technical solutions for COVID-19, Elsa L. Fan's Commodities of Care explores the scaling up of HIV testing in China stimulated by global health donors through programs of performance-driven financing. From the production of the category "men who have sex with men" (MSM) to the retraction of programs that offer lasting support beyond the positive test itself, Commodities of Care deftly illustrates how new trends in global health financing simultaneously usher in new subject positions, experiences of disease, and definitions of care. In so doing, the book offers a lucid glimpse into the stories and meanings of HIV for MSM in China while never losing sight of the political economy that makes these experiences possible. Commodities of Care is the result of Fan's comparative ethnographic work across several HIV organizations in a southern Chinese city. These community-based local centers, such as Bright Love, administer sexual health services as well as events and outreach programs, yet their funding structures are ambivalently tied to heterogeneous global health donors. Some, like the Health Fund and the Global Fund, have recently pushed for performance-based financing schemes that determine payments based on quantitative measures of HIV tests administered, positive test outcomes, and other related outputs, thereby reducing care to the transactional process of "selling blood (mai xue)" (3), as one of Fan's interlocutors [End Page 715] describes it. Analyzing the consequences of this shift—e.g., the purposeful proliferation of repeated and fraudulent tests for financial gain (40), the reduction of the HIV-positive population to solely MSM (17), and the "instrumentalization of community-based organizations as technical service delivery agents rather than stewards of social change" (116)—the author illuminates the transformative effects that "audit cultures" (Strathern 2000) can wield in the making of local and global health. Having worked in the development and philanthropy industries during these "ideological shifts" (19), Fan is uniquely positioned to tell the history of global health's financial streamlining at the turn of the millennium alongside the emergence of new players like the Gates Foundation. In the introduction and Chapter 1, she ethnographically analyzes how the world of HIV testing as a singular global health solution par excellence comes together in the Chinese context. Intricately describing the promotion of performance-based financing over peer-to-peer education (26) as well as the rise of statistics like the quality-adjusted life year and disability-adjusted life year in global health discourses (36), Fan traces how these shifts appear in the narrations and material practices of her interlocutors. For example, she digs into rumors of organizations splitting performance incentives with non-MSM migrant laborers, whom they recruit to get tested for the sake of their tally. She thus reveals the concrete, local consequences of approaches like evidence-based medicine (EBM) and their dominance in public health. In Chapter 2, Fan draws on Ian Hacking's (1986) concept of "making up people"–the production of new subject positions through categories and counting practices–to show how global health's enumeration strategies led to the "making up" of MSM in China. She charts the varied negotiations over the concept of MSM in China to understand organizations' concerns about recruiting testers, noting that many MSM were perhaps in publicly heterosexual relationships. Addressing this problem of a "hidden population" and insisting that Chinese MSM could not merely be drawn out and defined in the conventional terms of identity politics, Fan illuminates how practices of self-affirmation (ziworentong) "instill in these men an acceptance of their same-sex desires and a recognition of their HIV risk as part and parcel of desires" (77). The result of this affirmation, Fan reminds us, is not just the production of new personhoods but also the manufacturing of "commodities of care" in...