Customer Reviews

AIDS and Accusation: Haiti and the Geography of Blame (Comparative Studies of Health Systems & Medical Care)

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Farmer's excellent historical ethnography of Haitian illness (as seen through the contemporary context of the world AIDS epidemic), proves the necessity of developing anthropological approaches to understanding health systems and implementing medical care. The diagnosis and analysis of sickness, disease, illness, and treatment should go hand-in-hand with the cultural understanding of local systems of blame, accusation, causation, and cure. Where most approaches to medicine are based on the "Westernized" first-world nations' understanding of the causes of illness (tainted as well, as Farmer shows, by systematic "blame the victim" and shame techniques), the adoption of these approaches in treating the illnesses of other peoples can be catastrophic. Three ethnographies make up the structure of a detailed historical inquiry )

The longstanding tradition of conceiving of illness through the lens of powerlessness shapes the contemporary lives of the people in Haiti with whom Farmer worked. Although they could see the effects of the illness, people in this region were obsessed with the cause of the illness, and felt the need to understand AIDS through a constructed narrative of blame. A deep belief in their religion led villagers to look for the source of witchcraft that could possibly be harming them, and elaborate stories about neighbors, jealousies, and rivalries flourished as a result. Any improvement in the standing of one member of the society (through wealth, status, relationships, acquisition of property or food, or political power through employment or marriage) adds to the structure of distrust and blame.

Farmer's book shows how disturbingly complex and deep the layers of mistrust, misinformation, and the effects of racism, are. Among the medical hypotheses for the probable exposure is the theory of Haitian sex-workers' contacts through gay tourists to the early strains of HIV. Farmer outlines the long history of Haiti as a gay tourist attraction, and Duvalier's encouragement of tourism as a boost to the domestic economy. Although the possible cause of the gay sex trade for HIV exposure has not been confirmed, medical establishments in the U.S. based their theories of causation on other factors, such as Haitian religious practices. These theories were, in truth, reinforcing longstanding ignorance and racist misunderstandings about Haitian vodou. Stereotypes and racial profiling of Haitian citizenship as a "risk factor" (one of the "Four H's" along with hemophiliac, homosexual, and heroin user), contributed to public policies against Haitian immigrants. Haitians' belief that they are being attacked by some evil sorcery in the guise of a fatal illness called sida falls into place amidst the context of extreme antagonism and injustice.

While reading this book, I was compelled to ask myself if there isn't some truth in Haitians' understanding of AIDS as the result of malicious sorcery. Haiti was the only American society to successfully result from the direct action of a revolution against slavery and colonialism. As such, the small nation governed by creoles and black ex-slaves presented a threat to North and South American colonial societies, which were firmly entrenched in slave labor economic systems. Historically, the threat of a repeat of the Haitian revolution must have terrified white European landowners. This terror of African power and strength has been passed on in a racist legacy, adapted to political policies and nationalist agendas, and still exists in ignorant beliefs about AIDS and its causes. Haitians believe that they are victims of a longstanding racist agenda, and they may in fact be right. Farmer's book begins to illuminate some of the complicated historical and ethnographic realities of the overlapping connections between illness and racism, and between causes and effects.

This book dispels the common myths of Haitians and AIDS. It also shows very clearly the heavy involvement of the United States in creating the poverty Haiti has faced. This book makes use of statistics well, but unfortunately, at this point those stats are many years old. When Farmer wrote this book, only three people in the village of Do Kay had died of AIDS. Now, with huge percentages of Haitians exposed to HIV, the picture must certainly look different. This book is a geat candidate for a revised edition some time in the future.

I read this book for a medical anthropology class and found it incredibly interesting in its discussion of the politics and racism involved in the US treatment of AIDS in Haiti. It delves into how the American presence and influences lead to and exasperated the widespread AIDS and poverty problems in Haiti.

I read this book for a medical anthropology class and found it incredibly interesting in its discussion of the politics and racism involved in the US treatment of AIDS in Haiti. It delves into how the American presence and influences lead to and exasperated the widespread AIDS and poverty problems in Haiti.

AIDS and Accusations is an interesting narrative about the social and epidemiological history of HIV in Haiti. Above all, this book should be read with an open mind - and understood with a grain of salt. Less a medical book than an anthropologic account, Farmer's approach provides an understanding of the impacts of HIV and of Haitian responses to the emergence of the disease in both social and epidemiologic contexts.
Farmer erects a national and cultural history to frame the discussion. Though the stated purpose of the book appears to be illustrative, he takes the opportunity to draw several conclusions regarding related topics. The subtitle of the book is predictive when characterizing these conclusions. Farmer recalls frequent detrimental Western, and particularly American, interventions into Haiti and he is quick to cast essentially the entirety of the blame for Haiti's hardship on these interactions. Though such criticisms are vogue, especially in academia, the accusations appear to reflect a primarily personal understanding of events at the expense of a more complex, and (perhaps saliently) less dramatic perspective.
Despite his ironic accusations, Farmer adds a heartbreaking intimacy to the story of Haitian HIV victims, and truly to the story of Haiti, herself.
He proposes an unconventional understanding of AIDS in Haiti, but his view is both powerful and beneficial. The compassion and humanity that are evident in Farmer's account are welcome additions to the body of literature on Haiti.


Additionally, on a medical note, Farmer makes a compelling epidemiologic case for an America-to-Haiti origin of HIV, though recent genetic studies have since supported the Africa-to-Haiti-to-America pathway. The issue has not been settled.