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Making Sense of AIDS: Culture, Sexuality and Power in Melanesia
examines how HIV/AIDS is transmitted in Melanesia, as both a disease and as a social construct. Several threads run through this collection; moral messages that restrict understandings of HIV/AIDS to people associated with 'risk,' the related conceptualisation of HIV/AIDS transmission by affected communities, and a lack of power among women and other marginalised gender identities. This admirable collection serves to focus our attention on neglected complexities through which Melanesian sexualities are mediated. Diseases are never purely epidemiological, and HIV/AIDS is no exception—for this reason, this book is both timely and necessary.
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The book is useful for its collection of accounts of how messages aimed at prevention end up reinforcing prejudices and allowing the disease to be seen as a threat from the outside, from 'unclean' or 'immoral' individuals, and presenting sexuality as an activity of risk rather than pleasure. Using a number of ethnographic accounts, the authors describe a range of discursive actions which serve to distance the disease from the spheres of activity of most Melanesians, and reinforce mis-understandings about vulnerability to transmission.
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Clear ethnographic accounts are present relating to how the disease has been interpreted and situated within the worldviews of particular Melanesian societies. If HIV/AIDS prevention and treatment are to be effective, the approaches used must fit the circumstances, which very often diverge from the generalised transmission models used.
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Nicole Haley begins this collection with an examination of how HIV/AIDS is conceptualised in Papua New Guinea's Lake Kopiago. Here it is understood as an external threat against a backdrop of underdevelopment, rather than the more pressing dilemmas that dominate local political and social activity.
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Leslie Butt and Sarah Hewat give descriptions of how the logic of HIV/AIDS messaging serves to underline power-politics among elites, and how messaging reinforces preconceptions about the disease being spread conspiratorially through non-Papuan prostitutes. The nature of the state has long been contested in Papua, and ownership, rejection and reinterpretation of state interventions allow further development of these processes. Jack Morin's chapter on the situation of urban transexuals in Indonesian Papua describes how multiple layers of discrimination prevent access to and use of condoms and testing and treatment.
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In Papua New Guinea and Papua, heterosexual forms of transmission predominate, and 'risk groups' provide a falling percentage of infections. Despite this, information and advertising has thus far been largely targeted at sex workers and those who have sex with them, and men who have sex with men (MSM). The deliberate exclusion from advertising and prevention strategies of women and men who have sex with their female partners has had the effect of taking attention from high risk behaviours and placing it onto high risk individuals. Notifications of HIV/AIDS are increasingly showing that the epidemic has become generalised, particularly in highlands Papua New Guinea, but also elsewhere in the region.
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The inclusion of 'power' as a focus of the book is praiseworthy. No mention of HIV/AIDS transmission in Papua New Guinea would be complete without the description of the 'epidemic of violence' against women in the country. Such violence is discussed, particularly by Lawrence Hammar, and in a number of the articles which collectively serve to challenge the very notion that the Abstinence, Be Faithful and Condom use of the ABC model are even options available to many women. Throughout the book contests over morality and the social control this represents are prevalent. These disputes are at the centre of rich chapters by Holly Buchanan-Aruwafu and Rose Maebiru, Holly Wardlow, and Richard Eves.
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As Maggie Cummings describes, even women who are empowered in other social spheres may find themselves lacking in sexual agency, and it is precisely this lack of empowerment that dooms many HIV prevention strategies from the start. Christine Salomon and Christine Hamelin provide similar accounts of Kanak women's experiences in New Caledonia. The models which underpin many prevention efforts suggest that individuals have strong agency. This is an assumption which a number of authors challenge directly. Constrained by severe imbalances in power and strong social impositions, it is often in an individual's perceived interest to engage in behaviour despite high risks. Further, women and men of marginalised gender identities are often unable or unwilling to take medical testing, for fear of further marginalisation and ostracism.
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This book makes a consistent case against both medicalised and moralistic discourses as ways of understanding HIV/AIDS in Melanesia. The chapters, instead take us some way to understanding how the disease passes through social environments, and the traces it leaves on those it affects. This collection illustrates attempts to configure the bodies and sexual practices of Melanesians into the reductionist logic of many prevention programs, particularly those driven by development agencies and church groups.
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Katherine Lepani's calls in the final chapter are an important corrective to some of the restrictive practices and discourses outlined in the rest of the book. As elsewhere, in the Trobriand Islands the disease has affected sexual practices, and is beginning to have a number of corrosive affects on social relations. Her suggestions detail the creation of new understandings of sexuality which are sympathetic to traditions, embrace pleasure, and provide for the safety of participants.
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One of the strengths of this collection is the broad geographic coverage, which includes Indonesia's West Papua. While not often included in descriptions of Melanesia, the rate of infection is particularly high and patterns of transmission in West Papua are similar to those in Papua New Guinea, rendering an approach that addresses both sides of the border necessary.
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This book will be valuable to both health practitioners and a wide academic audience. The book complements a growing literature on how understandings of the disease affect communities and transmission, particularly regarding the regulation of bodies and sexuality. It is timely as awareness increases in organisations addressing the disease in Melanesia, of the gaps in previous understandings and the need for responses that address these.
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