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Reproductive Health Matters
An international journal on sexual and reproductive health and rights
Volume 11, 2003 - Issue 22: HIV/AIDS, sexual and reproductive health: intimately related
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Original Articles

“Typhoid Mary” and “HIV Jane”: Responsibility, Agency and Disease Prevention

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Pages 40-50 | Published online: 13 Nov 2003
 

Abstract

The construction of disease risks as knowable, calculable and preventable in dominant social science and public health discourses has fostered a certain kind of logic about individual risk and the responsibility for infection. Disease control measures that have developed out of this logic typically fail to recognise the socio-structural roots of many high-risk behaviours that are linked to the spread of infection. Instead, they hold the disease carrier responsible for managing his/her own risk of infection of others, and rely on constraining the agency of the carrier (e.g. by constraining movement, contact or occupation). In occupations associated with a high risk of infection, the idea of responsibility of the actor implicitly raises issues of “professional responsibility”. Using the case of “Typhoid Mary” and a hypothetical case of “HIV Jane”, this paper explores some of the problems with making sex workers responsible for the prevention of HIV transmission. It argues that for the notion of “responsibility” to make any sense, the HIV-positive person must be in a position to exercise responsibility, and for this they must have agency.

Résumé

Le discours dominant dans les sciences sociales et la santé publique estime qu'on peut connaı̂tre, calculer et prévenir les risques de morbidité, ce qui a encouragé une certaine logique sur le risque individuel et la responsabilité de l'infection. Les mesures de lutte contre la morbidité issues de cette logique méconnaissent les origines socio-structurelles de beaucoup de comportements à haut risque. Au contraire, elles estiment qu'il incombe au «porteur de la maladie» de gérer le risque qu'il a d'infecter autrui, et veulent limiter l'action du porteur (p. ex. en restreignant ses mouvements, ses contacts ou ses occupations). Dans des professions associées à un risque élevé d'infection, l'idée de la responsabilité du porteur soulève implicitement la question de «responsabilité professionnelle». Utilisant le cas historique de «Typhoid Mary» et un cas inventé de «VIH Jane», l'article étudie les problèmes soulevés quand on responsabilise les professionnel(le)s du sexe de la prévention de la transmission du VIH. Il affirme que pour que la notion de «responsabilité» ait un sens, la personne séropositive doit pouvoir exercer sa responsabilité et donc avoir une latitude d'action.

Resumen

En los discursos dominantes de las ciencias sociales y la salud pública se han construido los riesgos de enfermedad como elementos que se pueden conocer, calcular y prevenir, fomentando ası́ una cierta lógica acerca del riesgo y la responsabilidad individual con respecto a la infección. Las medidas de control de las enfermedades que se han desarrollado a partir de esta lógica desconocen las raı́ces socio-estructurales de muchos comportamientos de alto riesgo vinculados a la propagación de infección. Al contrario, dichas medidas consideran al “portador de la enfermedad” el responsable de manejar su propio riesgo de infectar a otros, y pretenden restringir el movimiento, contactos o actividades del portador. Con respecto a las actividades asociadas con riesgo de infección, la idea de la responsabilidad del portador plantea asuntos de “responsabilidad profesional”. Usando el caso histórico de “Marı́a Tifoidea” y el caso hipotético de una tal “Juana VIH”, este artı́culo examina algunos de los problemas inherentes en responsabilizar a las trabajadoras del sexo por la prevención de la transmisión del VIH. Plantea que para que tenga sentido la idea de la “responsabilidad”, la persona viviendo con VIH debe estar en una circunstancia que le permita hacerse responsable.

Notes

* Even in sub-Saharan Africa, where HIV is an infection of the general population and not just marginalised sub-populations, it is still strongly associated with the illicit relationships of mes petites, mistresses and sex workers,Citation69Citation78Citation79Citation80Citation81 69,78–81 in addition to vertical transmission and transmission in marriage.Citation82

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