‘We can’t do that here’: negotiating evidence in HIV prevention campaigns in southwest China

Abstract

Disease prevention and health care delivery, areas traditionally governed by the nation state and local communities, are increasingly being inhabited by ‘mobile sovereigns’ who carry a global currency of prevention strategies and treatments grounded in the universal standards of scientific evidence. Drawing on ethnographic evidence from research conducted on HIV in southwest China, this paper examines the impact of evidence-based science on the effectiveness of global health programming. It interrogates the intentions of global health partnerships and how the balance of power waged between those with money, science, and technical expertise, and those seeking assistance and resources, influences global health programming. Ultimately, the paper demonstrates the disconnect between the demand for a system of universal standards developed on the basis of scientific evidence and an appreciation for the local context, which shapes the way these standards should be modified for effective implementation of global health programs.

Keywords:

• China
• HIV/AIDS
• anthropology
• global health
• evidence
• ethnographic research

Acknowledgements

I am grateful for comments and feedback from the two anonymous reviewers for the manuscript as well as Kirsten Bell and Elsa Fan.

Notes

1. Many HIV-affected areas in China have been reluctant to welcome foreign assistance and programs for HIV because they don’t want to be thought of as a place affected by HIV, an association they believe can affect the local economy.

2. Many areas affected by HIV in China have not been welcoming of technical assistance from international organizations because of the stigma such projects can bring to an area and the possible threat that may pose to the local economy. This particular area was more open to exposing its HIV epidemic and saw opportunity in welcoming in international partners to aid in the response.

3. For more on the relationship between NGOs in general and government mother-in-law organization in China see Ho (2001) and Saich (2000).

4. Large municipal areas in China no longer take a siesta, but this is common practice in the area where research was conducted for this project.

5. For more on the background of the area see Uretsky (2016).

6. For more on these types of arrangements see Katherine Mason’s description of the expectations for carrying out a local measles vaccination campaign in (Mason, 2016).

7. The trainers themselves were comprised of a young college-educated woman working in public health and a former drug user who was now devoting his life to preventing drug abuse. They had been ‘trained’ in this method and program of HIV prevention training and most likely regurgitated back to their trainees the information that they had been fed. Lacking any understanding of the concept of harm reduction or any analytic capacity to help people work through the meaning of harm reduction within their own cultural landscape is a big handicap, I believe, to programs that train people about harm reduction. Such programs cannot give participants the skills to critically assess and respond to the unique aspects of global situations that affect their locales.