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AIDS and Accusation

AIDS and Accusation: Haiti and the Geography of Blame

Paul Farmer
Copyright Date: 2006
Edition: 2
Pages: 372
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  • Book Info
    AIDS and Accusation
    Book Description:

    Does the scientific "theory" that HIV came to North America from Haiti stem from underlying attitudes of racism and ethnocentrism in the United States rather than from hard evidence? Award-winning author and anthropologist-physician Paul Farmer answers with this, the first full-length ethnographic study of AIDS in a poor society. First published in 1992 this new edition has been updated and a new preface added.

    eISBN: 978-0-520-93302-6
    Subjects: Health Sciences, Anthropology

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-x)
  3. From Haiti to Rwanda: AIDS and Accusations
    (pp. xi-xxviii)
  4. Preface to the First Edition
    (pp. xxix-xxxii)
  5. 1 Introduction
    (pp. 1-16)

    At about 6 a.m. on June 26, 1982, Solange Eliodor expired in Jackson Memorial Hospital in Miami. When not in the hospital, the twenty-six-year-old Haitian refugee spent her final year in a rickety boat, which reached the shores of Florida the previous July, and in prison, as the reluctant ward of the U.S. Immigration and Naturalization Service (INS). The Dade County Medical Examiner denied that the young woman showed any signs of tuberculosis—“She didn’t have it. Period.”—although the INS had initially maintained otherwise. The medical examiner also said that “there was no sign the woman suffered a blow...


    • 2 The Water Refugees
      (pp. 19-27)

      The best view of Do Kay is from atop one of the peculiarly steep and conical hills that nearly encircle the village. Two deep valleys lie between this perch and the road that cuts through the village. To the left is the Peligre Reservoir, or at least that part of it not obscured by other hills. Ba Kay, several hundred feet below, is invisible from this hilltop. Viewed from the sharp outcroppings of rock protruding from the grassy crest, Do Kay looks less like a “line town” stretching along the road than a collection of tiny tin-covered huts randomly scattered...

    • 3 The Remembered Valley
      (pp. 28-32)

      As deforestation and erosion whittled away the hillsides on which the valley people now found themselves, it became more and more difficult to wrest sustenance from those hills. Their diminishing returns were bitterly compared to the bounty of Petit-Fond, which took on mythic dimensions.¹ The images used by the “water refugees” are often deeply affecting, as are the stories themselves. M. Kola is an eloquent representative of a generation that had grown up in the valley:

      Everyone lost half of his life. Even a tiny bit of land, no more than this courtyard, would yield more than you could eat....

    • 4 The Alexis Advantage: The Retaking of Kay
      (pp. 33-41)

      For many older members of the Kay community, the flooding of their valley was remembered with profound sadness. Yet, happier memories were invariably invoked in reference to the arrival of the Haitian cleric Jacques Alexis. To cite Absalom Kola again: “The sole advantage we’ve found has been the Alexis advantage.” As the villagers tell it, there seems to have been a period of relative calm after the road was completed. In many of the interviews, the next event remarked upon was the arrival, “about fifteen years ago,” of Alexis. He had, in fact, arrived much earlier, but had been spending...

    • 5 The Struggle for Health
      (pp. 42-47)

      The establishment of Clinique Saint-André as an autonomous health center may have contributed to the decline in morbidity and mortality noted above, as its staff insisted from the outset that clinical services must be linked to preventive efforts. This commitment led to the founding in 1983 of Projè Veye Sante, the preventive arm of the Kay-based health projects. Projè Veye Sante was designed to provide comprehensive preventive and primary care to inhabitants of the villages surrounding Kay, including vaccination campaigns, prenatal care, malnutrition and tuberculosis eradication programs, and AIDS prevention efforts. By August 1985, Projè Veye Sante had established satellite...

    • 6 1986 and After: Narrative Truth and Political Change
      (pp. 48-58)

      The fieldwork upon which the ethnographic portions of this study are based was conducted during a tumultuous period of Haitian history. For three decades, the country was held in the viselike grip of the Duvaliers, and it was not until late 1985 that their hold on Haiti began to slip. The discontent born of the destruction of the Creole pigs fanned the anger smoldering in rural areas. Many astute observers list it as key to the movement that later ousted Duvalier:

      The preliminary signs of the dictator’s fall were seen simultaneously in the hunger riots of 1984 and 1985, the...


    • 7 Manno
      (pp. 61-79)

      Manno Surpris moved to Do Kay in 1982, when he became a teacher at the community’s large new school. He was twenty-five years old. Born in the village of Saut d’Eau,¹ Manno grew up and received his early education in a family of peasant farmers. After having passed his primary school exams, Manno moved to Mirebalais, a large market town not far from Saut d’Eau. He began his secondary school education there, but found Mirebalais “very difficult. I had no one there, and couldn’t stay on in the room I was using.” Several months after his arrival, he received word...

    • 8 Anita
      (pp. 80-94)

      Anita Joseph once referred to herself as “a genuine resident of Kay,” but her name did not surface in the census of 1984. The following year, however, a study of ties to Port-au-Prince and the United States revealed that Luc Joseph, her father, had a daughter in “the city.” She was, he reported, “married to a man who works in the airport.” Less than two years later, Anita, gravely ill, was brought back to Do Kay by her father. After years of hearing almost nothing from Anita, Luc had received word that Anita was “lying in a stranger’s house,” laid...

    • 9 Dieudonné
      (pp. 95-109)

      Dieudonné Gracia was born sometime in 1963, on the top of a hill in Do Kay. He came into the world without dragging his placenta after him, recalls his mother, signaling at the outset the independence of spirit that marked his entire life. His father, Boss Yonèl, was fond of saying that his third son had “Dessalines’s blood in his veins,” a reference to the father of Haitian independence. That Dieudonné was quick-witted, if unruly, is clear from his school records: “Disruptive in class” is the sole remark next to one term’s harvest of good grades. He received hiscertificat...

    • 10 “A Place Ravaged by AIDS”
      (pp. 110-120)

      The suffering of mortally ill individuals can never be reduced to “cultural models” of suffering. Accordingly, we have closely examined the experience of the first three villagers to fall ill withsidain Do Kay. Because Manno, Anita, and Dieudonné lived in the relative intimacy of a small village, the responses of their covillagers shaped their experience, and the voices of many people from Do Kay are heard in the stories recounted in the previous three chapters. There is much, however, that these accounts do not capture. Through the misfortune of Manno and Anita and Dieudonné,sidabecame acollective...


    • [PART III: Introduction]
      (pp. 121-124)

      Although the human immunodeficiency virus cannot be shown to have been present in Haiti before the close of the 1970s, the country is now among those most gravely affected by HIV. As of March 20, 1990, Haiti had reported 2,331 cases of AIDS to the Pan-American Health Organization, making Haiti one of the world’s twenty most affected nations. And although no large random surveys have been conducted, several epidemiologic studies of asymptomatic city dwellers reveal HIV seroprevalence rates of between 5 percent and 9 percent. Some Haitian researchers have gone so far as to suggest that HIV-related disorders have recently...

    • 11 A Chronology of the AIDS/HIV Epidemic in Haiti
      (pp. 125-129)

      Most chroniclers of the AIDS pandemic agree that awareness of the new syndrome began in 1980 in California. Several physicians in Los Angeles observed thatPneumocystis carinii,a harmless parasite to those with intact immune defenses, had caused pneumonia (P.C.P.) in several young men without recognized states of immunodeficiency. The only epidemiological clue linking the cases was the sexual preference of the men. By June of 1981, the U.S. Centers for Disease Control (CDC), monitoring the distribution of drugs used to treat P.C.P., reported that “in the period from October 1980 to May 1981, five young men, all active homosexuals,...

    • 12 HIV in Haiti: The Dimensions of the Problem
      (pp. 130-133)

      How far has HIV spread in Haiti? Given the natural history of HIV infection, this question is best answered not by the epidemiology of AIDS, but through the study of HIV seroprevalence in asymptomatic populations. Researchers in Haiti have studied seroprevalence of HIV using both ELISA and RIPA (p24, gp120). During 1986 and 1987, sera from several cohorts of healthy adults were analyzed for antibodies to HIV (see table 3). In a group of individuals working in hotels catering to tourists, HIV seroprevalence was 12 percent. Among urban factory workers, 5 percent were found to have antibodies to HIV. In...

    • 13 Haiti and the “Accepted Risk Factors”
      (pp. 134-140)

      In Haiti, the epidemiological questions posed were the same as those in other areas facing the AIDS pandemic: Who is at risk for acquiring HIV infection? How is the virus transmitted? Specifically, what behaviors or preexisting conditions might be associated with seropositivity or HIV disease? What was the extent of infection in groups engaging in high-risk behaviors? A good deal of evidence suggests that answers to these questions have changed over the years. Initial research conducted among Haitian-Americans with AIDS identified none of the “accepted risk factors”—that is, homosexuality, bisexuality, IV drug use, a history of transfusion, or hemophilia...

    • 14 AIDS in the Caribbean: The “West Atlantic Pandemic”
      (pp. 141-150)

      The history of the Haitian AIDS epidemic is a brief and devastating one. Less than two decades ago, HIV may not have been present in the country. Now, complications of HIV infection are among the leading causes of death in urban Haiti. How are other Caribbean islands affected? Is Haiti, as some believe it to be, an AIDS-ridden pocket in an otherwise low-prevalence region?¹ Answering these questions is no mean task, as Pape and Johnson (1988a:32) suggest:

      First, in many countries there is no registry system for AIDS and it was only in 1984 that most nations started reporting cases...


    • [PART IV: Introduction]
      (pp. 151-152)

      Anthropology, Eric Wolf suggests, needs to rediscover history. In his view, anthropology needs to “transcend the customary ways of depicting Western history, and must take account of the conjoint participation of Western and non-Western people in this worldwide process” (Wolf 1982:ix). And so anthropology needed to rediscover not only the history of “victorious elites,” but also the history of the “primitive” societies so often studied by anthropologists. For many centuries now, Wolf argues, these have not really been two histories at all, but one dynamic and interconnected process. In his account, “both the people who claim history as their own...

    • 15 Many Masters: The European Domination of Haiti
      (pp. 153-163)

      In December of 1492, Christopher Columbus initiated the construction of the first European settlement in the New World. He chose a bay on the northern end of an island calledAyiti,“high country,” by the Amerindians who lived there. The Arawakan-speaking Taino people warmly welcomed Columbus, and soon fell victims to the first chronicled genocide in the New World. Weakened by exposure to new infectious diseases, the Indians were further reduced through peonage: on each adult Taino an impossible tribute of gold was imposed. The “lovable, tractable, peaceable, gentle, decorous” Indians, as Columbus had described them, did not fare well...

    • 16 The Nineteenth Century: One Hundred Years of Solitude?
      (pp. 164-176)

      The revolution that ended in 1804 destroyed much of the agricultural infrastructure of Saint-Domingue.¹ Contemporary British estimates suggest that of the more than half million blacks and mulattoes in Saint-Domingue in 1792, only 341,933 survived the revolution. Of these, a mere 170,000 were judged to be capable of field labor (Lacerte 1981:507). What is more, the Haitians found themselves in a world entirely hostile to the idea of self-governing blacks.² Mintz (1974b:60) puts it neatly when he suggests that the birth of Haiti was a “nightmare” for every country in which slavery endured. The new nation was completely surrounded by...

    • 17 The United States and the People with History
      (pp. 177-190)

      The United States Marine Corps invaded Haiti in 1915. To the student of Latin American history, it is hardly surprising that penetration of foreign capital, coupled with the almost continuous invasion by U.S. warships of Haitian waters, led to an armed occupation. As Rotberg (1971:109) remarks, “It is more surprising that the Americans waited until 1915 than that they intervened at all.” In 1901, the United States sent troops into Nicaragua. In the same year, after a three-year military occupation of Cuba, the United States formalized relations of dependency with the Platt Amendment, by which Cuba became a U.S. protectorate....


    • [PART V: Introduction]
      (pp. 191-192)

      In the next four chapters, we will turn back to the stories of Manno, Anita, and Dieudonné, and to the commentaries of the people of Kay. A number of features recorded in these accounts, including the diverse ways in which members of one community responded to a new sickness, invite further exploration. Social reponses to AIDS presented in these chapters might be classed by the dominant emotion revealed in each reaction: for example, the compassion of the families of the afflicted; the blame and anger manifest in sorcery accusations; the fear that undergirded so many responses to a new sickness....

    • 18 AIDS and Sorcery: Accusation in the Village
      (pp. 193-207)

      In the story told in chapter 9, it is clear that Dieudonné Gracia attributed the central etiologic role in his illness to sorcery. And despite the implications of his mordant critique of intraclass squabbling, Dieudonné designated as his aggressor a peer, another youth from rural Haiti. Sorcery was invoked, in one way or another, as a distal or proximal cause in each of the threesidadeaths described previously. What sense might be made of sorcery accusations vis-à-vis other social responses to AIDS? What logic underlies these accusations? Into what larger cultural system do these beliefs fit?

      When posed to...

    • 19 AIDS and Racism: Accusation in the Center
      (pp. 208-228)

      From the first years of the North American epidemic, when AIDS was widely termed the “gay plague,” members of the gay community answered homophobia with a rich cultural response that included artfully staged demonstrations, denunciations in the straight and gay presses, and an effective movement to provide services to gay men with HIV disease. Gay cultural activism in response to AIDS has brought us novels, poetry, plays, movies and even television specials. The dimensions and ardor of this response have been much commented on in the literature on AIDS in North America, and served to focus early debate about AIDS-related...

    • 20 AIDS and Empire: Accusation in the Periphery
      (pp. 229-243)

      Blame has played an important—and often destructive—role in social responses to AIDS. The early suggestions that AIDS originated in Haiti led to a great deal of unnecessary suffering. They also led to a counterattack from the disempowered people who had themselves been blamed. The counterattack was not violent, nor did it lead to the recovery of lost jobs or housing. It did nothing to augment the number of tourists visiting Haiti. It was, in fact, an entirely rhetorical measure: the elaboration of theories suggesting that powerful human agency played a role in either creating HIV or in using...

    • 21 Blame, Cause, Etiology, and Accusation
      (pp. 244-251)

      As long as we have known about AIDS, blame and accusation have been prominent among the social responses to the new syndrome. These responses have been prominent enough to be labeled by many the “third epidemic,” eclipsing, at times, the epidemics of AIDS and HIV. In the preceding three chapters, we have examined three different types of accusation born of the AIDS pandemic: the sorcery accusations registered in a small Haitian village; the accusations of North Americans (scientists, the press, the popular sector) blaming Haiti for the organism causing AIDS and also for the American pandemic; the counteraccusations of Haitians...

  11. 22 Conclusion: AIDS and an Anthropology of Suffering
    (pp. 252-264)

    Haiti’s first democratically elected president took office as this book was going to press. In an entirely unexpected turn of events, the leader of the persecuted progressive church—the very priest whose church was in 1988 attacked and burned down around him as he said mass—was elected by an overwhelming majority in a field of eleven candidates. President-elect Jean-Bertrand Aristide had just publishedIn the Parish of the Poor,a book about his country:

    Haiti is the parish of the poor. In Haiti, it is not enough to heal wounds, for every day another wound opens up. It is...

  12. Notes
    (pp. 265-300)
  13. Bibliography
    (pp. 301-332)
  14. Index
    (pp. 333-339)
  15. Back Matter
    (pp. 340-343)