Proquest Dissertations
Total Page：16
File Type：pdf, Size：1020Kb
Mapping disease and desire: Gender and perception of HIV risk at the turn of the millennium in Havana, Cuba Item Type text; Dissertation-Reproduction (electronic) Authors Pope, Cynthia Kay Publisher The University of Arizona. Rights Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author. Download date 06/10/2021 04:17:51 Link to Item http://hdl.handle.net/10150/280317 MAPPING DISEASE AND DESIRE: GENDER AND PERCEPTION OF HIV RISK AT THE TURN OF THE MILLENNIUM IN HAVANA, CUBA by Cynthia Kay Pope A Dissertation Submitted to the Faculty of the DEPARTMENT OF GEOGRAPHY AND REGIONAL DEVELOPMENT In Partial Fulfillment of the Requirements For the Degree of DOCTOR OF PHILOSOPHY WITH A MAJOR IN GEOGRAPHY In the Graduate College THE UNIVERSITY OF ARIZONA 2003 UMI Number: 3090005 UMI UMI Microform 3090005 Copyright 2003 by ProQuest Information and Learning Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. ProQuest Information and Learning Company 300 North Zeeb Road P.O. Box 1346 Ann Arbor, Ml 48106-1346 THE UNIVERSITY OF ARIZONA ® GRADUATE COLLEGE As members of the Final Examination Committee, we certify that we have read the dissertation prepared by Cynthia Kay Pope entitled Mapping Disease and Desire: Gender and Perception of HIV Risk at the Turn of the Millennium in Havana, Cuba and recommend that it be accepted as fulfilling the dissertation requirement ^r the Degree of Doctor of Philosophy Sds^ Craddock Date JdAlce Monk Date /"/ol Andrew Comrie Date "'i ^^ nna Dat/ ; f yAs/- Raul baba Date Final approval and acceptance of this dissertation is contingent upon the candidate's submission of the final copy of the dissertation to the Graduate College. I certify that I have read this dissertation prepared under my dirpctjion a^ recommend that it be accepted as fulfilling the dissertation requirement 'I ->-^ (31 Dissertation Directo san Craddock Date 3 STATEMENT BY AUTHOR This dissertation has been submitted in partial fulfillment of requirements for an advanced degree at The University of Arizona and is deposited in the University Library to be made available to borrowers under rules of the Library. Brief quotations fi-om this dissertation are allowable without special permission, provided that accurate acknowledgement of source is made. Requests for permission for extended quotation from or reproduction of this manuscript in whole or in part may be granted by the head of the major department or the Dean of the Graduate College when in his or her judgment the proposed use of the material is in the interests of scholarship. In all other instances, however, permission must be obtained from the author. Signed: 4 ACKNOWLEDGEMENTS I would like to thank my committee members, all of whom have been very supportive throughout the many phases of this project, from the pre-dissertation fieidwork through the final analysis. I am particularly grateful to Susan Craddock, Janice Monk, and Sally Stevens who guided me with their different intellectual insights into the research process and with their various perspectives on women's health, international collaboration, and HIV/AIDS. I also must thank K. Lynne Stoner who introduced me to Cuba during a summer research program in 1998. In addition, Andrew Comrie was instrumental in helping me with the logistics of the final stages of this project. The various stages of this work were funded by the Tinker Foundation (through the University of Arizona), the Latin American Area Center at the University of Arizona, Johns Hopkins Cuba Exchange Program, and the National Security Education Program. I would also like to thank my family for their encouragement of pursuing (and completing!) the doctorate degree, and also to my friends and current colleagues who have provided wonderful feedback and personal anecdotes throughout the process. 5 TABLE OF CONTENTS LIST OF TABLES 8 ABSTRACT 9 CHAPTER I; Introducing Women's Vulnerability and Resistance to HIV/AIDS in Cuba 11 Research Questions 11 Island of Paradoxes 12 The Role of Cuba in AIDS Discourse 15 The Importance of Gender 18 Definition of Key Terms and Acronyms 19 Significance of Research 21 Organization of the Dissertation 24 CHAPTER II: Weathering Economic and Epidemic Crises: Geopolitics, Health Care, Gender, and AIDS in Cuba 31 The Symbolic Capital of Cuba's Health Care Industry 36 Economic Crisis and Social Responses 38 Medicine 45 Gender, Revolution, and Health Care 49 Cuba Responds to the AIDS Epidemic 52 CHAPTER III: Conceptual Framework: Contextualizing Geographies of Blame, Identity, and Risk 57 Towards a Medical Geography of AIDS in Cuba 59 Discourses of Blame and Structural Violence 67 Sex Work and HIV Risk 72 Identity and Prevention 80 Risk and Space 84 CHAPTER IV: Field Methods in Cuba: Opportunities and Challenges for International Collaboration 90 Reflexivity in the Research Process 91 Pre-dissertation Fieldwork 93 Accessibility in the Field 95 Working in a New Paradigm 97 Issues of Marginality 100 International Political Relations and Research 101 Dissertation Methods 103 The Role of Research Assistants 104 Membership Roles 108 Ethics in a Cross-Cultural Context 110 6 TABLE OF CONTENTS ~ continued Demographics 113 Age of the Respondents 114 Race and Ethnicity 117 Employment 119 Survey Instrument 121 CHAPTER V: Power, Knowledge, and Risk Perception 125 Knowledge of Sexually Transmitted Diseases 128 STD Knowledge Acquisition 130 STD/HIV Prevention Awareness 133 Acquaintances and Sexually Transmitted Diseases 138 Spatial Regulation 140 Conclusion 141 CHAPTER VI: "Othering" and Marginalization 144 Perceptions of Foreigners 148 The Perseverance of Risk Groups 156 Inclusion and Exclusion Criteria 161 Prevention and Identity 162 Identity and Funding 169 Jinetera Vignettes 175 Lisbette 176 Elena Ill Rebeca 179 Conclusion 181 CHAPTER VII: Geographies of Risk 183 Neighborhood Risk 187 Temporal Exposure to Risky Spaces 188 Sexy Spaces 194 Homosexual Spaces 199 Youth-oriented Risky Places 202 Sex and Public Places 203 Homosexual Spaces and Media 207 Media Exposure of Risky Spaces 212 Conclusion 213 CHAPTER VIII: Reconsidering the Gendered Geographies of HIV Risk in Cuba....215 Knowledge Creation 216 Commercial Sex Workers 220 Homosexual Bodies 223 Heterosexual Bodies 226 7 TABLE OF CONTENTS ~ continued Regulating Bodies 227 Policy Implications 228 Future Research Directions 234 APPENDIX A: MAP OF CUBA 236 APPENDIX B; MAP OF VEDADO TO OLD HAVANA 237 APPENDIX C: SURVEY FORM AND CONSENT 238 APPENDIX D: HUMAN STUDIES APPROVAL 241 APPENDIX E: PHOTOGRAPHS 243 Photograph 1, Billboard 244 Photograph 2, Officer on Beach 245 Photograph 3, Pamphlet cover 246 Photograph 4, Pamphlet inside 247 Photograph 5, Knowledge Means Life 248 Photograph 6, Carrito por la vida 249 WORKS CITED 250 8 LIST OF TABLES TABLE 4.1, Self-reported ethnic categories 117 TABLE 5.1, Frequency of STD reporting 128 TABLE 5.2, Method of information 130 TABLE 5.3, STD prevention methods 134 TABLE 5.4, Relationship to respondent 139 TABLE 5.5, HIV/AIDS containment 140 TABLE 6.1, Risk and nationality 148 TABLE 6.2, Respondent-identified STD risk groups 156 TABLE 7.1, Reported high-risk places and areas 191 9 ABSTRACT In spite of Cuba's policy of HIV containment, women's rates of HIV seropositivity are rising in that country (Mann et a/.1992; MINSAP 1997-1999). As with increasing rates anywhere in the world, the reasons lie within a complex relationship of global geopolitical location, local economies, and cultural constructions of meaning. This project has three primary research objectives. First, I investigate why women are at risk for HIV in Cuba and which women, if any, are specifically more vulnerable. Secondly, I analyze the viability of HIV prevention programs for women in Havana. Finally, this project investigates how social and government organization of space impacts risk or perceived risk for HIV in women. The main phase of the dissertation fieldwork occurred in 2000 and 2001.1 conducted semi-structured surveys with approximately 225 individuals, as well as conducted open-ended interviews with public health officials, analyzed media, and used participant observation method. The primary findings indicate that individual risk is a reflection of one's identity. Often, individuals in this study made a point of distancing themselves from stigmatized groups in Cuba society, such as homosexuals or sex workers. In addition, the women who appeared to be most at risk were those in "monogamous relationships." While these participants thought that the stability in their relationship would make them immune to HIV, often their partners were not sexually faithful to one woman. Therefore, one policy recommendation is that prevention programs in the country target heterosexual women. 10 Additionally, geography factored into peoples' perceptions of risk. Participants associated physical places and spaces with disease and contamination. These spaces were generally where "deviance" was present, for example tourist districts and places where homosexuals are known to congregate. The AIDS sanatorium system is unique to Cuba, and one of its legacies is the "paradox of othering." Participants considered that the physical separation of people living with HIV from the general populace to be good for both the patients and citizens. The participants saw the sanatorium as a way to contain the virus, reform the individuals' behaviors, and thus integrate those with HIV into post- revolutionary Cuban society. 11 Chapter I Introducing Women's Vulnerability and Resistance to HIV/AIDS in Cuba "What we are witnessing [in Cuba] is like a novel by Kafka illustrated by Salvador Dali." Cuban official describing the nation's cultural landscape (Larmer and Leland 2000:33) It was as if the state had outlawed illness, expecting doctors to go about eliminating disease as if they were law enforcers.