Copyright (2010) by Suepattra Grace May ii For my father iii ACKNOWLEDGEMENTS Acknowledgements are a strange beast, forcing one to consider who should be included and exactly what constitutes inclusion, in a piece of work that is often considered one’s penultimate academic achievement (at least until you make it out of graduate school). In thinking about who I wished to acknowledge I thought of how I came to this point in my life, who and what I have been influenced by; and who and what helped shaped the success of my project and academic career. While I acknowledge many, I am ultimately responsible for the content herewith. I began college studying fashion marketing. With the emergence of the HIV/AIDS epidemic in Thailand in the early 1990’s -- a topic featured prominently in the international media at the time because of the large commercial sex tourism industry -- I became interested in the field of public health and wanted to learn more about Thailand and the AIDS epidemic. Thus, I embarked upon undergraduate work as an International Studies/Southeast Asia major at the University of Washington. It was there that I discovered the field of anthropology and its sub-discipline medical anthropology. Without a doubt, my time at the University of Washington shaped my desire to become an anthropologist. Courses on Buddhism with my former advisor Professor Charles Keyes showed me how ethnographic methods are used to study culture and religion; as well as how religion itself serves as a means for social interpretation and decision making in the lives of its followers. I enrolled in my first medical anthropology class with Dr. Lorna Rhodes, where I was introduced to the discourse of sexuality and power, e.g. The History of Sexuality by Michel Foucault, and transformed long held beliefs and iv stereotypes I had held about Thailand’s commercial sex industry. When I returned to the University of Washington as a Master’s in Public Health graduate student focused on breast cancer screening in Senegal, I continued my engagement with anthropologists. Dr. Noel Chrisman helped me to understand better the advantages of incorporating applied anthropology into public health and clinical practice. Dr. Marjorie Muecke provided sage wisdom and guidance about anthropology and “the field”, as I conducted my thesis research in West Africa. Dr. Sharyne Shiu-Thornton instilled in me the importance of cultural competence – no matter what the culture - in both public health practice and research methodology. All of these anthropologists cemented my desire to become a medical anthropologist. Many people throughout my academic career have influenced me and helped to shape the ideas, theories and trajectory I ultimately pursued in this project. That said, I am most grateful for the support, the collaboration, the intellectual stimulation, the social support and the friendships I have made in the UC Berkeley and UC San Francisco academic communities. Doctoral students in the joint program are fortunate to have a community of scholars at two universities. My doctoral path was difficult, and my ultimate embrace of embrace of medical anthropology not simple given my transition from public health, but I grateful to the faculty in the Department of Anthropology, History and Social Medicine (DAHSM) for recognizing in me something that I was not able to see so easily at first myself. My growth as an ethnographer, a scholar, a researcher and an anthropologist would not have been possible without the exceptional mentorship and guidance of my dissertation committee and other DAHSM faculty. v I am grateful to my entire dissertation committee for their support of this project and fortunate to have served on my committee an incredible group of social scientists. I am most thankful to my dissertation committee Chair, Professor Vincanne Adams, for her unwavering support as I struggled through the years to transition from being an applied public health practitioner to a bona fide medical anthropologist. She pushed me to excel and instilled in me the will to be a true anthropological scholar. Her devotion to her advisees is unmatched, and I am grateful for her critical mentoring, productive insights and all around support throughout my entire academic career at UCSF. In addition to serving on my dissertation committee, Professor Judith Barker acted as my academic advisor and Chair of my qualifying examinations committee. I am most grateful for the advice and guidance she has provided throughout the years and through her critical review, always ensuring my research would hold relevance in the public health sector. I am equally grateful to Professor Adele Clark for my rigorous training in qualitative research methods, Science and Technology Studies and Feminist theory. Her thoughtful guidance and mentoring was evident not only in our meetings, but in the many times I would find in my mailbox a journal article or news clipping on a topic related to my research that she thought I should know about. I am also incredibly thankful for the support, guidance and mentorship of Professor Lawrence Cohen, whose theoretical brilliance I would sometimes find intimidating, but whose warmth and accessibility, infectious excitement and steadfast encouragement about my project kept me inspired throughout. In addition to my committee members, there were many other faculty whose mentoring proved pivotal at crucial times throughout my academic career. Professor vi Sharon Kaufman helped me to craft my first pilot proposal on this subject and ensured through her dissertation seminar four years later when I had returned from the field, that my analyses were equally as rigorous. Professor Philippe Bourgois encouraged me to pursue a research topic that despite the lack of a participant observation component could still prove to be good ethnography. Jeremiah Mock and Nancy Burke served as invaluable mentors – not only about traversing the world of anthropology but in finding balance in graduate life. Rena Pasick and Marjorie Kagawa Singer, ensured that I remained within the MTPCCR community and provided invaluable support throughout my doctoral career, helping me to believe that I could truly do it. It goes without saying that without the assistance of Clair Dunne and Kimberly Bissell I would never have been able to navigate the UC bureaucracy, so I am thankful for their assistance throughout the years. Lastly, I am also grateful to the remaining staff and faculty of DAHSM. While they were not always involved directly in my work, they helped foster an environment that was conducive to the success of the project and myself as a doctoral student. I am especially grateful for the many colleagues and friends I have made in the UCSF-UCB Anthropology, Sociology and Science and Technology Studies communities. My work, outlook and life perspective has been deeply enriched and shaped by the friendships I have made as a result. In particular, I would like to acknowledge my 2004 Medical Anthropology Cohort: Shana Harris, Stephan Kloos, China Scherz and Scott Stonington, whose support helped me through the good times and the bad and whose friendships with I know shall be lifelong. Thank you friends. In addition, there are many more across the medical anthropology and sociology cohorts – far more than whom I can vii name here - whose friendship, guidance and support I am eternally grateful for including: Alex Choby, Ben Hickler, Robin Higashi, Kelly Knight, Jennifer Liu, Betsy Pohlman, Jade Sasser, Jennifer Liu, Meg Stalcup Thurka Sangaramoorthy, Katherine Thomson, Erica Solway and Martine Lappe. You may not know it, but at times, your friendship, a conversation we had, or a task we embarked upon together, meant a lot. And of course, my Anthropology 240 cohort and the ensuing cohort love. Despite the fact that when I was around them, I was often lost in the heady theoretical discussions they engaged in, but even so they knew how to have fun and they never made me feel like an outsider. Separately, I was able to participate and share my work and present my work during its development at many institutes. I made fantastic friendships and received immeasurable support and intellectual and epistemological encouragement from the people who I was fortunate to interact with. The 2006 Summer Institute on Sexuality, Culture and Society at the University of Amsterdam proved a seminal experience in my development as a researcher investigating sexuality and gender. I am grateful for the experiences that long hot summer in Amsterdam and for the intellectual and social stimulation I was exposed to in that wonderful place and space. In particular, I wish to acknowledge Annalies Hernandez and Rachel Kalish for their review and support of my work. Other places where I made wonderful friendships and received feedback on my research included the 2006 UCHRI Seminar in Experimental Critical Theory, the 2007 & 2008 Northern California Science and Technology Studies Workshops in the Marin Headlands, and the 2008 Spring Semester Gender and Sexuality Studies Seminar led by Lawrence Cohen. As well, I am thankful to friends and colleagues who read and viii commented on various drafts of my chapters as I wrote, including Dr. Brooke Wells for her critical reading and Sue Peacock for her statistical analyses. Thank you all. I was fortunate to receive funding from many sources. My research would not have been possible without it. Thus, I wish to acknowledge the UCSF Department of Anthropology, History and Social Medicine and the UCSF Graduate Division for awarding me the President’s Research Fellowship in the Humanities, the Graduate Dean’s Health Sciences Fellowship and the Graduate Student Research Award over the course of my academic career. I would also like to acknowledge the Society for Scientific Study of Sexuality for honoring me with their annual Graduate Student Research Award in 2008.