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The Role of Social Research in the Fight Against HIV/AIDS in Brazil and South Africa, 1990S-2010S

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The Role of Social Research in the Fight Against HIV/AIDS in Brazil and South Africa, 1990S-2010S The Role of Social Research in the Fight Against HIV/AIDS in Brazil and South Africa, 1990s-2010s An Assessment of the Socio-Political Context of Knowledge Production and Use José Katito ADVERTIMENT. La consulta d’aquesta tesi queda condicionada a l’acceptació de les següents condicions d'ús: La difusió d’aquesta tesi per mitjà del servei TDX (www.tdx.cat) i a través del Dipòsit Digital de la UB (diposit.ub.edu) ha estat autoritzada pels titulars dels drets de propietat intel·lectual únicament per a usos privats emmarcats en activitats d’investigació i docència. No s’autoritza la seva reproducció amb finalitats de lucre ni la seva difusió i posada a disposició des d’un lloc aliè al servei TDX ni al Dipòsit Digital de la UB. No s’autoritza la presentació del seu contingut en una finestra o marc aliè a TDX o al Dipòsit Digital de la UB (framing). Aquesta reserva de drets afecta tant al resum de presentació de la tesi com als seus continguts. En la utilització o cita de parts de la tesi és obligat indicar el nom de la persona autora. ADVERTENCIA. La consulta de esta tesis queda condicionada a la aceptación de las siguientes condiciones de uso: La difusión de esta tesis por medio del servicio TDR (www.tdx.cat) y a través del Repositorio Digital de la UB (diposit.ub.edu) ha sido autorizada por los titulares de los derechos de propiedad intelectual únicamente para usos privados enmarcados en actividades de investigación y docencia. No se autoriza su reproducción con finalidades de lucro ni su difusión y puesta a disposición desde un sitio ajeno al servicio TDR o al Repositorio Digital de la UB. No se autoriza la presentación de su contenido en una ventana o marco ajeno a TDR o al Repositorio Digital de la UB (framing). Esta reserva de derechos afecta tanto al resumen de presentación de la tesis como a sus contenidos. En la utilización o cita de partes de la tesis es obligado indicar el nombre de la persona autora. WARNING. On having consulted this thesis you’re accepting the following use conditions: Spreading this thesis by the TDX (www.tdx.cat) service and by the UB Digital Repository (diposit.ub.edu) has been authorized by the titular of the intellectual property rights only for private uses placed in investigation and teaching activities. Reproduction with lucrative aims is not authorized nor its spreading and availability from a site foreign to the TDX service or to the UB Digital Repository. Introducing its content in a window or frame foreign to the TDX service or to the UB Digital Repository is not authorized (framing). Those rights affect to the presentation summary of the thesis as well as to its contents. In the using or citation of parts of the thesis it’s obliged to indicate the name of the author. The Role of Social Research in the Fight Against HIV/AIDS in Brazil and South Africa, 1990s-2010s An Assessment of the Socio-Political Context of Knowledge Production and Use PhD Thesis in Sociology José Katito Supervisor: Peter Wagner TRAMOD Project University of Barcelona TO THE TRAMOD PROJECT AND MEMBERS For the great opportunity that has enabled me to address such a central contemporary issue. The AIDS epidemic is now considered not only a health problem, but also a development issue as well as a security threat. Javed Mohammad Iqbal (2009: 1) The urgent nature of the AIDS epidemic should push researchers towards new ways of thinking about and doing social science research. Naydene de Lange (2012: S9) Scientific research can only be conducted in a social system that is willing to take a critical look at itself. AIDS has forced us to examine certain previously ignored aspects of social life. Social as well as other scientists should be given opportunities to contribute to the development and evaluation of more effective methods for preventing the transmission of HIV. William W. Darrow (1991: 99) I TABLE OF CONTENTS A. Objectives ................................................................................................................................ 1 B. Theoretical and historical backgrounds ..................................................................................... 8 C. Snapshot of the chapters ........................................................................................................ 16 D. Methodological notes ............................................................................................................. 18 1 Understanding HIV/AIDS globally ............................................................................................. 21 1.1 HIV infection, transmission modes, and AIDS disease .......................................................... 21 1.2 HIV-1 and HIV-2 types ......................................................................................................... 23 1.3 The HIV pathogenesis .......................................................................................................... 23 1.4 HIV/AIDS global epidemiology, preventive and treatment measures .................................... 25 2 HIV/AIDS policy in Brazil and South Africa: an overview ........................................................... 31 2.1 The epidemiological scenario ................................................................................................ 31 2.2 Brazil and South Africa: similar starting-points, highly different outcomes ............................ 35 2.3 HIV/AIDS bureaucracies and policy steps ............................................................................ 37 2.4 South Africa's controversial policies vs Brazil's adherence to science ..................................... 43 2.4.1 The Sarafina II controversy ............................................................................................. 44 2.4.2 The controversy over Virodene ....................................................................................... 45 2.4.3 The controversy over notification.................................................................................... 47 2.4.4 Mbeki's HIV/AIDS denialism: the public face of controversy ........................................ 49 3 Comparative analysis on HIV/AIDS policy: the state of knowledge............................................. 61 3.1 Pioneer studies in the Americas: the case of Haiti ................................................................. 61 3.2 Recent international reports on the state of HIV-related social-research ............................... 64 3.3 Further reflections on the HIV/AIDS international scholarly arenas .................................... 69 3.4 Institutional-cultural approaches ........................................................................................... 73 3.4.1 Exemplifying cultural repertoires: openness to sexuality and Ubuntu values .................... 76 3.4.2 Botswana vs Uganda: exemplifying the institutional-cultural approach ............................ 78 3.5 The production and use of social-science knowledge ............................................................ 82 4 Approaches to HIV/AIDS globally: a shifting debate on the locus of social change .................... 87 4.1 From individual-information focus to structural vulnerability and community mobilization ..... 88 4.1.1 The first generation: individual-information focus for HIV/AIDS awareness ................. 89 4.1.2 The second generation: group-focus and peer education ................................................. 91 4.1.3 The third generation: structural vulnerability and community mobilization ..................... 95 4.2 The interlink between poverty and symbolic dimensions ....................................................... 99 4.2.1 On poverty .................................................................................................................... 100 4.2.2 On symbolic dimensions ............................................................................................... 104 4.2.2a Social representation approaches: the case of Sub-Saharan Africa ............................... 107 III 5 Social-science knowledge production on HIV/AIDS in Brazil and South Africa ........................ 119 5.1 Research bodies in Brazil and South Africa ......................................................................... 120 5.2 Scholarship .......................................................................................................................... 125 5.2.1 Brazil ............................................................................................................................. 126 5.2.2 South Africa .................................................................................................................. 132 5.2.3 Meta-analysis, with focus on South Africa ..................................................................... 137 6 Engaged scholarship and innovative educational approaches ...................................................... 143 6.1 IDUs and harm reduction in Brazil, and teachers training at South Africa's HEIs ............... 144 6.2 Peer education in educational contexts ................................................................................ 151 6.2.1 Playful and other innovative approaches to HIV/AIDS peer education ........................ 154 7 Understanding HIV/AIDS policy in Brazil and South Africa ..................................................... 162 7.1 Explaining the divergence between Brazil's and South Africa's HIV/AIDS-policy records .. 164 7.2 A Multidisciplinary explanation for South
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