Culture and Sexual Risk: Anthropological Perspectives on AIDS.

Edited by Han ten Brummelhuis and Gilbert Herdt. Amsterdam: Gordon and Breach Publishers, 1995, 355 pages. Cloth, $59.00; Paper, $49.00.

Reviewed by Mary S. Willis, Ph.D., Science and Diplomacy Fellow, American Association for the Advancement of Science, 1601 North Kent, Room 711, Washington, DC 20523-1819.

The vast amount of cultural and ethnic diversity found within the global community represents one of the world's great treasures. This worldwide cultural variation serves as a reservoir for new and innovative contributions to an array of human efforts. Everything from art to agricultural production manifests a cultural imprint. Yet cultural and ethnic variation has made the study of sexuality a highly complex endeavor resulting in few answers that might actually halt the AIDS pandemic. Given the rapid spread of HIV, we must focus research on barriers that prevent our understanding of human sexual behavior. Only then can we find solutions to halt the spread of HIV and, hence, save lives.

Han ten Brummelhuis and Gilbert Herdt have produced a provocative volume that dearly illustrates the complexity of studying human sexual risk behavior from a world perspective. They have culled 16 presentations from a 1992 conference entitled "Culture, Sexual Behavior and AIDS" to describe cultural diversity as it relates to HIV transmission. Emphasizing an anthropological perspective, they present material that illuminates the variation found among ethnic groups of a single country and the varied mechanism with which HIV/AIDS spreads to neighboring cultures. They discuss the impact on adult populations, but incorporate research on teenagers as well. They also have included contributions that describe sexual risk contexts, specific to either males or females, and the reasons that such behaviors persist for ether sex Although many contributing authors offer new insights for the study of sexual behavior, they implore all social scientists to rethink their research strategies, particularly as they embark on studies designed to have an impact on the alarming spread of HIV/AIDS.

Perhaps borrowing the structure of the 1992 conference, the editors group the contributions among four categories. But these divisions do not adequately assist readers in identifying the many issues they will confront. Nevertheless, this flaw does not deter from the fact that selections within the volume are well written and engaging. All provide specific cultural Contexts, describe methodological approaches for gathering data on sexuality, and offer theoretical discussions arising from the study of sexual behavior and HIV/AIDS.

Contributions from each of the editors' four divisions are briefly reviewed. Selections are neither exhaustive nor indicative of a specific overall quality Rather, they represent a few of the many excellent of barriers created by cultural contexts in this volume. The examples are divided between two categories, those that describe a set of data (Specific Cultural Contexts) and those that describe a theoretical or philosophical perspective (Essays/Discussions).

Specific cultural contexts. Popular notions of those populations most likely to be affected by HIV/AIDS fail to explain transmission in Haiti. Among poor rural Haitians, neither prostitution nor large numbers of sexual partners are the conduit for disease proliferation. Rather, men with mobile occupations, such as truck drivers and military personnel, bring HIV to rural women. Author Paul Farmer argues that because rural Haitians have different types of culturally sanctioned male-female relationships, the resulting sexual unions may enhance transmission throughout an accepted social network

In Brazil, Vera Paiva writes that the recommendations for protection from HIV are a direct threat to the elementary notions of Brazilian masculinity and femininity: Men ought not try to control sexual drive, whereas women must do so. Teenagers are forced to navigate among Western strictures imposed upon Brazilian culture and Brazilian ideologies, synonymous with the erotic and pleasurable aspects of life. Paiva, aptly shows that factors such as unemployment, an inadequate health care system, and a life without stability or certainty promote sexual risk For men, sex is a free, easily acquired pleasure. For women, children give focus and meaning to what might otherwise be an aimless existence.

The female sex trade for heterosexual men in Spain means that men take risks, and create them, without viewing their responsibility. Author Angie Hart asserts that customers have always enjoyed privilege in terms of law and society, whereas women have always been socially and legally regulated. Although some prostitutes are alcoholics and drug users, poor health, poor sanitation, few health clinic visits, unsafe sex, and low condom usage contribute to the dispersal of HIV in Spain. In contrast to the view that condom use is unnatural, satisfying one's sex drive is viewed as natural. Moreover, twist and friendship are essential components of the client/sexworker relationship, allowing customers to alter risk perceptions.

An entirely different set of problems confronts the social scientists in Thailand. Author Carla van Kerkwijka describes the Thai "sex market" that caters to every human sexual desire and preference, for international tourists as well as local Thai customers. Sex workers lead double lives, as do the clients they serve. HIV is passed from urban to rural residents, from one ethnic group to another, and from one country border and beyond through international tourism. Yet Thailand's rural hill tribes supply the greatest number of sex workers for these markets. Cornelia Kammerer, Otome Hutheesing, Ralana Maneeprasert, and Patricia Symonds have documented the horrific conditions that force the sale and seduction of the poorest rural women into city prostitution, with the youngest females sought as a means to avoid HIV/AIDS. An integral part of lowland Thai culture from at least the 15th century, prostitution was not an indigenous hill tribe practice and requires individually tailored intervention strategies for each ethnic group.

An essential element of sexual analysts is the actual encounter and the negotiated order of that contact. In the Swedish gay community, video clubs provide the setting for a study using participant observation. All ages visit clubs, with young men fulfilling a need for initiation and others finding a safe place to cruise and have anonymous encounters. Evolving from the long history of sexual repression, an elaborate "dance" signals availability. Although few safer sex messages are offered in pornographic materials, authors Benny Henriksson and Sven Axel Manssonit have determined that some men have indeed developed competence in safer sex negotiations. Both the age of participants and the sequence of sexual acts influence whether such negotiations take place.

Essays/discussions. Brooke Grundfest Schoepf stresses that, in most countries, sex research is still a highly controversial and political issue. Using Africa to illustrate this point, Schoepf demonstrates that Western researchers have further damaged the interpretation of a highly complex behavior: Sexuality has been shrouded in myth by Western society, and religious cultural intervention has actively. redefined an act of "sacred ritual power" as one of pollution and repression. Schoepf accuses Western researchers of describing Africans as "other.", as beings vastly different from Westerners. Yet interpretations of African sexual behaviors are taken out of the social context in which they are naturally embedded. The adoption of methodologies that incorporate local cultural tools and stimulate discussion of sexuality between African, rather than discussions that simply enhance a researcher's database, is urged.

Author Michael Clatts emphasizes the inappropriate focus on the gay community that has epitomized the study of HIV, underscoring the fact that the same sexual acts practiced by heterosexuals go unnoticed. Clatts, strongly advocates that we focus on behavior, not gender, on "what is risky," not "who is risky." He challenges social scientists to ask how high-risk sexual behavior is "embedded" within economic exchange systems, and he asserts; that the disparity of power and wealth is at the core of sexual risk behavior. Moreover, he aptly states that theoretical models become the "tools of neglect and abuse," building conceptual paths that have no relevance to the way people live and, hence, no link to HIV prevention. In a similarly convening manner, author Richard Parker describes the complete lack of understanding about the complexity and diversity of sexual expression Parker notes that the dominant research focus has been on survey methods and asserts that the psychological, social, and cultural meanings should take precedence over simply recording behavioral frequency. Parker challenges researchers to pose questions concerning the formation of sexual identity, the way in which desire and sexual excitement get elicited, and how power and domination shape sexual experience. He deplores the overemphasis on epidemiological approaches and criticizes the lack of attention paid to local contexts, alternative approaches, and multidisciplinalry perspectives.

A more fervent articulation of the inadequacy of research methods, particularly as applied to the developing world, is presented by author Michael Lim Tan. Tan questions the use of such psychosocial variables as locus of control, so often used in health research and highly suspect as a cross-culturally valid method. He rails against the use of Western-constructed instruments, particularly because their selection is dictated by a desire for easy quantification in Western countries. He strongly criticizes the use of a "pick up sticks" approach, a technique that haphazardly combines questions and scales from a range of U.S.-constructed surveys. He accurately describes the continued use of statements translated without linguistic equivalence, conceptual equivalence, or cultural appropriateness. He argues that such frequently used response options as "strongly agree and "somewhat agree" are distinctions of questionable value. Because culture's rich texture is often sacrificed through surveys, Tan challenges social scientists to triangulate surveys with qualitative methods.

In the unlikely event that the aforementioned materials do not stir tremendous mental energy and rumination, Ralph Bolton's essay certainly will. Bolton asserts that cultural relativism, the very essence of anthropology, perpetuates injustice and fails to take responsibility for human misery. He questions the use of a methodology to examine variables such as self-esteem and queries whether we have the time and the resources to change an individual's self-esteem and also address safer sex practices. Bolton precisely articulates the nemesis facing sex researchers today: He boldly asserts that quick research methods have privileged etic over emic, data quantity over quality, reliability over validity, statistical significance over real significance. He urges anthropologists to create culture, not just interpret it. He pleads that a focus should be on the pleasures of sexuality, not dangers. In an effort to achieve these ends, Bolton offers 18 guidelines for those conducting AIDS research.

Culture and Sexual Risk: Anthropological Perspectives on AIDS is a substantive contribution to the literature concerning HIV/AIDS. The volume will expose students to the layers of cultural complexity that social scientists must confront as they conduct research on humans, both within or between countries. It provides examples of the unique aspects within a cultural setting, the universal aspects of human culture, and the layers within which human behavior is embedded and from which it must be extracted by social scientists. For these reasons alone, this edited volume would be a very useful textbook for those teaching courses in anthropology, psychology, and sociology. It is a must read for those in epidemiology and public health. Yet it also provides examples of the various research methods that may be employed to collect data on sexual behavior. As a practical teaching tool, it focuses on a topic that affects all people, illustrating to the reader that HIV/AIDS has no single population boundary--not a specific ethnic group, country sexual preference, age group, or economic level. Furthermore, the reader is confronted with the inextricable link to the very essence of human biological replication--that HIV/AIDS has its greatest impact through heterosexual intercourse.

Culture and Sexual Risk: Anthropological Perspectives on AIDS exemplifies the great value of social science research to the health and well-being of the human species. For creating a highly readable volume that simultaneously informs students, medical and social scientists, and laypersons, Brummelhuis and Herdt are to be commended. However the editors have underestimated the usefulness of tins material for a wider audience. They have written an introduction that describes the many challenges facing the discipline of anthropology in the study of HIV/AIDS Yet the study of sexual risk behavior should challenge the theoretical perspectives and methods employed in all social science disciplines. Because AIDS is a disease that shows no population preference, material such as that found in this volume should address and be of interest to a wide audience. Although AIDS may be a "disease of development" from the global perspective, its eradication requires collaboration among developed nations, all academic disciplines, and individuals in all cultural and subcultural contexts. Culture and Sexual Risk: Anthropological Perspectives on AIDS is highly recommended as a significant contribution to that effort.