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Article Excerpt
INTRODUCTION
'As for me, I can give out the condoms to the men, but we don't give them out to women. The nursing sisters say 'no, you must follow God's law', that "it will only encourage the women to have sex again anyway"' (STD clinic employee, Enga Province, April 4, 2006).
This very special issue of Oceania is composed of provocative ethnographic data that have been collected, analysed and assembled by seasoned field-workers. Each contributor has shown sociological insight and pointed to exciting new directions for research on HIV, AIDS, sexually transmitted diseases (STDs), sexual behaviour, and health services delivery systems in Papua New Guinea (PNG). Collectively and individually, the essays are linked to other research areas, ask pregnant theoretical questions, and make me think harder about the future of PNG. If I say that it seems currently to be hanging in the balance, it's because for three years (2003-2006) I worked alongside colleagues at the Papua New Guinea Institute of Medical Research. The research we conducted on HIV, AIDS, STDs, and sexual health and behaviour brought us to 11 mainland field-sites, split roughly between 'urban' and 'rural' settings. (1) We worked in villages that hugged the shoreline toward PNG's border with Indonesia near Wutung, in settlements that straddled mine-site boundaries (and villages flung far from them), and in quasi-hamlets strung out along oil pipelines. The data we collected suggest that PNG's HIV epidemics will continue to expand and have increasingly devastating effects. That politicians and public health officials continue to draw comparisons to 'African-style epidemics' to understand something that is home-grown, however, is a terrible contradiction, another example of the process of externalisation that continues to hamper a 'national response to AIDS' that is in fact largely driven by foreign donors. This issue of Oceania is especially valuable for putting rural settings and responses front and centre where they belong.
Katherine Lepani's wonderfully reflexive discussion of sovasova in the Trobriand islands recalls what medical anthropologists used to call 'culture-bound illnesses' and is linked with early works of Paul Farmer in that the residents of the Haitian village in which Farmer worked (Do Kay--a pseudonym) attempted to 'fit' this new thing--SIDA--into preexisting ethnomedical schema. Do Kay villagers quibbled surprisingly little over the pathogenic agent of SIDA, eventually accepting rather easily the presence of a microscopically small virus and worrying over a vaguely expressed 'foreign homosexuality', slowly arriving at a consensus as to its putative transmission route--the 'sending of sickness' via sorcery, something that is happening daily across PNG. (2) This raises the problem of how, as Verena Keck makes clear in her interesting contribution here, 'biomedical information about HIV/AIDS is perceived and adopted into local contexts'. In even starker contrast, Trobriand islanders had no such schema within which to fit gonorrhea and Donovanosis, much less a particularly virulent and disfiguring form of syphilis, when they arrived in the late 19th and early 20th centuries. Some sufferers of syphilis were buried alive by frightened villagers, so horrified were they by the stigmata that initially resembled a fulminating presentation of yaws, the treponemal cousin of syphilis. Accounts have appeared of the stigmatization of those known or thought to be suffering from AIDS (Haley n.d.a., n.d.b.; Hammar n.d.b.; Layton 2004), including strangulation, torture, burning, drowning, and being thrown into rivers, latrines and chicken and pig enclosures. The Post-Courier and The National, PNG's two English-language daily newspapers, have reported the piling up of the bodies of AIDS victims in under-resourced morgues and their burial in unmarked graves. The airing in August of 2006 of the ABC documentary, 'Sick No Good,' was followed by public condemnation of the callous treatment it uncovered--and equally of its airing to foreigners.
At some point in the past several decades, members of Lepani's (then) host/(now) home village began to suspect improper sexual mixing: sovasova is said to be an internally stagnating form of sexual congress occurring between people thought too closely related. It causes changes in skin tone and pallor, chronic pains, swollen abdomens and other symptoms. As she makes clear in rich ethnographic detail, some villagers have begun to accept a bacterial cause for what might (or might not) be pelvic inflammatory disease--or worse. Indeed, their acceptance has been just as uneven and highly contested as have been worries about the efficacy of newly used 'traditional' cures. There was also great contestation in Haiti in the early years of its AIDS epidemic in terms of the efficacy of Christian prayer, village-based ritual, natural medicines, medical doctors, and Vodoun priests. Some Trobrianders appear to 'see' sovasova in what might be cases of AIDS ... or maybe they're just cases of sovasova. Whereas one acquires HIV from others in intimacy, and insofar as AIDS was in Haiti and is now in PNG thought to be 'sent' or 'done' by others, sovasova seems instead to occur and to do so literally between people.
Verena Keck's work among the Yupno of the Finisterre Range bordering Madang and Morobe provinces follows well upon the compelling writings of her countrymen Hansjorg Dilger (2003) and Wolfgang Kempf (2002) on the perils for (especially male) youth of modernity in this age of AIDS. (3) Keck focuses here partly upon the remoteness with which the Yupno must contend in economic terms and the degree to which their relative geographic isolation hinders the communication of potentially life-saving knowledge about HIV transmission risk and technologies, including condoms, especially to unmarried youth. The literal road is two-way, letting STDs in along with economic opportunities, but metaphorically one-way in that villagers do not perceive themselves as posing transmissive risks to others or 'the village' as a high risk setting. This is something that I suspect would resonate among Trobriand islanders and Gogodala. Not that some knowledge of viruses and bacteria isn't present among their host community members, but by discussing disease etiology (or in the case of Alison Dundon's contribution here, temporary mental illness (4)) in terms of disturbed social relations, Keck and Lepani place themselves in a lengthy intellectual genealogy of anthropologists (see Hammar n.d.c.). Insofar as AIDS is truly for Yupno, and apparently Gogodala and Trobrianders, a disease syndrome for which no cure exists, one can ask how they'll take on the 'miracle' cures and mushroom potions available just down the road in Lae and which Yupno will market them. These potions were for the Gogodala until recently available on nearby Daru island, but the most prominent seller thereof now peddles them from Mendi General Hospital in remote Southern Highlands Province with help from a Goroka-based medical doctor.
Our editors Alison Dundon and Charles Wilde have divided and pooled their labor sensibly; the short titles of their two very fine Ph.D. dissertations--Dundon's Sitting in Canoes (1998) and Wilde's Men at Work (2003)--suggest something of the content therein and in the several interesting essays they have already published about religion, work, and cultural and social change among the Gogodala of Western Province (see especially Dundon 2004; Wilde 2004, and other references to their work in this collection). Dundon's contribution here and data she presents elsewhere (e.g., 2004: 79) suggest that in the context of AIDS and its accusation, expressions of Christian femininity are becoming increasingly punitive and condemnatory. Their stinging rebukes of female sexuality, delivered with icy stares at what seem to be post-coital shenanigans or in near-delirious channelings of the Holy Spirit, probably haven't made sex--even within the ideal confines of a happy, Christian, monogamous marriage--an easier topic about which to speak with friend and family or behaviour to experience positively.
Insofar as there are few such happy, Christian, monogamous marriages, as Wilde (2005) found while researching Gogodala male attitudes toward condoms, no wonder that lust and longlong ('craziness', in Tok Pisin) go hand-in-hand. Gogodala women seem also to be active in what Richard Eves (2003: 256) has called in his important essay, 'AIDS and Apocalypticism', 'the general Salvationist project', and as such seek to 'contain sexuality within the confines of monogamous marriage'. Sexual desire, however, won't stay put in the ways preachers, politicians and public health officials want it to. It remains the irresistible force against the immovable object of many centuries' worth of religious and moral stigmatization of it and its alleged wages--venereal disease--which has been dubbed the 'dirtiest subject of them all' (Rosebury 1973: xvi). Wilde explores the terrible paradox facing young unmarried men in PNG: responding smartly to ad campaigns promoting the efficacy of condom usage (by using them) means to behave in ways thought immoral and anti-Christian. Another facet of such paradox is revealed also by Dundon, who shows that AIDS has become not so much the Great Imitator, as syphilis was dubbed centuries ago, but rather, the Great Deceiver. Its visual spectre is thought grotesque, but it comes nevertheless silently into communities, dressed in the guise equally of beloved spouses, feared criminal gang members, admired rugby players and demonised sex workers, spawning fear and cognitive mayhem in about equal amount. In similar settings but across the border in Manokwari in Indonesian Papua, Sarah Richards (2004) shows that Western horror film codes inform the fear and stigmatization of AIDS sufferers, and worse, excuse demonisation of those same sex workers. 'It was as if stories about people suffering AIDS drew symbolic material from the scripts of horror films' (Richards 2004: 82).
In similar fashion, some men in remote villages of Lake Kopiago District in Southern Highlands Province (and many more in Eastern Highlands and Simbu provinces) have sought to contain the cause of death within the confines of traditional ideas of gender relations and sorcery. They have taken advantage of the retreat of government services in the area to reassert recently waning masculine power over women. In one particularly grim case reported by Nicole Haley (Haley n.d.a., n.d.b.), the suspicious recent deaths of men (probably from AIDS) were blamed on vulnerable women dubbed witches, who were then horribly tortured and mutilated and in several cases murdered. (5) The contributions here and those of Wardlow (2006), Eves (2003), Haley (n.d.a., n.d.b.), Wood (1998), Levy (2005) and others (Hammar 2004a, 2004c) suggest a vibrant and growing corpus of ethnographic work about 'AIDS' 'in' 'rural' 'Papua New Guinea', each trope of which could sustain additional entire issues of Oceania. Common is the accusation of 'outsiders' for bringing AIDS into homes and villages and of those 'insiders' thought responsible, of being sorcerers, however feeble and marginalized socially they may be empirically. Lelet believe that 'HIV/AIDS is a disease of white people, introduced into PNG by them ...' (Eves 2003: 253).
This collection is situated within a broader field of HIV social research because it takes anti-condom discourse seriously. Frank fabrications of manufacturing flaws in condoms and beliefs about their alleged inducement of sexual promiscuity, even stories of their ability to 'carry' HIV in their tip thus becoming the agent of transmission, have increased in recent years and come equally from the pulpit as from the pages of newspapers. In the main they go unchallenged by public health officials and donor organizations, owing to the imperative not to offend Christian churches and sensibilities. One example was the decision made early on in high-level deliberations to replace the term 'MSM' with 'male sexuality' (Lepani 2004: 8), but which was overturned in the face of monies offered by organisations who trade heavily in such acronyms, such that now 'MSM' is practically required speech of workshop and conference attendees. Dr. Thomas Vinit is just one of many prominent physicians opposed to condoms, and he has been made head of the Lifestyle Diseases division of the National Department of Health. Because condoms were not '100% safe' (left undefined), he argued, the government was 'improper' in distributing them at all, and he dubbed this a 'medical scandal'. In explanation, he offered that 'the HIV/AIDS cells compared to the sperm cells were much smaller' (Peter 2006: 3). That he has been joined by high-placed politicians and religious leaders to condemn what they believe in earnest to be bad faith and poor policy is something about which I'll have more to say immediately below.
In order to extract as much as possible from such discourses and these kinds of ethnographic data I will discuss the concept of 'moral demographies' introduced by Philip Setel (1999) in A Plague of Paradoxes. Setel's fascinating ethnography is filled with accounts given by professionals and villagers, men and women, old and young, verbally and otherwise, of the kinds of social, nutritional, ecological and cosmological decline occurring on the slopes of Mt. Kilimanjaro. These are expressed nowadays by Papua New Guineans, too: lived accounts and embodied experiences inform readers of the historical processes of demographic, social, cultural and even sexual changes that have occurred in ways that bench scientific accounts of the properties of viruses simply can't. The singular moral demography that Papua New Guineans are now narrating to one another is of the stable, house--and garden-bound 'housewife' at the mercy of the mobile husband. He becomes infected at the site of employment by in-migrating predatory sex workers against whose wiles he is apparently defenseless, and then carries it home to his innocent wife (or wives) who then infect doubly innocent children. Setel's humanistic stance toward fieldwork, his findings, and his perceptive mode of analysis are relevant to PNG--and indeed for a brief time he worked there. I show this partly by reference to ethnographic data I helped to collect in our study of HIV, AIDS, STDs and sexual health. I will then discuss why this is an important collection and why questions of language have never been needed more in PNG public health and public policy debates. I don't know how widely open yet is the 'window of opportunity', but if there is one, the language of HIV and AIDS (beginning with terms such as 'HIV/AIDS') must change.
THE IMPOSSIBILITY OF CONDOMS
'Advising people to use condoms means to put them at risk of getting AIDS, and just spreads AIDS'
(Bishop Bonivento, Do Condoms Stop or Spread...
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