RESUMO
This paper builds on critiques that call for a more nuanced and contextualised understanding of conditions that affect HIV prevention by looking at West Papuan women's experiences of prevention of mother-to-child transmission services. Drawing on qualitative, ethnographic research with indigenous women and health workers, the paper demonstrates that women experience poor-quality HIV education and counselling, and that indigenous practices and concerns are largely not addressed by HIV services. We attribute this to a combination of national anti-indigenous and anti-separatist political concerns with donor-led interventions that result in limited localisation and reduced effectiveness of HIV prevention measures. In West Papua, services are needed that enhance cooperation and shared commitment, and that acknowledge and work to overcome existing inequalities, ethnic tensions and discrimination in the health system. Beyond Indonesia, donor-led HIV programmes and interventions need to balance avoidance of politically sensitive issues with complicity in perpetuating health inequalities. Translating global health interventions and donor priorities into locally compelling HIV prevention activities involves more than navigating local cultural and religious beliefs. Programme development and implementation strategies that entail confronting structural questions as well as social hierarchies, cleavages and silences are needed to render more effective services; strategies that are inherently political.
Assuntos
Infecções por HIV/prevenção & controle , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Sistemas Políticos , Grupos Populacionais , Complicações Infecciosas na Gravidez , Antropologia Cultural , Aconselhamento , Cultura , Epidemias , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Promoção da Saúde , Disparidades em Assistência à Saúde/etnologia , Humanos , Indonésia/epidemiologia , Recém-Nascido , Gravidez , Pesquisa QualitativaRESUMO
In the era of scale up, global donor-driven HIV activities are transforming NGO work by demanding administrative, technical, and data-oriented activities. Drawing on interviews and participant observation in an NGO in the West Papuan city of Manokwari between 2011 and 2014, I attempt to understand why Indigenous Papuan NGO employees were steadily replaced by non-Indigenous migrant settlers, mainly of Javanese heritage, to deliver HIV services. I show that new rivalries, technical roles, performance targets and efficiency rhetoric intersected with existing racialization to produce a preference for Javanese employees, who were assumed to be more compliant and professional than their Papuan counterparts and to operate more easily within the technocratic regime imposed by donor expectations. I use the term technocratic racism to describe the way that global HIV rationalities intersect with ethnic stereotypes and gendered racial ideas to make possible certain HIV workers and not others. I contribute to anthropological literature on the delivery of HIV services by showing how a technocratic approach to HIV/AIDS intervention intersects with a settler-colonial context to gradually exclude Indigenous employees. Approaches that allow for relational, independent and flexible services would assist to decolonize HIV responses in West Papua.
Assuntos
Infecções por HIV , Racismo/etnologia , Antropologia Médica , Colonialismo , Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Infecções por HIV/terapia , Pessoal de Saúde , Humanos , Indonésia/etnologia , Havaiano Nativo ou Outro Ilhéu do Pacífico/etnologia , OrganizaçõesRESUMO
This paper compares and contrasts two similar sets of data about AIDS (acquired immune deficiency syndrome) and AIDS awareness from the island of New Guinea. The goal of this comparison is to show that state policies and values can dramatically affect personal knowledge about safer sexual practices. One set was collected in 2001 in the Indonesian province of Papua, which is home to indigenous Papuans and many inmigrating Indonesians. The second set was collected in 1991-1992 in the independent state of Papua New Guinea (PNG). Papuans and Papua New Guineans share many sexual beliefs and cultural practices and have experienced similar effects of modernization, but we show that there are marked differences in public knowledge about AIDS and condoms. In general, Papuan respondents know less about condoms and use them less frequently than their PNG counterparts. We argue that a colonial form of government in Papua makes it more difficult to design culturally appropriate and effective programs.