Infections & Inequalities, Paul Farmer:
Millions of women living in similar circumstances--but with very different psychological profiles and cultural backgrounds--can expect to meet similar fates. Their sickness [AIDS] is a result of structural violence: neither culture nor pure individual will is at fault; rather, historically given (or economically driven) processes and forces conspire to constrain individual agency. Structural violence is visited upon all those whose social status denies them access to the fruits of scientific and social progress.
If we are to present meaningful responses to AIDS, we must examine the differential political economy of risk. Structural violence means that some women are, from the outset, at high risk of HIV infection, while other women are shielded from risk. Adopting this point of view--that we can describe a political economy of risk and that this exercise helps to explain where the AIDS pandemic is moving and how quickly--we begin to see why similar stories are legion in sub-Saharan Africa and India, why they are fast becoming commonplace in Thailand and other parts of Asia. The experiences recounted here may be textbook cases of vulnerability, but their moral is deciphered only if we clearly understand that these women have been rendered vulnerable to AIDS through social processes--that is, through the economic, political, and cultural forces that can be shown to shape the dynamics of HIV transmission. The anthropologist Brooke Schoepf, writing from Zaire, explain how AIDS has "transformed many women's survival strategies into death strategies":
Women, who often lack access to cash, credit, land or jobs, engage in "off-the-books" activities in the informal sector. Some exchange sex for the means of subsistence. Others enter sex work at the behest of their families, to obtain cash to purchase land or building materials, to pay a brother's school fees, or to settle a debt. Still others supplement meager incomes with occasional resort to sex with multiple partners. [Whether these women are] married or not, the deepening economic crisis propels many to seek "spare tires" or "shock absorbers" to make ends meet.
Taken together, the dynamics of HIV infection among women and the responses to its advance reveal much about the complex relationship between power/powerlessness and sexuality. But many questions remain unanswered. For example, by what mechanisms, precisely, do social forces (such as poverty, sexism, and other forms of discrimination) become embodied as personal risk? What role does inequality per se play in promoting HIV transmission?
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arbitrarily constricting the social field generates the illusion of equally shared risk. It obscures inequalities central to the advance of HIV.