The syndemics model of health focuses on the biosocial complex, which consists of interacting, co... more The syndemics model of health focuses on the biosocial complex, which consists of interacting, co-present, or sequential diseases and the social and environmental factors that promote and enhance the negative effects of disease interaction. This emergent approach to health conception and clinical practice reconfigures conventional historical understanding of diseases as distinct entities in nature, separate from other diseases and independent of the social contexts in which they are found. Rather, all of these factors tend to interact synergistically in various and consequential ways, having a substantial impact on the health of individuals and whole populations. Specifically, a syndemics approach examines why certain diseases cluster (ie, multiple diseases affecting individuals and groups); the pathways through which they interact biologically in individuals and within populations, and thereby multiply their overall disease burden, and the ways in which social environments, especia...
Evidence from the past 40 years of HIV technology development and implementation indicates that t... more Evidence from the past 40 years of HIV technology development and implementation indicates that the public health social contractwith its expectations of patient/citizen compliancehas hampered global disease control efforts. Despite the availability of a wide array of effective technologies, including antiretroviral drugs as treatment and prevention, voluntary medical male circumcision procedures, and newly developed intravaginal ring products, new infections among adults globally have not decreased significantly. In this paper, I describe a historical trend of limiting access to effective biomedical technologies to those deemed most deserving and compliant given concerns of misuse (non-adherence), product repurposing (not using the product for purposes originally intended), and the incitement of autonomy (increasing the risk of public exposure to diseases given personal protection from a specific disease). Examining the expectations of good citizenship (compliance, adherence, appropriate product use, and continued risk reduction) as it relates to human-technology interactions, reveals a continuing narrative of initially restricting access to newer technologies perceived fragile or costly based on an assessment of patient/citizen worth. In this, the conventional public health social contract continues to be an obstacle in the advancements of technologies to effectively reduce the global burden of HIV.
The syndemics model of health focuses on the biosocial complex, which consists of interacting, co... more The syndemics model of health focuses on the biosocial complex, which consists of interacting, co-present, or sequential diseases and the social and environmental factors that promote and enhance the negative effects of disease interaction. This emergent approach to health conception and clinical practice reconfigures conventional historical understanding of diseases as distinct entities in nature, separate from other diseases and independent of the social contexts in which they are found. Rather, all of these factors tend to interact synergistically in various and consequential ways, having a substantial impact on the health of individuals and whole populations. Specifically, a syndemics approach examines why certain diseases cluster (ie, multiple diseases affecting individuals and groups); the pathways through which they interact biologically in individuals and within populations, and thereby multiply their overall disease burden, and the ways in which social environments, especially conditions of social inequality and injustice, contribute to disease clustering and interaction as well as to vulnerability. In this Series, the contributions of the syndemics approach for understanding both interacting chronic diseases in social context, and the implications of a syndemics orientation to the issue of health rights, are examined.
Voluntary medical male circumcision (VMMC) has been rapidly accepted by global HIV policy and don... more Voluntary medical male circumcision (VMMC) has been rapidly accepted by global HIV policy and donor institutions as a highly valuable HIV prevention strategy given its cost-effectiveness, limited interactions with a health facility, and projected long-lasting benefits. Many southern African countries have incorporated VMMC into their national HIV prevention strategies. However, intensive VMMC promotion programs have met with limited success to date and many HIV researchers have voiced concerns. This commentary discusses reasons behind the less-thandesired public demand and suggests how inclusion of the traditional sector-traditional leaders, healers, and circumcisers-with their local knowledge, cultural expertise and social capital, particularly in the realm of social meanings ascribed to male circumcision, may improve the uptake of this HIV prevention strategy. We offer Lesotho and Swaziland as case studies of the integration of universal VMMC policies; these are countries with a shared HIV burden, yet contrasting contemporary socio-cultural practices of male circumcision. The similar hesitant responses expressed by these two countries towards VMMC remind us that the incorporation of any new or revised and revitalized public health strategy must be considered within unique historical, political, economic, and socio-cultural contexts.
Despite constitutional obligations to provide clean water to all citizens in South Africa, access... more Despite constitutional obligations to provide clean water to all citizens in South Africa, access to water and related services remains highly contested. The discord between constitutional promises and lived realities of water access, particularly through national infrastructure, provides a platform upon which to examine Foucauldian notions of biopolitics, the control of populations through technologies of governing. Drawing on the situations of residents in the rural Vhembe district in the north eastern corner of the country, I examine how individuals conceptualize the relationship that exists between citizen and state and the responsibilities of each in post-apartheid South Africa as it relates to water access. In addition, I describe strategies employed throughout South Africa to voice rights to water and how these approaches are perceived. Finally, I consider how the three primary forms of 'water citizenship'-citizen, agent, and subject-influence the current and future health of vulnerable residents.
The South African constitution ratifies water as a human right. Yet millions of citizens remain d... more The South African constitution ratifies water as a human right. Yet millions of citizens remain disconnected from the national water infrastructure. Drawing on data collected in 2013-2014 from women in northern South Africa, this study explores "water citizenship"-individual civic engagement related to improving water service provision. Literature indicates that water insecurity is associated with emotional distress and that water-related emotional distress influences citizen engagement. I extend these lines of research by assessing the connection that water insecurity and emotional distress may collectively have with civic engagement to improve access to water infrastructure. This article is protected by copyright. All rights reserved.
Introduction S ince the 1980s, the interlinking of global networks, commonly known as the Interne... more Introduction S ince the 1980s, the interlinking of global networks, commonly known as the Internet, has allowed us to communicate via email video and voice (e.g., Skype); search, organize, and store vast quantities of data via the World Wide Web; share facts, myths, and opinions; and network with long-lost friends or global strangers. Consequently, the Internet has revolutionized how we conduct business, communicate, shop, learn, and even how we access health knowledge and health care. Eight million Americans go online for medical advice on a typical day, which means people are seeking online health guidance as often as they pay bills, read blogs, or search for phone numbers or addresses online (Fox 2006). According to the Pew Internet and American Life Project, "More people go online for medical advice on any given day than actually visit health professionals" (Fox 2006). The Internet is an obvious source for health knowledge as it offers privacy, immediacy, convenience, anonymity, information tailoring, a wide range of information, a variety
Tropical disease syndemics, the adverse morbidity-enhancing interaction of two or more neglected ... more Tropical disease syndemics, the adverse morbidity-enhancing interaction of two or more neglected tropical diseases (NTDs), like the diseases that comprise them, have been largely unrecognized and generally neglected. However, their role in contributing to the health burden of the poor is significant. This paper presents syndemics as a new theoretical perspective with which to develop a comprehensive approach to understand and respond to the health consequences of adverse interactions among NTDS and between NTDs and other diseases. Specifically the paper examines local social factors and macro-level political economic factors that are both the ultimate source and ultimate arbiter of public and medical responses to syndemics of NTDs. [neglected tropical diseases, syndemics, diseases of poverty, social origins of disease]
Traditional male circumcision practices have been strongly discouraged by HIV prevention campaign... more Traditional male circumcision practices have been strongly discouraged by HIV prevention campaigns in Lesotho. Traditional circumcision rituals are perceived as a possible transmission route for HIV because of the reuse of unsterilized cutting instruments. While individuals living in urban areas and the lowlands have increasingly considered traditional circumcision a practice of the past, foregoing the procedure all together, those dwelling in rural areas continue to consider the practice vital in the construction of male national identity. Initially, the national government voiced strong concern over the publicizing of medical male circumcision (MMC) – conducted by surgeons in sterile clinics. There have been claims that male circumcision (either traditional or MMC) does not have the same level of protective benefit against HIV in Lesotho that research suggests it has in other countries in the region. This article critically examines the development of government responses to inter...
Drawing on work examining HIV prevention initiatives in Lesotho, this paper considers the hesitat... more Drawing on work examining HIV prevention initiatives in Lesotho, this paper considers the hesitation of national state actors towards the new strategy for HIV prevention - voluntary medical male circumcision (VMMC). Lesotho offers a representative case study on global health governance, given the country's high HIV burden and heavy dependence on foreign donor nations to implement local HIV prevention initiatives. In this paper, I use the case of VMMC opposition in Lesotho to examine how the new era of 'partnerships' has shifted the architecture of contemporary global health, specifically considering how global agreements are translated or negotiated into local practice. I argue that Lesotho's domestic policy-makers, in employing national statistics to assess if VMMC is an effective approach to addressing the local epidemic, are asserting a claim of expertise. In doing so, they challenge the traditional structures of global health politics, which have largely been managed by experts and funders from and in the global North. I explore the development of global VMMC policy, what drives Lesotho's resistance to comply, and consider the impact renegotiation efforts may have on future global health architecture.
ABSTRACT Use of the syndemics concept has diffused from medical anthropology to an array of healt... more ABSTRACT Use of the syndemics concept has diffused from medical anthropology to an array of health-related disciplines. This development reflects a growing awareness that diseases and disease sufferers do not exist in a vacuum and that many of the most damaging human epidemics are the possible or probable consequence, not of a single disease acting alone but of several diseases acting in tandem. Syndemics offer a useful conceptual framework for the study of global health inequality. As work guided by a syndemics perspective is conducted on a range of diseases and in diverse regions of the world, the practical health implications of this approach are beginning to unfold.
Amidst growing global endorsements of new biomedical HIV prevention strategies, ARV-based pre-exp... more Amidst growing global endorsements of new biomedical HIV prevention strategies, ARV-based pre-exposure prophylaxis (ARV PrEP) has garnered considerable attention as a potentially promising prevention strategy. Though it may offer more effective protection for certain at-risk groups than conventional prevention strategies (such as sexual partner reduction, condom use, and prevention of mother-to-child transmission), PrEP is more costly. PrEP requires more ongoing contact between individuals and providers, and a level of surveillance from the health system that is not necessary with other preventive measures. In this sense, it represents a new biotechnology for HIV prevention that poses particular challenges for worldwide implementation, given developing countries' struggling health systems and incomplete HIV treatment programs. Since the emergence of PrEP has stimulated ethical discussions premised on incomplete knowledge of efficacy and implementation, this paper explores the ethical parameters of a likely scenario for PrEP usage in a single, resource-poor country. We first develop a plausible model for PrEP deployment and utilization based on current PrEP research, while carefully considering the reigning institutional values of feasibility and effectiveness in global health approaches. Drawing on ethnographic research of HIV treatment and prevention approaches in Lesotho, we address ethical questions arising from this scenario of PrEP delivery. Lesotho presents a compelling and emblematic case study of PrEP's potential successes and pitfalls in a developing country, given the country's high HIV prevalence, struggles to achieve universal access to HIV treatment regimes, continued existence of stigma around the epidemic, and difficulties in addressing persistent social inequalities that fuel infections.
Abstract Until recently the HIV epidemic in low-income countries was largely managed through prev... more Abstract Until recently the HIV epidemic in low-income countries was largely managed through prevention and palliative care efforts given insufficient funds and infrastructure for biomedical interventions. As such, biomedical knowledge of HIV has become an important tool for populations and individuals in the fight against infection, promoted by neoliberal economic policies of privatisation and individual agency. Biomedical knowledge, like other technologies, has been unequally distributed, is culturally embedded, and a product of a particular historical, political and social context. This article explores how the spread of biomedical HIV knowledge through its multitude of government, non-government and private channels has impacted the explanatory accounts and practices of youth in Lesotho. Three interwoven issues aim to illustrate the significance of HIV knowledge in contemporary debates about health equity. The first addresses how biomedical HIV knowledge is created, circulated and received. The second explores how biomedical knowledge about HIV is acted on in particular sociocultural settings. Finally, the impact that HIV knowledge has on whom, and why, is discussed. Rather than empowering individuals to utilise knowledge for the maintenance of health, the focus on biomedical knowledge acquisition has disempowered individuals, as they are held responsible for the inappropriate lifestyles that result in HIV infection.
Economy, Finance and Business in Southeastern and Central Europe
In an effort to expand the wine tourism industry in Greece, wine producers have formed regional a... more In an effort to expand the wine tourism industry in Greece, wine producers have formed regional associations, such as the “Wine Producers Association of the Northern Greece Vineyard,” established in 1993. Efforts of this, and similar organizations, involve networking with small-scale wineries, travel agencies, hotels, restaurants, and other local merchants to promote regional wineries, as well as establishing wine tourist routes. Significant work has been conducted investigating consumer motivations and market segmentation in wine tourism, locally and internationally. Informed by this work, wineries can modify the programs offered in order to attract certain market segments. However, examinations of the relationships between the three primary stakeholders in wine tourism—consumers, wine producers, and the tourism agents who promote the programs offered by the wineries—remain limited. This paper explores the interconnections between winemakers, individuals and organizations involved in wine tourism, and consumers to better understand how to improve agritourism in small-scale wineries. In particular, we evaluate the alignment of the winery’s tourism programs, the infrastructure and efforts of established local tourist agency networks, and the motivations of potential domestic consumers.
The syndemics model of health focuses on the biosocial complex, which consists of interacting, co... more The syndemics model of health focuses on the biosocial complex, which consists of interacting, co-present, or sequential diseases and the social and environmental factors that promote and enhance the negative effects of disease interaction. This emergent approach to health conception and clinical practice reconfigures conventional historical understanding of diseases as distinct entities in nature, separate from other diseases and independent of the social contexts in which they are found. Rather, all of these factors tend to interact synergistically in various and consequential ways, having a substantial impact on the health of individuals and whole populations. Specifically, a syndemics approach examines why certain diseases cluster (ie, multiple diseases affecting individuals and groups); the pathways through which they interact biologically in individuals and within populations, and thereby multiply their overall disease burden, and the ways in which social environments, especia...
Evidence from the past 40 years of HIV technology development and implementation indicates that t... more Evidence from the past 40 years of HIV technology development and implementation indicates that the public health social contractwith its expectations of patient/citizen compliancehas hampered global disease control efforts. Despite the availability of a wide array of effective technologies, including antiretroviral drugs as treatment and prevention, voluntary medical male circumcision procedures, and newly developed intravaginal ring products, new infections among adults globally have not decreased significantly. In this paper, I describe a historical trend of limiting access to effective biomedical technologies to those deemed most deserving and compliant given concerns of misuse (non-adherence), product repurposing (not using the product for purposes originally intended), and the incitement of autonomy (increasing the risk of public exposure to diseases given personal protection from a specific disease). Examining the expectations of good citizenship (compliance, adherence, appropriate product use, and continued risk reduction) as it relates to human-technology interactions, reveals a continuing narrative of initially restricting access to newer technologies perceived fragile or costly based on an assessment of patient/citizen worth. In this, the conventional public health social contract continues to be an obstacle in the advancements of technologies to effectively reduce the global burden of HIV.
The syndemics model of health focuses on the biosocial complex, which consists of interacting, co... more The syndemics model of health focuses on the biosocial complex, which consists of interacting, co-present, or sequential diseases and the social and environmental factors that promote and enhance the negative effects of disease interaction. This emergent approach to health conception and clinical practice reconfigures conventional historical understanding of diseases as distinct entities in nature, separate from other diseases and independent of the social contexts in which they are found. Rather, all of these factors tend to interact synergistically in various and consequential ways, having a substantial impact on the health of individuals and whole populations. Specifically, a syndemics approach examines why certain diseases cluster (ie, multiple diseases affecting individuals and groups); the pathways through which they interact biologically in individuals and within populations, and thereby multiply their overall disease burden, and the ways in which social environments, especially conditions of social inequality and injustice, contribute to disease clustering and interaction as well as to vulnerability. In this Series, the contributions of the syndemics approach for understanding both interacting chronic diseases in social context, and the implications of a syndemics orientation to the issue of health rights, are examined.
Voluntary medical male circumcision (VMMC) has been rapidly accepted by global HIV policy and don... more Voluntary medical male circumcision (VMMC) has been rapidly accepted by global HIV policy and donor institutions as a highly valuable HIV prevention strategy given its cost-effectiveness, limited interactions with a health facility, and projected long-lasting benefits. Many southern African countries have incorporated VMMC into their national HIV prevention strategies. However, intensive VMMC promotion programs have met with limited success to date and many HIV researchers have voiced concerns. This commentary discusses reasons behind the less-thandesired public demand and suggests how inclusion of the traditional sector-traditional leaders, healers, and circumcisers-with their local knowledge, cultural expertise and social capital, particularly in the realm of social meanings ascribed to male circumcision, may improve the uptake of this HIV prevention strategy. We offer Lesotho and Swaziland as case studies of the integration of universal VMMC policies; these are countries with a shared HIV burden, yet contrasting contemporary socio-cultural practices of male circumcision. The similar hesitant responses expressed by these two countries towards VMMC remind us that the incorporation of any new or revised and revitalized public health strategy must be considered within unique historical, political, economic, and socio-cultural contexts.
Despite constitutional obligations to provide clean water to all citizens in South Africa, access... more Despite constitutional obligations to provide clean water to all citizens in South Africa, access to water and related services remains highly contested. The discord between constitutional promises and lived realities of water access, particularly through national infrastructure, provides a platform upon which to examine Foucauldian notions of biopolitics, the control of populations through technologies of governing. Drawing on the situations of residents in the rural Vhembe district in the north eastern corner of the country, I examine how individuals conceptualize the relationship that exists between citizen and state and the responsibilities of each in post-apartheid South Africa as it relates to water access. In addition, I describe strategies employed throughout South Africa to voice rights to water and how these approaches are perceived. Finally, I consider how the three primary forms of 'water citizenship'-citizen, agent, and subject-influence the current and future health of vulnerable residents.
The South African constitution ratifies water as a human right. Yet millions of citizens remain d... more The South African constitution ratifies water as a human right. Yet millions of citizens remain disconnected from the national water infrastructure. Drawing on data collected in 2013-2014 from women in northern South Africa, this study explores "water citizenship"-individual civic engagement related to improving water service provision. Literature indicates that water insecurity is associated with emotional distress and that water-related emotional distress influences citizen engagement. I extend these lines of research by assessing the connection that water insecurity and emotional distress may collectively have with civic engagement to improve access to water infrastructure. This article is protected by copyright. All rights reserved.
Introduction S ince the 1980s, the interlinking of global networks, commonly known as the Interne... more Introduction S ince the 1980s, the interlinking of global networks, commonly known as the Internet, has allowed us to communicate via email video and voice (e.g., Skype); search, organize, and store vast quantities of data via the World Wide Web; share facts, myths, and opinions; and network with long-lost friends or global strangers. Consequently, the Internet has revolutionized how we conduct business, communicate, shop, learn, and even how we access health knowledge and health care. Eight million Americans go online for medical advice on a typical day, which means people are seeking online health guidance as often as they pay bills, read blogs, or search for phone numbers or addresses online (Fox 2006). According to the Pew Internet and American Life Project, "More people go online for medical advice on any given day than actually visit health professionals" (Fox 2006). The Internet is an obvious source for health knowledge as it offers privacy, immediacy, convenience, anonymity, information tailoring, a wide range of information, a variety
Tropical disease syndemics, the adverse morbidity-enhancing interaction of two or more neglected ... more Tropical disease syndemics, the adverse morbidity-enhancing interaction of two or more neglected tropical diseases (NTDs), like the diseases that comprise them, have been largely unrecognized and generally neglected. However, their role in contributing to the health burden of the poor is significant. This paper presents syndemics as a new theoretical perspective with which to develop a comprehensive approach to understand and respond to the health consequences of adverse interactions among NTDS and between NTDs and other diseases. Specifically the paper examines local social factors and macro-level political economic factors that are both the ultimate source and ultimate arbiter of public and medical responses to syndemics of NTDs. [neglected tropical diseases, syndemics, diseases of poverty, social origins of disease]
Traditional male circumcision practices have been strongly discouraged by HIV prevention campaign... more Traditional male circumcision practices have been strongly discouraged by HIV prevention campaigns in Lesotho. Traditional circumcision rituals are perceived as a possible transmission route for HIV because of the reuse of unsterilized cutting instruments. While individuals living in urban areas and the lowlands have increasingly considered traditional circumcision a practice of the past, foregoing the procedure all together, those dwelling in rural areas continue to consider the practice vital in the construction of male national identity. Initially, the national government voiced strong concern over the publicizing of medical male circumcision (MMC) – conducted by surgeons in sterile clinics. There have been claims that male circumcision (either traditional or MMC) does not have the same level of protective benefit against HIV in Lesotho that research suggests it has in other countries in the region. This article critically examines the development of government responses to inter...
Drawing on work examining HIV prevention initiatives in Lesotho, this paper considers the hesitat... more Drawing on work examining HIV prevention initiatives in Lesotho, this paper considers the hesitation of national state actors towards the new strategy for HIV prevention - voluntary medical male circumcision (VMMC). Lesotho offers a representative case study on global health governance, given the country's high HIV burden and heavy dependence on foreign donor nations to implement local HIV prevention initiatives. In this paper, I use the case of VMMC opposition in Lesotho to examine how the new era of 'partnerships' has shifted the architecture of contemporary global health, specifically considering how global agreements are translated or negotiated into local practice. I argue that Lesotho's domestic policy-makers, in employing national statistics to assess if VMMC is an effective approach to addressing the local epidemic, are asserting a claim of expertise. In doing so, they challenge the traditional structures of global health politics, which have largely been managed by experts and funders from and in the global North. I explore the development of global VMMC policy, what drives Lesotho's resistance to comply, and consider the impact renegotiation efforts may have on future global health architecture.
ABSTRACT Use of the syndemics concept has diffused from medical anthropology to an array of healt... more ABSTRACT Use of the syndemics concept has diffused from medical anthropology to an array of health-related disciplines. This development reflects a growing awareness that diseases and disease sufferers do not exist in a vacuum and that many of the most damaging human epidemics are the possible or probable consequence, not of a single disease acting alone but of several diseases acting in tandem. Syndemics offer a useful conceptual framework for the study of global health inequality. As work guided by a syndemics perspective is conducted on a range of diseases and in diverse regions of the world, the practical health implications of this approach are beginning to unfold.
Amidst growing global endorsements of new biomedical HIV prevention strategies, ARV-based pre-exp... more Amidst growing global endorsements of new biomedical HIV prevention strategies, ARV-based pre-exposure prophylaxis (ARV PrEP) has garnered considerable attention as a potentially promising prevention strategy. Though it may offer more effective protection for certain at-risk groups than conventional prevention strategies (such as sexual partner reduction, condom use, and prevention of mother-to-child transmission), PrEP is more costly. PrEP requires more ongoing contact between individuals and providers, and a level of surveillance from the health system that is not necessary with other preventive measures. In this sense, it represents a new biotechnology for HIV prevention that poses particular challenges for worldwide implementation, given developing countries' struggling health systems and incomplete HIV treatment programs. Since the emergence of PrEP has stimulated ethical discussions premised on incomplete knowledge of efficacy and implementation, this paper explores the ethical parameters of a likely scenario for PrEP usage in a single, resource-poor country. We first develop a plausible model for PrEP deployment and utilization based on current PrEP research, while carefully considering the reigning institutional values of feasibility and effectiveness in global health approaches. Drawing on ethnographic research of HIV treatment and prevention approaches in Lesotho, we address ethical questions arising from this scenario of PrEP delivery. Lesotho presents a compelling and emblematic case study of PrEP's potential successes and pitfalls in a developing country, given the country's high HIV prevalence, struggles to achieve universal access to HIV treatment regimes, continued existence of stigma around the epidemic, and difficulties in addressing persistent social inequalities that fuel infections.
Abstract Until recently the HIV epidemic in low-income countries was largely managed through prev... more Abstract Until recently the HIV epidemic in low-income countries was largely managed through prevention and palliative care efforts given insufficient funds and infrastructure for biomedical interventions. As such, biomedical knowledge of HIV has become an important tool for populations and individuals in the fight against infection, promoted by neoliberal economic policies of privatisation and individual agency. Biomedical knowledge, like other technologies, has been unequally distributed, is culturally embedded, and a product of a particular historical, political and social context. This article explores how the spread of biomedical HIV knowledge through its multitude of government, non-government and private channels has impacted the explanatory accounts and practices of youth in Lesotho. Three interwoven issues aim to illustrate the significance of HIV knowledge in contemporary debates about health equity. The first addresses how biomedical HIV knowledge is created, circulated and received. The second explores how biomedical knowledge about HIV is acted on in particular sociocultural settings. Finally, the impact that HIV knowledge has on whom, and why, is discussed. Rather than empowering individuals to utilise knowledge for the maintenance of health, the focus on biomedical knowledge acquisition has disempowered individuals, as they are held responsible for the inappropriate lifestyles that result in HIV infection.
Economy, Finance and Business in Southeastern and Central Europe
In an effort to expand the wine tourism industry in Greece, wine producers have formed regional a... more In an effort to expand the wine tourism industry in Greece, wine producers have formed regional associations, such as the “Wine Producers Association of the Northern Greece Vineyard,” established in 1993. Efforts of this, and similar organizations, involve networking with small-scale wineries, travel agencies, hotels, restaurants, and other local merchants to promote regional wineries, as well as establishing wine tourist routes. Significant work has been conducted investigating consumer motivations and market segmentation in wine tourism, locally and internationally. Informed by this work, wineries can modify the programs offered in order to attract certain market segments. However, examinations of the relationships between the three primary stakeholders in wine tourism—consumers, wine producers, and the tourism agents who promote the programs offered by the wineries—remain limited. This paper explores the interconnections between winemakers, individuals and organizations involved in wine tourism, and consumers to better understand how to improve agritourism in small-scale wineries. In particular, we evaluate the alignment of the winery’s tourism programs, the infrastructure and efforts of established local tourist agency networks, and the motivations of potential domestic consumers.
Course Description: Many speak of "global health," and yet what does that term mean for an indivi... more Course Description: Many speak of "global health," and yet what does that term mean for an individual, for a community, for a nation, for a planet? One group of physicians and public health professionals developed this definition:
Course Description: This course will introduce students to medical anthropology, the comparative ... more Course Description: This course will introduce students to medical anthropology, the comparative study of health, illness, healing practices and medical systems in the context of culture. Over the course of the semester we will seek an understanding of the ways in which people perceive and interpret health and illness; we will also consider anthropological contributions to public health issues, especially how ways of seeking and delivering care are inextricably bound up with cultural norms, beliefs and values, as well as with social structure, political systems and environmental conditions. We begin by reading work that explores different approaches to health (biosocial versus sociocultural). From there we examine how these perspectives are applied in addressing various health concerns.
This course explores medical systems in diverse cultural contexts. Students will engage in an in-... more This course explores medical systems in diverse cultural contexts. Students will engage in an in-depth investigation of ethnomedicine, major medical systems, alternative medical systems, medical pluralism, cross-cultural healing practices, the symbolic and religious meaning of illness and curing, gender, illness and healing, culture-bound syndromes and folk illnesses, and the interplay of biomedicine and traditional medical practices. We will also consider how macro-level processes, such as globalization, impact ethnomedical practices as well as individual illness experience and healing practices. Students will be encouraged to critically engage in the course material.
The goal of this course is to examine social and political organization, as well as other standar... more The goal of this course is to examine social and political organization, as well as other standard topics (such as marriage, economy, art, gender, religion) within social and cultural Anthropology, at a level appropriate for Anthropology Majors. The course examines social structures cross-culturally in greater depth and detail than in 1000-level courses, reviews the history of anthropological theory, and introduces current theoretical debates in the discipline. The course aims to analyze the differences and similarities between cultures in various world ethnographic areas, and to show how social and cultural Anthropology can challenge stereotypes in the study of human beings. Points and arguments developed in assigned readings and lectures will be illustrated with media presentations such as films, songs, and art. The course will teach students how to formulate an anthropological analysis of specific topics and issues in the study of human societies.
Recent research suggests that insecure access to key resources is associated with civic engagemen... more Recent research suggests that insecure access to key resources is associated with civic engagement. Many of these studies suggest that the capitalist agenda of neoliberal state reforms limiting access to universal state supplied services including water and sanitation services, and biopolitical arrangements of rationalized health citizens promote civic engagement to demand improved services. The present study is the first to systematically examine patterns of citizen engagement related to water services in a rural setting. In 2013-2014, we collected interview data from a random sample of 50 female household heads in Zimauri, a collection of villages in the Vhembe district of Limpopo, South Africa. We examined the extent to which citizen engagement is linked with inadequate water supply; engagement in water sanitation activities to prevent water-borne disease; and water-related emotional distress, and with social attributes including economic assets, age, and years of school attended. We found that water supply, emotional distress related to safe water access and age are significantly associated with citizen engagement, while health behaviors, economic assets, and years of education were not. These results suggest that citizen engagement to voice concerns over water services is directly related to water source, develops as a result of water-related emotional distress, and is intimately tied to social characteristics (age) that demarcate positions of authority within these communities.
With millions of people accessing health information online, there is mounting concern that unrel... more With millions of people accessing health information online, there is mounting concern that unreliable information is pushing patient demand for unnecessary diagnostic testing or inappropriate treatment. To explore the role of the Internet in emergent health-seeking models, we turn to the Net Generation. University students (age 18-25) are engaged in a life transition, formulating life patterns which include making healthcare decisions. This paper, using qualitative and quantitative methods, offers a preliminary understanding of both the extent to which online health information is penetrating illness conceptions and health-seeking behaviors of male and female students and the potential need for intervention to limit further burdening our healthcare system.
Ethnographic tree decision modeling (EDM) is a rigorous qualitative method used to understand and... more Ethnographic tree decision modeling (EDM) is a rigorous qualitative method used to understand and predict how and why people in certain groups make particular decisions. This paper presents an EDM of the male condom use decision process employed by college students attending an academic institution in the northeastern region of the United States. The model was derived from data collected from individual interviews and an Internet questionnaire and tested for internal and external validity. There is much of application value to understand the contextual nature of decisions to use male condoms and the distribution of that decision nationally and internationally.
HIV/AIDS prevention interventions continue to rely primarily on the individual acquiring new scie... more HIV/AIDS prevention interventions continue to rely primarily on the individual acquiring new scientifically validated knowledge about risk and risk avoidance in order to self-regulate and discipline personal behavior. In Lesotho, a small nation in southern Africa with the third highest adult prevalence of HIV/AIDS in the world, individuals acquire HIV/AIDS knowledge from multiple avenues. This paper examines how the circulation and reception of HIV/AIDS prevention information among students attending a tertiary education facility in the capital city of Maseru systematically produce marginalization via inaccessibility, inaccuracy or frame conflict. The resulting confusion generates erroneous risk calculations and high risk behaviors, further increasing HIV/AIDS transmission rather than socializing young adults into health-enhancing sexual norms.
Diseases are increasingly being linked to lifestyle choices, with public health interventions pro... more Diseases are increasingly being linked to lifestyle choices, with public health interventions providing specific biomedical knowledge to be translated by rational individuals into health enhancing behavior change. As a result, people are judged on their perceived relationship to medical knowledge, or what they know, as evidenced by their corresponding actions of hygiene and other means of disease prevention and treatment irrespective of the social context that may compel their continued involvement in behaviors that increase their risk for disease. In Africa, many policy makers, public health workers and social scientists remain troubled by the lack of connection between peoples’ apparent high levels of knowledge and awareness of HIV/AIDS prevention and their continued failure to engage in protective measures. This paper explores the conveyance of HIV prevention messages by journalists of four national newspapers in Lesotho from 2009-2011. This work follows the work of Michael Warner and Charles Briggs in examining the circulation and interpretation of public discourse and the consequent creation of divisions among the public. Specifically, in Lesotho, the press identifies “cultural” norms as high risk behaviors that are associated with specific high risk groups namely individuals and communities in highland areas involved in “traditional” living. Individuals in urban areas with “modernized” lifestyles are distanced from risk; despite national statistics indicating greater HIV prevalence within urban areas. The circulating public discourse generates a rift between the intended audience and the disparate publics created, redistributing perceived vulnerability and shifting blame.
Prevention campaigns in Lesotho remain dynamic with the MoHSW developing a “reenergized response”... more Prevention campaigns in Lesotho remain dynamic with the MoHSW developing a “reenergized response” to HIV. However, youth members of major national government parties stood in unison against the prevention plan, arguing it did not address issues placing youth at high risk. Strategies remain focused on behavior change communication. Some biomedical prevention strategies including a heavy focus on treatment and MTCT have been well accepted at both government and individual levels, others such as male circumcision and PEP remain controversial. This paper examines the active engagement of youth in Lesotho with evolving HIV-prevention strategies reflecting a desire for bottom-up participatory approaches.
Social models of youth HIV risk in Lesotho reveal that significant complexity exists between risk... more Social models of youth HIV risk in Lesotho reveal that significant complexity exists between risky social environment factors, specifically social control and orientation to modernity. Modernity, as portrayed by media, is linked with notions of individual rights, independence from social obligations, and sexual liberalization. Youth engage in risk either because the behaviors are linked with modernity (multiple sexual partnerships), or the behaviors are a means of acquiring the commodities necessary to appear modern (transactional and intergenerational relationships). The greater the local distinction between urban/modern and rural/traditional, as in the case of labor migration, the higher the HIV risk.
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Papers by Nicola Bulled