Two years ago, in May 2007, UNAIDS and WHO issued new guidelines on HIV testing. Prepared to meet the demands of the AIDS pandemic and the prospects of extending the benefits of antiretroviral therapy to regions where such treatment had been all but out of reach, the new guidance was the product of an extended period of sometimes acrimonious controversy both within the two UN agencies and globally. Those pressing for change had argued that a paradigm of testing that had emerged at a time when little could be done for those infected with HIV was inappropriate to the current moment. Those who viewed with skepticism, if not hostility, the claims that current practice and stringent ethical standards had become an impediment to effectively confronting the challenge of AIDS saw in the proposed changes a threat to the bedrock ethical principles of informed consent. In the end, of course, decisions about HIV testing will be taken by nation -states, with the recommendations of international organizations constituting but one element, however important, that will shape policy. Nevertheless, an examination of the history and the dynamics of the recent controversy and its outcome will provide a unique resource to those faced with policy choices; it will also provide a unique opportunity to lay bare the complex and politically charged relationships evolving between public health and human rights.
Throughout the 1990s, a dramatic rise in HIV prevalence rates among drug users in Vietnam attracted the attention of international observers concerned about the prospect of a more generalised epidemic. Vietnam subsequently became the target of extensive funding and advocacy which sought to introduce needle exchange and methadone in a country where drug use was considered a 'social evil', and drug users were subjected to what international observers viewed as draconian incarceration measures. What were the goals of proponents of harm reduction when they came to Vietnam? How did they perceive the state of prevailing approaches to drug users in the context of the Vietnamese HIV epidemic? How did they understand the strategic challenges they faced and the dilemmas they had to confront? Based on in-depth interviews with international harm reduction proponents working in Vietnam, this paper explores the encounter of two grammars of harm reduction, one based on broadly accepted international approaches, the other rooted in Vietnam's own history and politics. From this encounter a set of policies and practices characterised by needle exchange and methadone maintenance emerged, as well as an extensive network of closed centres where tens of thousands of drug users are currently detained.
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This paper explores the movements of asylum patients in and out of psychiatric care in French Indochina as the product of everyday interactions between psychiatrists, colonial authorities, and the public, especially patients' families. Throughout the interwar years, families and communities actively participated in psychiatric decision-making in ways that disrupt our notions of the colonial asylum as a closed setting that patients rarely left, run by experts who enjoyed broad, unquestioned authority. Vietnamese families, by debating individuals' suitability for social life, engaged with professional psychiatrists to find common ground for thinking about and discussing mental illness. At the same time, they pursued their own strategies in ways that significantly limited the power of experts. Debates revolved around the mental health of patients, but also around the capacity of families to assume their care upon release, and whether the asylum itself was the most appropriate site for treatment and rehabilitation. By considering how lay people and experts came together to negotiate the confinement and release of asylum patients, this paper offers a novel perspective on the development of psychiatric knowledge and power in colonial settings. I argue that by situating the history of psychiatry within the local dynamics of colonial rule as opposed to expert discourse, the asylum emerges here less as a blunt instrument for the social control and medicalization of colonial society than as a valuable historical site for reframing narratives of colonial repression and resistance.
This paper argues that the colonial experience was never just “out there” but was a constitutive feature of the global development of psychiatry and, indeed, of social medicine itself. I show how regional knowledge about psychiatry, produced in scientific exchanges across colonial Southeast Asia over four decades and culminating with the 1937 Bandung Conference, became part of new international approaches to health care in rural areas, and later, in developing nations. In particular, I discuss how the embrace of the agricultural colony as a solution to the problem of asylum overcrowding occurred at the same moment that colonial public health experts and officials were moving away from expensive, technocratic fixes to address indigenous health needs. Yet in the search for alternatives to institutionalized care, including forms of family and community support, colonial psychiatrists were increasingly drawn into unpredictable and unwieldy networks of care and economy. Drawing on research from Vietnam, this paper decenters the asylum so as to recast the history of colonial and postcolonial psychiatry as integral to the history of social medicine and global health. The paper then returns to Bandung in 1955, the site of another famous meeting in the history of Third World solidarity, to consider how the embrace of the “Bandung spirit” may provide new avenues for decolonizing the history of colonial and postcolonial psychiatry.
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