Assisting or compromising intervention? The concept of 'culture' in biomedical and social research on HIV/AIDS

This paper addresses how the notion of 'culture' has been understood and employed by both epidemiologists and anthropologists with respect to the literature on HIV/AIDS in Sub-Saharan Africa. It examines the shift towards non-biomedical understandings of the epidemic. The concept of 'culture' has been 'bandied about' [Schoepf, B.G. (2004). AIDS, history and struggles over meaning. In E. Kalipeni, S. Craddock, J.R. Oppong, & J. Ghosh (Eds.), HIVand AIDS in Africa: Beyond epidemiology. Oxford: Blackwell.], and yet no authors in the literature reviewed here attempt a more systematic account of the 'bandying about' itself. This paper thus attempts to address and close this gap. For biomedical researchers and epidemiologists, broadly speaking, 'culture' appears to compromise intervention, whilst for medical anthropologists, 'culture' is often seen as having the potential to assist intervention. 'Culture' comes to be multifaceted and laden with varying assumptions, which range from 'culture' being bounded and timeless, to 'culture' being linked to macroprocesses, historically shaped, and contested. In turn, 'culture' has variously been understood as both the cause of, and solution to, the epidemic. It is also understood as having structured local interpretations of, and responses to, the epidemic. At the same time as noting the apparent dichotomy between the biomedical and social approaches, however, the models may inadvertently share certain assumptions about 'culture' as an essentializing signifier of difference. To this extent HIV/AIDS research could be improved by incorporating wider anthropological debates about the problems of the 'culture' concept. Keywords: Sub-Saharan Africa; HIV/AIDS; Intervention; Culture; Epidemiology; Anthropology