A Review of ‘Second Chances’
The ethnography: Second Chances, is the work of eight people, covering eleven personal accounts of how the human immunodeficiency virus (HIV) pandemic has impacted society, families and individuals in Uganda. This review works to illustrate and analyse the second chances at life that were given to people when antiretroviral therapy (ART) was introduced. Many people within this bio-generation, marked by biological and biomedical characteristics, started a lifelong form of treatment. Susan Reynolds Whyte, the editor of Second Chances, as well as the authors and researchers of the book, explore the ways in which the first generation of patients that received a medical diagnosis resulted in them also receiving a severe impact on their identity. It covers cases of people’s every struggles from the first fieldwork, held by Ugandans from 1969 to 1971, to the Enhancement of Research Capacity project that started from 1994 and was held until 2008. This ethnography is a generational book that first looks at patients of which first received HIV and then went on to live without treatment, then looking at patients that received treatment after it was discovered and introduced in Uganda. It is divided into cases and chapters, focusing on topics that the case workers themselves were interested in. The ethnography focuses on three themes: generation, sociality, and second chances. It provides an in depth perspective of people living in rural and urban areas, covering cases of free and fee paying patients. The case workers would be involved in the patient’s personal lives, occasionally checking up with them at work or at home. More specifically, the objective of this review is to outline the undertakings and methodological approach, whilst also providing a brief summary of the ethnography.
HIV and AIDS is considered to be one of the most researched of diseases in History (Whiteside, 2016). HIV is a virus that crossed from primates to humans, the first case being recorded in the 1920s, or perhaps, earlier (Whiteside, 2016). The disease spreads through blood to blood contact, sexual contact, the sharing of needles and from mother to child during pregnancy, birth, or breastfeeding. Sub-Saharan Africa has the highest number of people living with HIV, with 70% of the global population living with the disease (Whiteside, 2016). More specifically, Uganda comprises of 7.3% of this figure (Whiteside, 2016). People that are infected with this disease live so with it for the rest of their lives, however, there are a lot of preventative measures that have been introduced in Uganda to decrease the likelihood of more people contacting the disease. Prior to the introduction of ART, AIDS was thought of as to be a death sentence. The concept of the “Lazarus Effect” is attributed to this time, where many were considered ‘resurrected’ once treatment had begun. When patients survived this death sentence, they introduced “positive living” into their lives. This involves changing their lives, taking medication consistently, eating well, abstaining from alcohol and tobacco, as well as taking more consideration when engaging in sexual contact.
This collaborative polygraph, as opposed to monograph, provides insight from many different perspectives. It’s also an academically generational ethnography, divided into twelve chapters. This allows the readers to read the chapters separately, leaving the reader to extract the information that they require from what they read. However, since each chapter brings to the ethnography a different style of writing, many might find the book to be considerably more difficult to read. It brings to light views from objective and subjective standpoints, attempting to be: ““multi-sighted” in that eight pairs of eyes (and ears) were at work, and it is multi-sited in that it describes a range of people, locations, treatment programs, and dimensions of concern” (Susan Reynolds Whyte, ed, 2014). It unites two sets of four people from the north and southern hemispheres: four local Ugandan anthropologists being the final generation to conduct research and two Danish students of Susan Reynolds Whyte and Michael Whyte being the second generation. The Danish students had had a relationship with the patients of the families prior to conducting fieldwork, therefore, increasing the quality of the ethnography. In doing so, it places importance on the collaborative work that the authors faced.
One of the most important things to note in this ethnography, is that patients with HIV did not only have to have access to treatment, but also had to attain it. The chance to receive a second chance is difficult and unfair. The ethnography shows the struggle to receive treatment in the first chapter. Patients had to rely on ‘contingent sociality’, making it crucial that those suffering with AIDS had to have a connection or contact with someone that worked within the medical field before treatment began. Many also had to learn about the disease through others. For example, Joyce, one of the interlocutors who worked with a case worker, was encouraged to test for HIV and AIDS by a colleague. John Janzen, a professor emeritus, suggested the idea of the therapy managing group (TMG). This would include kin, friends and associates of which would support patients throughout treatment. The notion of this was that patients tended to be unable to make decisions in regards to treatment, and had to be influenced by those that surrounded the patient. A requirement for patients that relied on free treatment was that they had to live within the catchment area of a project giving free treatment. Whyte writes, “the lives of drugs flow in channels that carry them mainly to the urban, the more prosperous and the better connected. The lives of most people are rural and constrained by poverty. They are unlikely to have a chance of getting ARVs unless they happen to reside in the catchment area of a project giving free treatment” (Susan Reynolds Whyte, 2004). Another way patients could receive treatment significantly faster is if they became a fee paying patient.
Second Chances raises and answers questions as to how people lives with the human immunodeficiency virus (HIV). There are mentions and/or chapters surrounding this in the ethnography, for example; Chapter Three: Mobility, Chapter Eight: Food, and Chapter Eleven: Life. One of the factors that entangled itself into a patient’s personal life was through the biological therapeutic client ship. This requires patients to coordinate with their doctor very closely through index memberships, where doctors are able to follow patients over time with documents that records their illness. This, in itself, is a form of treatment, affecting personal relationships and professional relationships alike. This, as shown in Chapter Two, resulted in unintended consequences whereby patients felt a responsibility to then go on to educate others about the disease. The long term transaction between a health worker and patient indicates the interdependence that is required. It brings a sense of belonging to the patients, and showing adherence allows the doctors to understand the competence that the patients is bringing in doing so. This is an exchange of time for medication. With the release of new medication, anthropologists argue that Second Chances is becoming outdated. The 90-90-90 is a treatment intended to work towards ending the AIDS epidemic. The aim of this program is to ensure that 90% of those living with HIV, will receive a diagnosis and as a result, receive the required treatment and medication through antiretroviral therapy (ART) and antiretroviral drugs (ARVs). This is a program created by UNAIDS to complete by 2020 (Joint United Nations Programe on HIV/AIDS, 2014).
There is an incredible amount of dense information to extract from Second Chances. It allows the reader to understand the fundamental impact that global health programs can have on countries such as Uganda through very personal accounts. This follows the lives of those suffering with AIDS and the progression to recovery, the transition from a death sentence to a life sentence, and the obstacles that they faced in order to overcome and continue to live with and manage the disease. The overarching health narrative through the form of a polygraph also demonstrates the potential of what a polygraph itself can provide. This ethnography was not written by a single account but many accounts, resulting in a new standard being set as a result. It intertwines three themes; generation, sociality and second chances. Posing questions and allowing for reflection in regards to the historical events and situations that are shared between those living with AIDS. The ethnography brings to light those that suffer with AIDS, receiving a second chance at life.
Bibliography
Joint United Nations Programe on HIV/AIDS, 2014. 90–90–90 – An ambitious treatment target to help end the AIDS epidemic. [Online] Available at: http://www.unaids.org/sites/default/files/media_asset/90-90-90_en.pdf [Accessed 22 March 2018].
Susan Reynolds Whyte, ed, 2014. Second Chances: Surviving AIDS in Uganda. Durham and London: Duke University Press.
Susan Reynolds Whyte, e. a., 2004. Treating AIDS: Dilemmas of unequal access in Uganda.. s.l.:Sahara-j: Journal of Social Aspects of HIV/AIDS.
Whiteside, A., 2016. HIV & AIDS: A Very Short Introduction. Oxford: Oxford University Press.