The Geography of Blame in HIV/AIDS: Paul Farmers Insights from Haiti.

Paul Farmer, in AIDS and Accusation: Haiti and the Geography of Blame, shows how fatal disease leads to blame and how the blame's direction can be interpreted through anthropological and historical examination. AIDS has hit Haiti very hard, to the point that it can be called and epidemic. North America stigmatized Haiti as a "focus point" of the disease and linked it's origins in the U. S. to Haiti to the point that Haitian AIDS became a sort of urban legend which created a Haitian stigma as we see in his references to the New York discrimination of Haitians.

Paul Farmer argues that through anthropological, historical, and medical research we can better understand both the AIDS epidemic as we see it now, and the stigmas that surround it. Paul Farmer claims that the AIDS epidemic of Haiti has no connection to the epidemic in Africa as many had suggested. He proves this point by studying the patterns which early AIDS contraction followed.

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Haiti gradually inherited the North American sex tourism trade from Cuba when Castro eliminated it there after the revolution.

There was a large component of gay sex tourism, and Haitian poverty facilitated widespread local participation in the commercial sex trade. In Haiti this pattern was seen in Port-Au-Prince especially in one suburb called Carrefour, the principal center for prostitution in Haiti. Evidence corroborating the theory that gay and heterosexual prostitution caused the AIDS epidemic in mainly urban poor was obtained through means such as interviews and gay literature articles.

The highest rates of AIDS in the Caribbean basin are in the five countries with the greatest trade with the United States, and the lowest rate is in Cuba, a country that because of its socialist revolution now has nearly no contact with the United States whatsoever. The story of how that happened is a story of factors Farmer labels "structural violence" and "constrained choices. " Military dictatorship, crowding, urbanization, migration, loss of peasant lifestyles, lack of effective treatment of other sexually transmitted diseases, gender inequality, and institutional inertia all contributed to the process.

The spread of AIDS into the rural areas can be traced through a look at political history in Haiti. The 1991 military coup featured intense repression in neighborhoods in Port-au-Prince where the sex trade had been a driving force of the economy. This drove high-risk urban dwellers from urban sex slums back to the countryside, where AIDS had not yet become prevalent spreading it to the rural areas quickly. Despite the epidemic in Haiti, cases of AIDS are virtually non-existent in high socioeconomic status Haitians.

Farmer sees one big global gradient in health, wherein the distribution and character of disease among the poor of the world, beset by infectious diseases and violence, is similar regardless of where they live but different from the rich, who face chronic diseases in mid- and late life, regardless of their nation of residence. The "lived experience" of disease, Farmer argues, helps to explain how many national and international factors play into the role of everyday life in a region.

In Do Kay, for example, the way villagers spoke of their trials, such as AIDS affliction, were closely linked to the larger scale sociopolitical events occurring in Haiti. Furthermore, international events, such as discrimination of Haitians in Miami and New York, have direct consequences in Haiti and can go to further an already grave problem. He poses the question of the future of the little girl who had to drop out of school to show how international events can strongly relate to rural Haitian life.

Haiti was stigmatized as the country that brought AIDS into the Western Hemisphere. Its tourist industry, which had become its second largest, was destroyed and Haitian emigrants to other countries became the object of AIDS-related discrimination. Once AIDS was endemic in Haiti the forces of social inequality, such as migration by rural peoples into urban areas for work, prostitution for subsistence, and domestic and foreign discrimination, could be counted on to turn it into an epidemic which forever changed life in Haiti as well as North America.

Cuban isolation protected it from the fate of those Caribbean countries that traded largely with North America or had a large American tourist industry. The lived experience of AIDS as studied by farmer shows the economic struggle and deep mysticism of Haiti as well as has some direct reactions to the American ideals of Haitian AIDS. This lived experience mirrors and reacts to the personalization of larger national and international events.