Global Responses to AIDS: Science in Emergency (review)

Cristiana Bastos.Global Responses to AIDS: Science in Emergency. Bloomington: Indiana University Press, 1999. 224 pp. $27.95 cloth.

There is no good reason why social scientists have paid so relatively little scholarly attention to understanding the AIDS epidemic as a thoroughly global phenomenon. After all, epidemiologists and historians have long been inclined to think of the spread of epidemics in transnational terms, tracing infectious contact across borders and along trade routes and, nowadays, through the confined spaces of jets that rapidly crisscross the planet. AIDS, moreover, was an international epidemic from its earliest days: The illness had already spread to at least three continents by the time of its first discovery. More profoundly, the impact of AIDS can be taken as emblematic of globalization itself (Altman 1999). Not just HIV, but funding, knowledge, treatments, and organizational forms are transmitted around the globe in the most intricate patterns, and, in response to AIDS, global relationships of power and inequality are reordered in ways that cut across the divisions between the rich and poor nations or between the First and Third Worlds.

It is therefore surprising that most well-known works on the social, cultural, political, and economic character of the epidemic have continued to emphasize the experiences of the United States and other rich countries and that so few of those studies that do range further afield have sought to explicate this characteristically global dimension of the epidemic. Anthropologist Cristiana Bastos makes a welcome intervention, then, when she positions her book, Global Responses to AIDS, in relation to a fundamental contradiction: "on one hand, an interconnected society, capable of distributing information simultaneously across the globe to achieve the illusion of proximity and shared experiences; on the other hand, a society in which global interconnectedness increases differentiation and contrast" (8-9). Although most of Bastos's ethnographic data come from her work in two cities--New York City and Rio de Janeiro--the point of the study is to force a consideration of the global patterns of exchange that give shape to the epidemic in places as different as the United States and Brazil. In so doing, Bastos demonstrates a number of recent turns in the field of anthropology: for example, the use of "multisited ethnography" to develop a "macroanthropology" of global issues and the intersection of cultural anthropology with the field of science studies, which investigates the social processes of knowledge making.

Bastos insists that we understand the AIDS epidemic in relational terms, and she focuses on two sets of relationships in particular: first, the tense but productive interactions between credentialed experts and lay activists and patients; and second, the complex web of connections between places at the "center" and "periphery" of global politics, economics, and culture. The first of these sets of divides has already been well described elsewhere (Arno and Feiden 1992; Epstein 1996; Treichler 1999), at least with reference to the United States, in works that emphasize how the politics of AIDS has challenged our standard, top-down conceptions of communication between experts and laypeople. To a degree unmatched by any group of patients before them, people with AIDS accomplished the mass conversion of a "disease constituency" into a social movement whose contentious and telegenic activism was matched by a heady engagement with hard science. Teaching themselves the fine details of virology, immunology, and biostatistics, activists contributed to scientific debate about research priorities and methods and reformed the drug regulatory process in the United States. Bastos's intriguing point of departure is to wonder whether this leveling of the conventional hierarchy of power and knowledge has a corollary in geopolitics: In the domains of AIDS prevention, research, and treatment, does the "periphery" ever "talk back" to the "center"? Does the flow of knowledge about AIDS ever become bi-directional, moving from the zones of neglect in the so-called Third World back to the citadels of science in rich Western...