Sin, Sex and Stigma: A Pacific Response to hiv and aids (review)

This monograph concerns the relationship between hiv/aids and gender, social structure, and the cultural and religious politics of sexuality in Papua New Guinea. The author, a longtime scholar of sexuality and sexual health in that country, draws on historical and ethnographic work, media reports, policy documents, interviews, and his own research experience as his principal data sources. The major aim of the work is “to pay critical attention to several aspects of Papua New Guinea’s national response to hiv and aids and hopefully thereby to strengthen it” (24). Thus, as opposed to being a disinterested academic, Hammar is an engaged advocate, compelled to write by a “hot glow of anger” (47) and his self-declared “special responsibilities in the world” (387).

The book is divided into two very different sections. The first, “Sexual Networking and Sexually Transmitted Dis-ease in the Pacific,” contains five chapters. At the outset of these chapters, Hammar identifies 7—though there actually appear to be 8—key points on which the monograph is based: (1) National and international public health and policy personnel have not yet grasped the root causes of hiv transmission in Papua New Guinea. (2) The national response to hiv/aids has been based on insufficient empirical data. (3) Because hiv/aids programs are externally funded and rely on a foreign epidemiological model and surveillance system, the epidemiological database is too “loose” to capture behavioral practices and guide the national response. (4) The response to hiv/aids is too biomedical and technical in nature, and it ignores social factors. (5) The risk of contracting hiv has inappropriately been externalized away from oneself, one’s marriage, and one’s sexual partners. (6) This tendency to externalize risk is related to the inability of program managers, politicians, and religious leaders to accept normative sexual practices. (7) The “abc” (Abstinence, Be faithful, use Condoms) model is inappropriate for Papua New Guinea—in concept, motivation, and implementation—and ignores the constraints of social structure, political economy, and gender. (8) Christian churches, more than any other institution, have encouraged unsafe sexual practices and prevented initiatives that would lead to safer sex.

The next three chapters are primarily historical. Chapter 2 is an interesting but excessively lengthy and detailed history of the customary sexual practices of south coast groups, which shows the slow changes over time in the meaning and value of women’s bodies and sexual services. Hammar argues here that women’s growing involvement in prostitution since the 1960s is best explained in terms of social change and political economy, rather than any reified notion of traditional sexual practices. Chapter 3 is a history of hiv surveillance and policy responses in Papua New Guinea between the mid-1980s and 2007, and Hammar does a good job of drawing on media coverage and policy literature in his analysis. Chapter 4 is a history of “leading messages and programmes” (143) related to hiv/aids in Papua New Guinea. Hammar suggests that insufficient energy has been directed toward critically and reflexively interrogating risk categories and the quality of epidemiological data, meaning that any response based on this data is flawed. Chapter 5 is a discussion of the anti-condom discourse in Papua New Guinea, showing how the introduction of condoms has been incredibly contentious, leading to ideological struggles, stigmatization, and the spread of disinformation. Peculiarly, Hammar spends considerable time in this chapter seriously engaging and refuting multiple claims—eg, that condoms are actually causing an increase in the spread of hiv—made by the Catholic bishop of Vanimo.

Part 2, “What the Experts (Still) Don’t Get,” consists mostly of transcribed discussions with colleagues, and opens with an unnecessary discussion of male genital cutting. Chapter 6 is a conversation with a graduate student researching sexual health in the Indonesian territory of Papua. Chapter 7 is a...