Birth in the Age of AIDS: Women, Reproduction, and HIV/AIDS in India by Cecilia van Hollen (review)

In the past few decades of the HIV/AIDS crisis, there has been an outpouring of popular and academic accounts that describe the epidemic in different parts of the world. In this increasingly crowded field, Cecilia van Hollen’s Birth in the Age of AIDS: Women, Reproduction, and HIV/AIDS in India occupies a distinct niche. The book sits at the intersection of anthropological literature on reproduction and HIV/AIDS, as it tracks the experiences of HIV-positive women who become pregnant and go on to become mothers in the southern state of Tamil Nadu in India. It illuminates how these women—who in this study are typically from lower economic strata and visit public sector clinics and hospitals in urban settings—make decisions about the most intimate aspects of their lives such as whether to undergo HIV testing, whether to continue a pregnancy, and whether to breastfeed their infants.

The book reflects how any study of the AIDS epidemic demands simultaneous consideration of local, national and global phenomena. In her analysis, van Hollen interviews and observes several dozen HIV-positive women who availed of services provided by the Indian government’s Program for Prevention of Parent to Child Transmission of HIV (PPTCT). On the one hand, the government’s program improves the chances of infants being born without HIV. And yet the prevention program has unintended consequences. For instance, because of their visits to prenatal clinics, many women become aware of their positive status before their spouses. Consequently, their husbands’ families frequently accuse them of being promiscuous and spreading the disease to their husbands. The ensuing stigma and blame become reasons for often denying these women rights to their husbands’ property. The AIDS epidemic becomes the context in which age-old discriminatory norms get reproduced.

And yet the social stigma that the women face by no means overwhelms all possibilities for positive change. One of the abiding insights of the book is in showing how HIV-positive women exercise agency even in settings where they frequently face social condemnation. These women challenge ossified cultural mores, with many demanding inheritance rights to their recently deceased husbands’ lands, and others pushing up against taboos of widow remarriage. That the AIDS epidemic is the setting for transforming social norms is not surprising. After all, the epidemic in India led to the influx of a well-resourced armamentarium of human rights activists and NGOs.. The activist networks, which are utterly cosmopolitan even as they work in local settings, rallied around the HIV-positive women, helping them challenge discriminatory social customs.

Van Hollen’s remarkable book is as much about global health as it is about India’s national health policy and local experiences. The author situates her work firmly within the growing annals of medical anthropology that document how discourses of global health intersect with local realities. There is insightful analysis of how global health techniques—such as of informed consent—are implemented in Tamil Nadu hospitals. While acknowledging some of the problematic reasons for the centrality of informed consent procedures, she nonetheless focuses on them in order to highlight the gap between global policy on the one hand and local practice on the other hand.

But the analysis of informed consent does more work than just highlighting the gap between policy and practice. In choosing to study a practice that is central to the global health vernacular, the author renders the Indian epidemic recognizable across countries, inserting the experience of the women in Tamil Nadu into frameworks that can be understood beyond India. The author could have chosen to focus on a parochial ethical concern that was particular to Tamil Nadu. Instead by focusing on informed consent, she facilitates the understanding of India’s epidemic as part of a global phenomenon.

Another way in which the book ‘globalizes’ India’s AIDS epidemic is by frequent...