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

This important book is about the enormous challenges women with HIV/AIDS face as they become mothers and struggle to ensure good health for their children. Closely examining state health policies, household dynamics, and the difficult personal choices women have to make, Van Hollen presents an in-depth ethnographic account of the lives of women living with HIV/AIDS in the southern state of Tamilnadu, India. Birth in the Age of AIDS enriches existing anthropological studies of HIV/AIDS by bringing to the fore the myriad things a woman has to maneuver as a wife, widow, mother, and daughter-in-law, and also as a person with HIV/AIDS, all the while maintaining a “positive” outlook to life. This ethnography is the story of many individual women, their collective struggle for health, and the support of their families and the state. Through a reading of state health policies and women’s experience, Van Hollen depicts how women with HIV/AIDS negotiate a universe operating within the “logic of the discourse of limited resources” (52–53).

Public health programs strongly impinge on people’s lives, especially in India where state health care schemes are advertised widely in the media and painted prominently on walls in public spaces, “telling” people how to lead healthy lives. Such “top-down” approaches, well-documented in Van Hollen’s (2003) previous work on childbirth, are critically examined here as well. Focusing on the intersections between gender, class, and state policies on and about women’s bodies, this book unpacks the “tension between a close rendering of the local and effective engagement with the global” (Janes and Corbett 2009:170). The Prevention of Parent to Child Transmission program for women with HIV/AIDS (henceforth PPTCT) is the lens through which the author argues for a focus on “local embodiment to world history” (8).

In Chapter 2, Van Hollen astutely captures the change in the Indian government’s handling of HIV/AIDS through a description of two train journeys: the Mukti (Salvation) Express in 1990 and the Red Ribbon Express in 2004. The Mukti Express transported women rescued from brothels—tested for HIV and stigmatized as sex workers and diseased persons (38)—from Mumbai to Tamilnadu. Over a decade later, the Red Ribbon Express travelled across India, distributing material about HIV/AIDS and advocating a more sympathetic approach toward those affected by the disease (43). These train journeys can be mapped on to government efforts to show how the state’s changing public health approach to HIV/AIDS had come a long way: from Phase I of the government’s HIV/AIDS control program (1992–1999) which emphasized “awareness” (39), to Phase II (1999–2007) which signaled an inclusive approach, to Phase III (2007–2012) when the Red Ribbon Express was introduced. Here, Van Hollen rightly dissects the often-abused term “awareness”—bereft of any attention to structural factors, be it gender or economic inequality—in Indian public health campaigns to show how problematic it could be when all attention is focused solely on “educating” the supposedly ignorant (40). The Red Ribbon Express was a manifestation of the state’s realization that health policies are not simply about creating “awareness,” but incorporating those affected by the disease as stakeholders.

In Chapter 3, the focus moves to the HIV/AIDS counselors who have to translate national and international health policies for the public. Counselors with the PPTCT program were usually individuals with at least high school education and some training in counseling. The counselors face an uphill task in bringing patients to the testing centers. Employed by the state AIDS control society, their performance is assessed based on the number of HIV tests (72) they encourage. In their eagerness to make the test sound “palatable” (67), they inadvertently play down the effect a “positive” result would have on a patient. Space constraints along with turf wars with and harassment by hospital staff add...