CJCCJ/Volume 64.1 (2022)
A Socio-Criminological Analysis of the HIV Epidemic
By Bruno Meini
Wilmington, Delaware: Vernon Press. Series in Sociology. 2020, 168 p.
A Socio-Criminological Analysis of the HIV Epidemic is a scholarly text about one of the longest-lasting epidemics in recorded human history, easily beating other contenders like measles, cholera, and the bubonic plague that is the HIV epidemic.
The book was launched when the world’s attention has mainly been redirected to the unfolding crisis of the COVID-19 pandemic, which reminds us that health issues have an international dimension that necessitates strategic global interventions. Indeed, awareness has grown, and new treatments have been developed that make HIV far more manageable, and between 2005 and 2012, the annual global deaths from HIV/AIDS dramatically dropped. However, worldwide there are still an estimated 40 million people living with HIV which provides the canvas for the author’s discussion of this vital topic.
The monograph provides a multifaceted perspective that remains by necessity kaleidoscopic as it draws on selected sociological and criminological vantage points. Yet, the views are skillfully integrated into a coherent discourse. In doing so, the author, who contributed to the many academic articles that deal with HIV and AIDS before writing this monograph, identifies an array of disciplines like sociology, criminology, law, medicine, victimology, epidemiology, and risk management, whose multiple fault lines point to the concepts and ideas against which the phenomenon must be discussed. Therefore, it is not surprising that the explication of the subject includes treating many topics (e.g., human rights, law enforcement, injecting drug use, medical confidentiality, sexuality and stigma, health and safety, sexual violence, and discrimination).
The book uses primary and secondary sources and sports an impressive bibliography with more than six hundred entries, without giving the feel of being cluttered. This vast assemblage of sources becomes the author’s thesaurus from which he draws concepts and ideas, mostly at face value. But it is precisely this eclectic approach that gives the text its ingenuity which brings about what the author himself names an “independent and original epistemology of HIV” (p. ix).
The book’s predominantly sociological perspective covers conceptual chores proffered by known sociologists and explains their heuristic relevance for understanding the HIV/AIDS epidemic. The author applies, for instance, Parson’s ‘sick role’ to highlight that under the conditions of the HIV/AIDS epidemic, the “dysfunctioning of an individual’s organic system (disease)” and the “capacity to adjust on a personal and social level” (p. 22) is out of sync. Another example is Beck’s notion of risk, which “has come to dominate how the HIV epidemic is interpreted as a public health crisis” (p. 83). The content of the book is divided into six logically sequenced chapters and concludes with some final considerations.
In the Introduction, the author begins by identifying gay men, other men who have sex with men, people who inject drugs, sex workers and transgender people as the key populations who are most at risk of acquiring or transmitting HIV, and highlights that the global expansion of HIV parallels the expansion of the drug and sex markets. The text already underlines the importance of AIDS phobia, HIV related stigma and discrimination, which in later chapters become central topics for discussion.
Chapter 1 traces the origins of AIDS, clarifies the conceptual difference between health and illness/disease, and introduces other vital aspects of the ensuing discourse on HIV. The text describes the disease’s initial epidemiological reception, which, perplexed by a pre-existing stigma attached to homosexual and bisexual males, led to the erroneous conclusion that AIDS was an exclusively homosexual disease. Features of the HIV epidemic, the routes of transmission of HIV, epidemiological factors, and a theoretical approach to prevention policy conclude the chapter.
The focus of Chapter 2 shifts to the ongoing sociological discourse on infectious diseases. The author uses Parsons’ ‘sick role’ as a descriptive framing device to point out the sociocultural elements in the experience of being ill (Burnham, 2012, p. 776) with HIV/AIDS. He then discusses intentionality in attracting HIV against lifestyle-related risks of being infected and the social reaction, which he compares with the social response to deviance. The chapter concludes with a passus on children orphaned by AIDS and their deviant tendencies. With a focus on the child soldier phenomenon brought about by the pandemic in some African societies, the author reminds us of how social learning (Edwin Sutherland) may be assumed to fill in the cultural void caused by orphancy.
Chapter 3 plays a central role as it puts forth HIV-related stigma as a disenabling (sic) key mechanism to HIV prevention, diagnosis and cure. The author lays out how HIV-related stigma, which has had its effect from the very early labelling of the disease as Gay-related Immunodeficiency (GRID) at the beginning of the 1980s, unfolds its devastating effects on children orphaned by AIDS. The chapter points to the explicit and implicit violation of children’s rights in the process.
Chapter 4 highlights the intricate relation between intimate partner violence and HIV in South Africa. Violence against women is recognized as a cause and as a consequence of HIV and a driving force behind the epidemic. The author acknowledges, and significantly so, violence against women and children as a global concern, whose incidence nonetheless varies according to the culture and organization of different societies, the author homes in on the pervasive nature of gender-based violence in South Africa and much of Sub-Saharan Africa.
In Chapter 5 the author draws from a previously published article (Meini and Tognetti, 2019). Here the question under focus is how certain traditional practices, e.g., polygyny and virginity testing, are related to HIV; this phenomenon is called at times “benign concurrency.” The text highlights an interesting insight from a multilevel analysis of the relationship between polygyny and HIV: Whereas at the individual level polygyny correlated positively with HIV status, the correlation was negative at the aggregate level. The victimological analysis ends by shedding light on two interrelated concepts of victimization processes, that is, secondary HIV transmission through harmful traditional practices.
In the last chapter (Chapter 6), the author discusses the risk-security-nexus which integrates perspectives on HIV, risk, and social cohesion. Taking Beck’s notion of risk as a point of departure, he follows the emergence of HIV as a security issue from the beginning of the 3rd millennium, and describes the process of securitization of HIV. The impact of AIDS on democratic processes, HIV prevalence and state weakness, and the HIV-related loss of experience, skills and personal information in law enforcement, come under focus towards the end of the chapter.
In the final considerations, the author returns to his initial contention, namely that the socio-criminological analysis centred in a concept of “social interaction constitutes an original interpretative lens, capable of bringing out the multifaceted nature of the virus” (p. 99).
The HIV pandemic shows no signs of abating. Accordingly, A Socio-Criminological Analysis of the HIV Epidemic is a timely academic contribution to our quest for effective policy choices to tackle it. The book is not only highly original in its focus but it represents an ambitious effort to present “the multifaceted socio-criminological dimensions of the HIV epidemic” (p. ix). A project of this nature requires the presentation of perspectives on the HIV epidemic across many disciplines, and the author achieved this by knitting the many allied themes associated with HIV into a wide-ranging treatment of the subject.
Against the backdrop of the above, notwithstanding the impression that the transitions between the chapters are not always smooth, it can be expected that the book will have a wide-reaching international appeal. For those involved or interested in global health issues and infectious diseases, this text offers an interesting novel perspective. It should be likewise of interest to medical researchers, health workers, social scientists, social workers, policymakers, humanitarian workers, HIV and human rights activists, and graduate students.
NAMIBIA UNIVERSITY OF SCIENCE AND TECHNOLOGY (NUST) – WINDHOEK
Burnham, J.C. 2012. The Death of the Sick Role. Social History of Medicine, 25(4); 761–776.
Meini, B. and Bordagna, M.T. 2019. The contribution of harmful traditional practices to HIV transmission among adolescent and adult females in sub-Saharan Africa: A victimological approach. International Journal of Gender Studies in Developing Societies 3(1): 37–59.