30 December 2008

Sexual arousal: towards a truly useful theory of sex

One of my larger projects is to try to develop what I call a theory of sex that is useful for anthropology. This would involve a theory of sex that is truly social and that can lead towards and understanding of sex AS culture, sex AS social, and sex AS social action. The alternative, what we have now, is various social constructionist approaches (Foucault, Lacquer, etc.), psychological (Freud, Maslow, all psychologists), or biological-essentialists (the 'evolutionary' theorists and their just-so stories, the real biologists, etc.)

One of the issues that concerns me now in this effort is the issue of sexual arousal, or what I call (here) Long term sexual arousal (LTSA). It seems to me that this is distinctively human and importantly, even centrally, social.

The existence of LTSA may be responsible for the difficulty in talking about sex. But it is more than this. I want to address a few topics here, and ask a question for anyone who might read this.

In my writing and thinking about sex, ‘the material realities of sexual relations’, as you say, the stuff that gets lost in the ‘discourse’, I have been thinking lately about something that seems to me to be distinctive: long term sexual arousal. This seems to be a human characteristic, and one that is distinctly human and therefore critical to understanding sex. It is largely neglected, however, as a significant feature of sexuality. Clearly it is the ‘condition for the possibility’ of sex, or at least arousal is *for males*, but is still a problematic category for thinking-about.

It seems to me that arousal has some of the characteristics of that other evolutionary mystery, or set of mysteries, loss of oestrus, and concealed ovulation. Also of menopause, and the social role of ‘grandmother’ (caring for grandchildren that this is supposed to have enabled).

In brief, I have been thinking about the social consequences of arousal. According to the theoretical perspective that I am developing, we have to account for the pair-relationship in social ways, and as a consequence and context for sex. This clearly does not mean monogamy in humans, but it does mean that there is a close intimacy established, generally between two and only two people, during sex. I call this ‘the space of the dual’. My current problem is to explain how this ‘space’ of intensive pair-wise focus (the sexual couple) comes about.

Obviously (?), this has to do with arousal. Or that is what I have been thinking. Humans are capable of long-term (hours, or even days ?) of ‘arousal’, that is, an ‘alternative’ or ‘altered’ consciousness of another person that is—or is intensely perceived as—sexual. This long-term arousal is, it seems to me, unique to humans, and is coordinated with loss of oestrus and concealed ovulation since the dynamics of arousal replace the dynamics of oestrus signals (red bottoms on female baboons, oestrus odours, etc.) and effectively make up for the ‘concealment’ of ovulation. In other words, for an aroused, ‘horny’ couple, it does not matter whether their bottoms are red or if their smell signals fertility: they are aroused by each other, and this is a profoundly social bond.

So, one of the lynchpins of a truly social theory of sex that is useful for anthropology is a focus on the notion of arousal, especially long term sexual arousal (LTSA). Clearly arousal is not the same thing as ‘pleasure’ or ‘desire’ but has a more direct effect on social action. In trying to develop such a theory, it may be important to leave ‘gender’ entirely or relatively out of it. That is, to not make sex the reflex of abstract categories, but rather a social act that is predicated on meanings and motives. It would be useful to develop a theory of sex that does not collapse in the presence of “homosexuality” (sex that is seen as wrong, with wrong ‘object’, non-fertile, etc.) but which can account for sex-as-sex, sex in general social terms, rather than moral terms, or in terms of its effect on fertility and populations (evolutionist and bio essentialists views).

The problem, however, is to what extent is arousal ‘gendered’? When I first presented some of these view at the beginning of December 2008 at a seminar at University of North Carolina in the Anthropology department, one of the female members of the seminar said to me afterwards, ‘But its not like that for women; your perspective is entirely masculine’. Of course, and male these days is used to hearing that almost any view they express is nothing but a ‘male perspective’, ‘gendered’ and so on. But there is also some merit to her suggestion that men and women do not experience arousal in the same way. My interlocutor, a woman, suggested that “Of course, women don’t necessarily become aroused at all. You are just talking from a male perspective.” Ouch. But so be it. From a ‘male perspective’. She is certainly right in some cases, but not all.

In thinking about this, it occurs to me that it may be rather the case that no two people experience arousal in the same way, but that some men and women do experience it is very similar or the same ways, while others irrespective of ‘gender’ experience it in other ways. In other words, it seems to me that arousal may be a very social experience, but is also high variable. Indeed, its variability points to a social and cultural dimension since features that are simply determined by biology, or by evolution, are generally much more stable and determined.

Clearly, too, sexual arousal for the male is necessary for sex (penetrative sex) to occur at all and this is not (necessarily) the case for females or for anal-receptive males. This also makes female prostitution possible and profitable (while it is much more difficult for a male prostitute to have as many clients in a night, say, that for a female), but does not make is ‘necessary’—that is, it is a condition for the possibility of female prostitution, but not a cause of (female) prostitution. There are many others issues like this that arise as well.

This difference between the sexes in arousal also, I think, has implications for the question of female ‘subordination’ and for male claims to power (I don’t always agree with the feminists that men have as much social power as they are attributed by feminists, but that is another matter).

The claim I wish to make, then, is that long-term sexual arousal is a fundamental human characteristic that is partly biological and partly social and cultural, and therefore a significant dimension that must be investigated in order to develop a theory of sexual action that is useful to anthropology. Arousal cannot simply be assimilated to the discourse on desire, pleasure (Foucault), impulse or libido (Freud), and is highly social, but in a restricted sense: it involves the pair, the one-to-one relation, rather than the social (Many-to-many, or many-to-one relations), and is not restricted to the psychological (the one, the self).

The problem is that it appears to be so variable in the way it is experienced, and also both necessary AND contingent.

This has become too long.

My question, then, is how to examine this variability in the experience of arousal?

09 December 2008

I have rarely read an article more wrong and dangerously amoral than Mahmood Mamdani's recent article in the London Review of Books (4 December 2008) on 'The Lessons of Zimbabwe' (http://www.lrb.co.uk/v30/n23/mamd01_.html ). What we might most profitably learn from the the man is how wrongly African politics can be conceived by those isolated from its realities, as this Columbia University professor surely is.

The article is insulting to Africans, and to Zimbabweans who have suffered mightily at the hands of Mugabe and his cronies. Mamdani's claims are predicated on what might be called a 'romantic' vision of this part of the world in which leaders like Mugabe could be said to have some moral standing and good intention. This is not the case. Mamdani's mistakes are many. Indeed, it is all but impossible to recognise the real Zimbabwe in what Mamdani has to say about it. The most charitalbe thing that can be said about Mamdani's "Lesson from Zimbabwe" is he has apparently learned very little from his previous life among the elites of Africa. In this article, he repeasts some of the worst mistakes made by these elites who despite long residence in AFrica, understand almost nothing about it. In this, Mamdani resemble much more the colonial masters that he claims to excoriate than he does any person of the African soil.

First, Mamdani labours under the misconception that Mugabe has somehow 'reformed' land holding in Zimbabwe. This is nonsense. There has been no land reform in Zimbabwe if by this term we mean, as we should, a productive redistribution of land resources that offer some benefit to society, the country's economy, or to some category of beneficiaries. This has not happened in Zimbabwe. He has indeed given 'ownership' to two categories of people. The first category is constituted by his cronies and janusaries, those who protect him and who live off his largesse. The second category is the so-called 'war veterans', many of whom are much too young to have actually fought in the Rhodesian war, or Chimurenga. Whatever they age, they are 'beneficiaries' not of land or largesse but of the bush. The land that has been 'returned' to them has been of little or no profit to them because they have had no resources to farm it, for the most part, and certainly no economy in which to participate as farmers. It means nothing to have land if the product of the land cannot be marketed, where and if a product can be produced at all. Even his cronies have, for the most part, simply allowed the land to lapse into bush fallow again.

In this part of Africa, that does not take long. Agricultural land will return to bush in a matter of a few years. The effort to reclaim it for agriculture increases exponentially with eahc passing year. This has happened all over Zimbabwe. The result has not only been increasing poverty on a vast scale, but the removal of most of this land from any productive use for many years, even decades to come.
This is one of the things that Mamdani's romantic notions does not allow for. Productive agricultural land has little to do with the land itself. The land is simply the physical site and substrate of huge and accumulated effort over many decades, and in most cases, many generations. It is not too much to say that the agricultural product of land has much more to do with knowledge--even culture--than it does have to do with the simple 'material' substances in and on which it is based. Agriculture is a social and cultural system, usually of great historical depth and cultural complexity. Its results--what we see as 'fertile land'--is the result of complex social orders, marketing networks, with carefully maintained institutions of knowledge production and application, and with social hierarchies and organisations.

This social and cultural basis for agriculture has been lost in Zimbabwe. It is at risk of being lost in South Africa, too. But it is not land that is at issue. This is merely 'redistributed' as a kind of political trick. Without the support of all of the other complex social and cultural structures, having land is a recipe for destitution and failure. This is clearly the case in Zimbabwe.

It is a romantic fantasy, then, to claim as Mamdani does that there has been 'land reform' in Zimbabwe. This however is the first premise of his mistaken belief that Mugabe can be redeemed in any way by means of his supposed land reform. He and his regime are unredeemable.

Mamdani's other bizarre claims pale somewhat in the light of this primary mistake. He is not alone in making this mistake, but he is certainly in the moral minority for believing that Mugabe is praised or revered in southern Africa for his land reform. That is, he is not revered among honest people. There is however a large and increasing category of criminals, politcal opportunists, and those who are involved in the illegal and often largely criminal economies of southern Africa. For them Mugabe is indeed a god send. Apart from his deliberate ruination of his own country, Mugabe has facilitated a criminal economy that now spans most of the southern part of the continent. By providing vast areas of ungoverned bush land, Mugabe's land reform has created the conditions under which an ungoverned exploitatio ofAfrican resources can take place without oversight or control. Much of this is indirectly managed by Chinese middle men, although middle men from many of the world's undergrounds are involved. These include European mafia(s), Lebanese gun and diamond merchants, Israeli gem buyers, Malaysian timber merchants, among others. The natural resources of Zimbabwe are being carried off for nothing by agents from around the world. Mugabe's palace was not built by the Chinese, with Chinese materials, for nothing. It came at a cost, and that cost is the rape of Zimbabwe's wild flora and fauna for Chinese "medicine" and aphrodesiacs, the exploitation of its gold and other high-value minerals by Libyan and other Arab business intereststs, among others. But it is not only Zimbabwe that is being plundered. By providing access to all of the southern Congo through the ungovered and literally 'unknown' parts of this darkest of African regions, Mugabe and his military oversee, and profit from the exploitation of Congolese forests. Trainloads of huge and ancient teak and other first-growth African timber are shipped out of this area daily. Most of this 'trade' is unregistered, and unrecorded. Most of its ends up in Arab or Chinese hands.

Thus, Mugabe's land reform is not reform in any real sense, but rather the covert creation of a context in which this illegal, ungoverned, unregistered, unsustainable, and brutally exploitative economy can operate. That is its first and greatest achievement.

Mamdani's comparison of the situation in Zimbabwe to Idi Amin's expulsion of the "Asians" in Uganda is one of the most bizarre of his efforts. He claims that 'many people' have indeed offered this comparision, and this may be true, but it does not make the comparison valid nor fruitful of any insight. It is true that Mugabe's regime and Idi Amin's regime both deliberately destroyed the countries over which they ruled. Both did this with what at first seemed to be "good intentions" (broadly and charitably conceived), and both quickly descended to a level of criminality and brutality that was unmatched in the countries that surrounded them. Idi Amin, however, was wiley but stupid; Mugabe is a undeniable genius. The principle difference between them is that Idi Amin ultimately appeared so foolish and so brutal that even "socialist" Tanzania under Nyerere eventually felt compelled to attack this hated distator and to unseat him. They sent him to exile in Saudi Arabia (where he was still hated but was cosseted and sequestered where he could do no more harm). Mugabe has been brilliant, by contrast. He has deflected every move to push him aside or even to mitigate his damages. He has increased his police force and military, and has handsomely rewarded those who have stood by him in his chicanery and deceit. (This probably includes the ex President of South Africa, Thabo Mbeki, who is clearly also owned by Mugabe.)

Mugabe has been so clever, in fact, that he has deceived even the Herbert Lehman Professor of Government in the Departments of Anthropology, Political Science and International Affairs at Columbia University. Somewhat to his credit, Mamdani is scarcely alone in this ignoble company. Maintaing this deceit in a publication such as the London Review of Books does no service to anyone, however.

As Mamdani knows very well, Uganda was not a colony. It remained a Protectorate under British rule. This meant that little or no land was 'alienated' to 'settlers'. All of it remained in Ugandan hands. Thus Idi Amin was not able to use land as a token in his demogoguery. Instead, realising that the Indians controlled almost all of the economy, including the sale of agricultural products, he expropriated the Indian traders and businessmen (called "Asians" in Uganda). But of course, while he was able to take their shops, factories, homes and stock (and even some of their daughters), he was not able to expropriate the knowledte and networks that made these mere things into an economic system. The economic system did not 'collapse'; it simply ceased to exist. This is a remote point of similarity gbetween Uganda and Zimbabwe. Mugabe, like Idi Amin, destroyed the social system and the knowledge on which it depended. While the old Indian shops still remain in Uganda, they are now merely historical architecture. The same could be said of the soil or earth of Zimbabwe: it is now no longer 'agricultural land' although it continues to be geologically what it always was. By 'returning' land, Mugabe has done far more damage than even a complete scortching of the entire earth of Zimbabwe. He has removed the possibility for recovery for a very long time to come.

The errors and misconceptions abound. But let's leave it here for now...
9 December 2008

19 September 2008

I have just received enough copies of my new book to feel confident that it is truly 'out there', in the world. I had a couple of 'advance copies' weeks ago, and finally received a box of the 10 that the press had promised. What a lovely day. It was just in time to sell them all to my HIV/AIDS in Context class. I teach the course with sociology and history, and the next couple of weeks are mine to teach. Naturally, I will use the book as the primary text.

The book details and information are all below.

Robert J. Thornton.

Unimagined Community: Sex, Networks, and AIDS in Uganda and South Africa

California Series in Public Anthropology, 20

$60.00, £35.00; ISBN 978-0-520-25552-4


$24.95, £14.95; ISBN 978-0-520-25553-1

304 pages, 6 x 9 inches, 7 b/w photographs, 13 line illustrations.

September 2008, Available worldwide

Categories: Anthropology; Cultural Anthropology; MedicalAnthropology

Unimagined Community examines the social-structural and cultural contexts and forces that shape the radical differences between prevalence trends in Uganda and South
Africa from the late 1970s to the present. This book is not,
however, about statistics, demography or epidemiology of HIV trends
or AIDS, or about the social, cultural and economic consequences
of HIV and AIDS.

Instead, it shifts our focus away from the personal/ individual aspects of sexual behaviour and risk to the large scale social-structural issues. In line with this shift in scale of analysis, the principle theoretical innovation is to demonstrate that ‘sexual networks’ can be understood as social structures, albeit ‘invisible’ or‘unimagined’ ones. These, in turn, are part of the social contexts in which they form and are partly determined by them.

Kinship, family property and inheritance regimes, population mobility, local-level and ‘traditional’ authority, national-level political structures, and systems of traditional healing are all examined and brought into relation with one another in order to explain the specific differences in the configuration or topology of sexual networks.

This approach explains, for instance, specific apparent anomalies such as the fact that South Africa has the lowest (and falling) total fertility rate (TFR) in Africa but rapidly rising rates of HIV. Uganda, on the other hand, has the one of the highest TFR in Africa that is very stable whileHIV has both risen and fallen dramatically over the same period.

This study shows that large-scale social facts such as these can only be explained at the social level, not at the individual level of sexual ‘behaviour’ and ‘risk.’

Radically different political responses to AIDS emerged in Uganda and South Africa. The book argues that in Uganda HIV-caused illnesses were already part ofindigenous knowledge or ‘native medical categories’ bythe time the virus was identified by science, and this fostered amore rational national response. In South Africa, on the other hand,indigenous medical categories did not encompass this disease. Forthis and other reasons the American scientists Duesberg andRasnik—the so-called ‘AIDS denialists’—had asympathetic audience in South Africa. The book demonstrates how andwhen South African ‘denialism’ arose and why it capturedcentral ideological ground in the AIDS struggle.

The author also examines the differing impacts of land-tenure systems, inheritance patterns, and traditional authority structures on patterns of sexual networks. South African and Ugandan indigenous healing epistemologies are compared, especially with respect to differing
concepts of gendered bodies and the flows of 'sexual substance' between them. This deep yet comparative anthropological investigation is focused on explaining how differences between
large-scale patterns of sexual networks can advance our knowledge of the large differences that exist between HIV prevalence and trends in different regions.

It goes well beyond merely pointing to the significance of sexual networks, for instance,as in Helen Epstein’s recent book ‘The Invisible Cure’. It develops a sophisticated anthropological approach to the epidemiology of diseases that are spread by and through social networks rather than, as is most other cases, across populations through random distribution of pathogens.

The book is written in a way that will be widely accessible. (The mathematics, for instance,
is isolated in sidebars and text boxes. It is not necessary to understand the mathematics of networks to understand the argument, but the mathematical analysis is innovative and compelling.)

'Blurbs' on the back cover rate the book highly.

"Like Durkheim in Suicide, Robert Thornton's audacious ambition is to reveal the collective causes of intimate personal behavior; and he takes as the critical zone for his investigation thehidden network linking sexual partners to society at large. Unimagined Community succeeds as a compellingly original study of AIDS and as a work of deep anthropology. This book is a tour de force, reflected in the consistently high quality of the writing which never flags."—Keith Hart, author of Money in

Thornton cuts an original and creative path through
the massive AIDS literature assembled since the 1980s. Based on his
view that sex is to be seen as a social relationship, not a behavior,
he uses this as a building block in his analysis of the different
configurations of sexual networks in Uganda and South Africa.
Thornton departs from current purely epidemiological, demographic,
sociological, and behavioral approaches, and also goes beyond the
analysis and proposals for intervention to be found in most medical,
public health, and policy studies. It is a study grand in conception
and scale."—
Shirley Lindenbaum, coauthor of The Time

University of California Press's Description

This groundbreaking work, with its unique anthropological approach,
sheds new light on a central conundrum surrounding AIDS in Africa.
Robert J. Thornton explores why HIV prevalence fell during the 1990s
in Uganda despite that country's having one of Africa's highest
fertility rates, while during the same period HIV prevalence rose in
South Africa, the country with Africa's lowest fertility rate.
Thornton finds that culturally and socially determined differences in
the structure of sexual networks—rather than changes in
individual behavior—were responsible for these radical
differences in HIV prevalence. Incorporating such factors as
property, mobility, social status, and political authority into our
understanding of AIDS transmission, Thornton's analysis also suggests
new avenues for fighting the disease worldwide.

book can be ordered from the Univ. of California Press’s
website at http://www.ucpress.edu/books/pages/11116.php#bio
or from other booksellers.

03 August 2008

Ethics and knowledge practices in HIV/AIDS reserach in the medical and social sciences

It is difficult to know where to begin a "blog."

So let this be a beginning. There are a number of things that I will address in this blog. Most have to do with various aspects of politics, culture, health and sexuality in southern Africa.

Since my book, Unimagined Communities is due soon from the University of California Press, and since I am now the new a reluctant chair of the Witwatersrand University Human Research Ethics Committee, the issue of ethics and HIV/AIDS research is one of the issues that I will begin this blog with.

Differences between the social and the medical sciences:

Fundamental differences exist between the social sciences and the bio-medical sciences in the assessment of ethical standards for research on sexuality and HIV/AIDS, and in the conduct of research on these topics.

These differences have serious implications for the application of ethical standards for University ethics committees in their assessment and clearing of research proposals, for the nature and quality of the knowledge that this research produces.

This also has significant impacts on the formulation of public health policy, for the effectiveness of public health programmes and interventions aimed at improving reproductive health and the prevention of STIs including HIV.

These differences arise primarily from

  • epistemological differences, that is, differing standards for the assessment of ‘truth’ or validity of knowledge,
  • methodological differences, that is, different ways in which data is gathered, and,
  • differences in what we might call, more generally, knowledge practices.

The epistemological and methodological difference are already well known and extensively discussed in literatures for all fields concerned. The latter, however—knowledge practices—are a set of practices (activities, procedures, customary usages deriving from intellectual traditions of disciplines) aimed at gathering and interpreting knowledge, rather than (or in addition to) the usually conceived methodological and epistemological concerns of standard science and the philosophy of science.

The notion of ‘knowledge practices’ includes issues of

  • distribution and creation of knowledge,
  • knowledge management,
  • knowledge transfer and communities of knowledge,
  • ‘traditional knowledge’ and ‘indigenous knowledge systems’.

The idea of knowledge practices has emerged as a central focus in anthropology, especially in areas of material culture, anthropology of science and technology, and in the new histories of science deriving from work by Bruno Latour, Michel Foucault, and others. It is concerned with the social embeddedness of ways in which knowledge is created, used, distributed and evaluated, especially by specific communities of knowledge practitioners (educators, scientists, technicians, bureaucrats, doctors, healers and others).

One example of a ‘knowledge practice’ in the areas of reproductive and sexual health is the ‘global gag rule’ imposed by the US government on organizations involved in reproductive and sexual rights and health issues.[1] The US government, through it agencies such as USAID and the State Department require that any organization that received funding from the US government may not discuss in any way issues of prostitution, transactional sex and abortion, and must promote ‘abstinence’ only programmes.

This is a political imposition of a specific moral or moralistic approach to intervention in matters sexual and reproductive, and severely limits effective activity in these fields by restricting the kinds of knowledge that can be communicated to the public. It also restricts the kinds of knowledge that may be deployed in development of search for new knowledge (research agendas, questions, methodologies) and has had extremely deleterious effects on the ability of NGOs that might be funded—directly or indirectly— by the US government to be effective in their overall mission.

For instance, in directly prevents distribution of condoms, knowledge about reproductive and sexual alternatives, and any interaction with abortion or prostitution. Since the US, through USAID and the State Department, is the largest global funder of development programmes worldwide, its impact has been enormous. This is not an issue of epistemology or methodology, but one that can be more generally considered under the rubric of knowledge practices.

A critique of this issue arises from the interaction of bio-medical research practices and ethnographic research practices in the areas of sexuality and reproductive health. Because the biological, medical and social-cultural aspects of sexuality and reproduction are virtually inseparable, bio-medical and social scientific approaches to research in these areas come into close contact. Ethical and moral questions are necessarily paramount in all matters of sexuality and reproduction. Conflicts between the two scientific paradigms (bio-medical and social scientific), therefore, come into sharpest focus here.

Institutions and research programmes, therefore, spend a great deal of effort on resolving ethical issues having to do with these research projects, but in our view these often result in misunderstanding and talking past one another.

Especially in anthropology, and in the case of ethnographic methods used in many of the social sciences today, knowledge is derived from its distinctive method of ‘participant observation’, or observant participation in communities. When we conduct research in sexuality and reproductive health, anthropologists—as a community of knowledge practitioners—are involved in specific knowledge practices (ethnographic methods) that are designed to interact with the knowledge practices involved in sexuality and reproduction as close to the ‘ground’ of actual practice as possible.

The randomised control trial (RCT) versus the ethnographic approach

This often brings it into conflict with the bio-medical approaches to knowledge creation (‘research’) that also aim to produce knowledge about sexual and reproductive practices, but do so in an entirely different way. Overwhelmingly, research in the bio-medical sciences is based on one form or another of the randomized controlled trial (RCT). The RCT is a highly focused, rigorous, rule-bound and ‘objective’ empirical method involving

  1. randomized selection of
  2. research subjects from a
  3. population for whom different
  4. experimental interventions or
  5. invasive procedures are allocated to
  6. two or more groups (control and experimental group).

This method is held to eliminate both observer and subject bias (the so-called ‘double-blind’ research design), ‘spurious causes’ and ‘confounding factors’.

For medicine, and especially for pharmaceutical companies, this is especially important with respect to legal challenges, profitability, and political acceptability. Since health, especially public health, is understood to be concerned with the biological state (health, illness, disease, epidemic infection) of population composed of biologically-defined collections of individual subjects, who are themselves either susceptible, immune, recovered (or dead), this does not generally concern itself with the social causes or context of illness. These are in fact specifically excluded as ‘confounding factors’, or bias.

All experimental interventions, including questions to be asked and expected responses are known in advance. Unexpected results, including novel responses or ‘creative interpretations’ of experimental conditions, questionnaires, interventions and informed consent protocols, are regarded as experimental errors, ‘confounding factors’, ‘data outliers’, experimental bias, and are usually dropped from consideration. From the point of view of social sciences, this data is lost, while from the perspective of RCT methodology, it is regarded as excess, epiphenomenal, or external.

In the social sciences, however, the so-called confounding factors and ‘bias’ are understood as the more fundamental issue, while the biological ‘facts’ of illness and disease are secondary to their social and cultural contexts. Unusual responses, creative or alternative interpretations.

Above all, for bio-medical sciences, all such experimental (RCT) or studies are regarded as potentially or actually harmful or deleterious to the subjects of the research. In order to make this type of research morally acceptable—and thus, ‘ethical’—it is held that subjects must

(a) be fully informed of the potential risks (and possible benefits—though these do not usually accrue to the experimental subject, but rather to the population) of the RCT,

(b) give specific and informed consent in a formal and legally-valid way, usually by signing a written form after they have listened to a statement about the nature of the research and their participation in it, and

(c) receive, in some cases, some form of compensation in goods, money, or services (such as counselling or other medical services) to offset the real or implied risk to their own health and/or well-being or, minimally, for their time (as transactable commodity).

The research subjects’ acceptance of gifts received as ‘compensation’ also legally guarantees their consent in the form of an implied exchange contract in which consent is freely ‘sold’ on the basis of full knowledge of its value in exchange for other goods and services provided by the experimenter or institution under whose auspices the RCT is carried out. These practices are now fully routinised, tested in international and national legal forums, and validated by most global scientific organisations.

Implicit in this methodological division is a more general issue of the knowledge practices of the research situation. For social scientists engaged in ethnographic methods, the object of their interest is the knowledge and beliefs concerning health and illness.

In the areas of sexuality, this involves knowledge and experience of sexual practices, feelings, identities, and emotions, and the way they are embedded in social and cultural structures, especially those involving gender and social power.

For reproduction, this involves myriad issues around kinship (affinity, consanguinity, ‘blood’, solidarity, family, wealth…), masculinity and femininity, fertility and many other ‘embodied’ concepts of self, other, group, identity and so on. Issues of health, well-being, illness, disease, and death are fundamental to all of these concerns.

For the social scientist, these are held to be integral to being human, while for the bio-medical sciences and RCT, humanity is—experimentally speaking—a confounding factor, and legally speaking, something that must be managed through informed consent protocols.

Ethnographic methods versus the Randomised Control Trial

Ethnographic methods in particular and social science methods more generally, do not operate with the same methodological assumptions implicit in RCT.

First of all, the research situation is not held to be present risks to those we work with that are not also present for the researchers themselves. In other words, the ‘risks’ that exist are risks that are common to all of us as human beings, rather than specific to the subjects of research under investigation by an ‘objective’ scientists. Social science ethics, and anthropological ethics in particular, assume a community of risk that includes the researcher. Thus, the anthropologist is ethically enjoined to prevent harm to those he or she works with, but also may be expected to mitigate external risks to the communities involved.

Paradoxically, these external risks might come from RCT experiments, especially those run by large pharmaceutical industries, or by First world bio-medical researchers in Third World situations. Thus, the social scientist may come into direct ethical conflict with bio-medical research, especially with respect to RCT.

Recent examples include studies RCTs involving circumcision in southern Africa and microbicide trails. Microbicides once looked like they would offer protection from HIV transmission. Although they should have worked, given everything we know, they did not. It seems, quite simply, that we did not know enough. We do not precisely how HIV enters the body; assumptions were made that proved unwarranted. There was little investigation of the erotic effect of these gels given the specific beliefs and practices of those who might use them. Regardless, because they looked effective in vitro, it appeared that they would be effective in vivo, 'in life', as we say. But 'in life' was not a meaningful category: rather, sexual lives are lived through culture, and it was the cultural categories that interfere. In some RCTs, the 'subjects' were subjected to testing that actually increased their risk of infection. though the trials were stopped, little was done to investigate the cultural context in which 'in vivo' actually has meaning and real effect.

With respect to institutionally mandated ethical protocols, however, anthropologists do not generally believe that their knowledge practices present unusual risks to those they study. This presents a special challenge to expectations that formal informed consent protocols are required in all cases of research.

[1] According to the Council on Anthropology and Reproduction, Society for Medical Anthropology (a unit of the American Anthropological Association), ‘The Global Gag Rule prohibits foreign NGOs that receive U.S. family planning assistance from offering abortion, counseling about abortion services, or lobbying to change abortion laws, even if they do so with non-U.S. funds. The policy was first enacted by President Ronald Reagan in 1981, rescinded by President Bill Clinton in 1993, and reinstated by President George W. Bush in 2001. The Global Gag Rule puts the United States at odds with global agreements on reproductive rights, including those reached at the International Conference on Population and Development (Cairo, 1994), and the ICPD+5 conference (New York, 1999. Online: http://www.medanthro.net/stand/overview/index.html (accessed 21 Feb 2008). See also http://www.globalgagrule.org/background.htm