Mapping disease and desire: Gender and perception of HIV risk at the turn of the millennium in Havana, Cuba

Abstract

In spite of Cuba's policy of HIV containment, women's rates of HIV seropositivity are rising in that country (Mann et al. 1992; MINSAP 1997--1999). As with increasing rates anywhere in the world, the reasons he within a complex relationship of global geopolitical location, local economies, and cultural constructions of meaning. This project has three primary research objectives. First, I investigate why women are at risk for HIV in Cuba and which women, if any, are specifically more vulnerable. Secondly, I analyze the viability of HIV prevention programs for women in Havana. Finally, this project investigates how social and government organization of space impacts risk or perceived risk for HIV in women. The main phase of the dissertation fieldwork occurred in 2000 and 2001. I conducted semi-structured surveys with approximately 225 individuals, as well as conducted open-ended interviews with public health officials, analyzed media, and used participant observation method. The primary findings indicate that individual risk is a reflection of one's identity. Often, individuals in this study made a point of distancing themselves from stigmatized groups in Cuba society, such as homosexuals or sex workers. In addition, the women who appeared to be most at risk were those in "monogamous relationships." While these participants thought that the stability in their relationship would make them immune to HIV, often their partners were not sexually faithful to one woman. Therefore, one policy recommendation is that prevention programs in the country target heterosexual women. Additionally, geography factored into peoples' perceptions of risk. Participants associated physical places and spaces with disease and contamination. These spaces were generally where "deviance" was present, for example tourist districts and places where homosexuals are known to congregate. The AIDS sanatorium system is unique to Cuba, and one of its legacies is the "paradox of othering." Participants considered that the physical separation of people living with HIV from the general populace to be good for both the patients and citizens. The participants saw the sanatorium as a way to contain the virus, reform the individuals' behaviors, and thus integrate those with HIV into postrevolutionary Cuban society.