AIDS and Accusation: Haiti and the Geography of Blame

by Paul Farmer

Does the scientific "theory" that HIV came to North America from Haiti stem from underlying attitudes of racism and ethnocentrism in the United States rather than from hard evidence? Anthropologist-physician Paul Farmer answers in the affirmative with this, the first full-length ethnographic study of AIDS in a poor society.

Genres: Nonfiction, Anthropology, Medicine, History, Health, Medical, Ethnography

338 pages, Paperback

First published January 1, 1992

About the author

Paul Farmer was an American medical anthropologist and physician. He was Professor of Medical Anthropology at Harvard Medical School and Founding Director of Partners In Health. Among his books are Infections and Inequalities: The Modern Plagues (1999), The Uses of Haiti (1994), and AIDS and Accusation: Haiti and the Geography of Blame (1992). Farmer was the recipient of numerous awards, including a MacArthur Foundation "genius" award and the Margaret Mead Award for his contributions to public anthropology.

Farmer was born in the U.S.A. in 1959. He married Didi Bertrand Farmer in 1996 and they had three children. He died in Rwanda in 2022, at the age of 62.

Reviews

[Brad · Rating 5 out of 5]

After reading this ethnography, there's a lot on my mind. I'd previously read about the impact of structural violence and racism on other epidemics (such as the 2014-2016 Ebola epidemic in West Africa) but didn't know much about the HIV/AIDS epidemic in the Americas. Farmer's book pulls together history, political economy, anthropology, and epidemiology to tell the tragic story of HIV/AIDS in Haiti. He synthesized lived experiences which he placed in the historical and contemporary context of US imperialism and racism (both at home and abroad). In addition to what I learned about Haiti, US imperialism, poverty, public health, and structural violence, I also learned how anthropology can play an important role in the movement towards global health equity.

[Hanaan · Rating 2 out of 5]

A potentially great book ruined as the author decended into an angry diatribe against foreign intervention in Haiti. The first 150 pages were exellent - Farmer meticulously documents the story of a small Haitian village, its history, community and the beginning of its AIDS crisis. It is both a moving story and extremely compelling reading. Farmer then dedicates a large section of the book to a history of the Haitian state and its political economy, and this is where he unfortunately goes off the rails. He seems anything but objective as he blames foreign interference for every misfortune and Haitian heroism for every success in the country's history. All of it is quite believable but Farmer is so seething with righteous indignation in every sentence that he takes away every pretense of objectivity. Probably when the book was written, in the early 1990s, this section was needed in order to counter anti-Haitian discrimination and misinformation, but it reduces the bulk of the book to a potentially outdated polemic. What a shame! The first half was so good. I would have loved instead to real research and analysis of the connection between poverty-driven prostitution and the spread of AIDS in Haiti, which Farmer implies but chose not to really explore, though that is the theory (compelling!) which underlies his whole argument blaming the US and its interventionist policies for the Hatian AIDS epidemic.

[Donna · Rating 4 out of 5]

Paul Farmer’s mission to educate the western world about the true causes of sickness and poverty, about the connections between political economy and human suffering is admirably addressed in this powerful book. Farmer tells us the stories of individual Haitians stricken with AIDS in the late 1980s in the tiny community of Do Kay. He explains how local knowledge and personal reactions to illness are connected to larger national and global forces, and how the stage was set hundreds of years ago for the misery that is the reality for most people in today’s Haiti. It is impossible, he argues, to understand the suffering of individuals without placing them and their communities in political, economic, and temporal context. Through the practice of fieldwork, the discipline of anthropology is uniquely positioned to help us understand how the lived experience of human suffering at the level of the individual is constructed within a larger social, biological, and political framework that he is mostly powerless to affect.

[Cifa · Rating 4 out of 5]

Brilliantly written. Incredibly thorough ethnographic and medical research has been done and yet it does not read like other research-dense ethnographies. Impressive, intense, and interesting; A triple whammy!

Not to mention the debunking of multiple stigmas stemming from racist and colonial attitudes, regarding HIV/AIDS.

[Deb · Rating 5 out of 5]

Great book. Should have 5 stars for significance, really. "Like" isn't the right word for the book -- maybe utmost respect and admiration? Incredibly compelling, and the importance of the subject carried me through the one or two dry statistics chapters in the middle. He shows the obstacles poor rural Haitians face without making them seem like victims, nor obscuring their individuality. Great brief history of Haiti, and its intertwining with the U.S. And also a great job of medical anthropology, weaving together first-hand ethnography of illness in a village, local history, national/international history, the context of the AIDS epidemic in the late 80s, politics of AIDS, etc., all passionately told with -- as I suggest above -- a real respect and love for the Haitian individuals he writes about.

[Priyanka · Rating 5 out of 5]

This is an excellent book that provides insight on Haiti through the interdisciplinary lens. It's not just about AIDS. It's about how the AIDS epidemic took place in Haiti through the actions of the United States as well as Haitian leadership. It is a historical account of events with personal accounts of real people, on the backdrop of environmental justice. Did you know that the US gov. wiped out ALL creole pigs, which were Haitian pigs, so that pigs from the US would be sent over there? Haitians had once relied on these hearty animals since for their livelihood. There's so much in this book that I probably forgot by now. I liked it because it gave me a new way of looking at AIDS.

[Coleen · Rating 4 out of 5]

I read this book for a class at Rutgers called "The Color of AIDS" taught by Instructor Carlos U. Decena. It was definitely an interesting read. I liked learning about Haiti and I liked that Farmer included its history as a backdrop. It's definitely dense. I wouldn't read it for leisure. However, I'm glad I read it and I would refer to it as a resource if I ever did research in this realm.

[Evan Streeby · Rating 4 out of 5]

A stellar work of medical anthropology. One of the top comments here complains about the author’s focus on Haitian geopolitics, which is essentially just saying you’d rather stay ignorant than acknowledge the historical suffering of a people who are perpetually punished for being so bold as to overthrow slavery themselves rather than waiting for whites to do it many years later

[Elliott Brady · Rating 5 out of 5]

This is an incredible book for those interested in the lived experiences of poverty stricken individuals with AIDS. Extensive background was given for the social, historical, and cultural precursors to why AIDS has uniquely affected Haiti. At times I wished less academic tones were used in a piece caked in anthropology and holistic human experiences. However this may be intentional, refraining from bias and emotion, leaving stone-cold facts for readers to question moral implications for themselves.

[Elizabeth Gill · Rating 4 out of 5]

Solid ethnography- well researched and informative. I learned a lot about the history of tension between the US and Haiti, traditional Haitian culture/practices, the geography of Haiti, and how each of these factors contributed to the AIDS epidemic. My only qualms with this book is that it is written quite scientifically (which makes sense given that Farmer is an MD/PhD and was a founder of PIH in addition to being an anthropologist), making for a dense read with less emotional appeal than a creative non-fiction writing style.

[Mary · Rating 5 out of 5]

This was a captivating book about Dr. Farmer's learning from his years in Haiti. I read this as a requirement for a faculty-led trip abroad (a Creighton University program), but I would read it again regardless. This is a must-read for anyone claiming to care about sustainable health care.

[Ktbird · Rating 4 out of 5]

Fascinating look at the economic, historical, political, and social aspects of disease. Thought-provoking book!

[Anna B · Rating 4 out of 5]

Introduces idea of structural violence, foundational text to ethnographies, but I liked the others better

[Michael · Rating 5 out of 5]

How I fell in love with Global Health.

[Courtney · Rating 4 out of 5]

I read this for a Medical Anthropology in Biocultural Perspective class, and all I can say is, yeah, now I ~get~ the cult of Paul Farmer.

[Lindsay · Rating 3 out of 5]

Parts of this book were very good, parts of it were very boring. Farmer wrote this book from his dissertation and you can definitely tell. There is a lot of background information that is "unnecessary" to the heart of the story (the sociological study of HIV in Haiti) that would not be missed by the common reader. The most interesting stuff is the qualitative interviews he does with the people of Do Kay around the 4 case studies of HIV that he does. I feel like his arguments around the blame and accusation of Haitians is weak, but noneless it does bring up interesting questions about emerging epidemics. I would recommend the book in its entirety to people studying HIV. I don't know that it would be enjoyable to anyone outside of that.

[Lisa · Rating 5 out of 5]

My all time favorite ethnography. Farmer possesses this brilliant ability to write to many audiences at once. You may read the text with a level of academically oriented sophistication or approach it with little interest and background in anthropology or medicine and take something very valuable away. He is also successful at weaving the local and the global together with artistic and scholarly style. He writes of personal stories from Haiti and contextualizes them within different levels of analysis. In addition to providing so much information, Farmer himself offers an inspirational example of someone with a vision for meaningful life's work.

[HyL · Rating 5 out of 5]

Vitally important book, a must read for anyone working in public health, medical anthropology, health and foreign policy, and most especially, HIV. If every organization working on the reconstruction of Haiti after the earthquake of 2010 (http://en.wikipedia.org/wiki/2010_Hai...) isn't listing this book as mandatory reading for every single worker, volunteer, advisor... they should! Event though it came out in 1994, the key points - about assumptions and how they can have devastating effects for people, are entirely relevant. After reading this book, follow it up with everything else that Paul Farmer has written.

[Bri · Rating 3 out of 5]

This is a very thorough look at the exploitation of Haitians and Haiti's role and history in world politics. It is fairly repetitive and I don't know how convincing it is as an ethnography since the lens is more historical and global. But it has a lot of merit for complicating ideas about AIDS, Haiti, and the U.S. The story of AIDS in Haiti is very dark and much more complicated than early considerations were. The main message I got was that Haitians have a much better idea of the discrimination and structural violence they have faced than the North American public and scientific community.

[Kristen · Rating 4 out of 5]

Excellent example of medical anthropology. Farmer combines history, political economy, epidemiology and lived experience. He poses a convincing challenge to the idea that AIDS was brought to the U.S. from Haiti and argues that, most likely, it was the other way around. But he doesn't stop there. He digs deeper, exploring the historical, sociological and cultural roots of the propensity to blame Haiti for all its problems -- and, now, for AIDS.

[Melissa · Rating 4 out of 5]

It's quite repetitive, but it provides a good understanding of why many development projets don't work (they don't consider the local and social practices). It also questions the implication of Occident countries (specifically in this case, US) in southern countries and shows the inequality on the ground (the US authorities have more power than local citizen) and questions the power of sovereignty.

[Jeffcolli · Rating 4 out of 5]

A fantastic critique of the initial epidemiology performed by western experts, which lead to the creation of the "4 H club", one of which stood for Haitians. Farmer convincingly argues that when AIDS arrived in the western hemisphere, it most likely moved from the U.S. to Haiti, and not the other way around.

[Sarah · Rating 3 out of 5]

Read for class. I couldn't get into it, I felt that Farmer repeated himself and I had trouble keeping up with the names. I felt that the book could have been a little better organized for an easier and less flustrating reading.

The best parts were the chapters that focused on the individual stories of specific people.

[Michelle · Rating 4 out of 5]

Farmer outlines the beginning of the AIDS epidemic and the structures that led to the blame of Haiti for transmission of the virus to the United States. As always, Farmer looks at the root causes of inequality that are the real culprits of the transmission of infectious disease.

[Dale · Rating 4 out of 5]

The cover shown here is the earlier edition, I am reading the updated version from 2006. This is an excellent look at the politics of the AIDS crisis from one of the leading experts in public health and medicine in the third world, as well as here at home. Recommended reading.

[Lisa · Rating 5 out of 5]

I think Paul Farmer is one of the greatest academic writers. His texts are fairly accessible and engaging. This one of the earliest books of his that I read and it upended many of my ideas on what is happening in the world around me.

[Catrina]

so far it is is giving a great overview of the history of AIDS and has very touching personal stories from women who had AIDS.

[Kendra · Rating 2 out of 5]

Concisely, the enthographic accounts in Paul Farmer´s AIDS and Accusations are worth the read---a lot of the rest is dry and difficult to get through, even for a public health major.

[Patrick · Rating 4 out of 5]

Stigmas and the bastards that created them...

[Especianise · Rating 5 out of 5]

Great book that provide in insight of how HIV made its way to Haiti, the devastating effects it has on lives, and Haiti being blame for HIV in the USA and the social implication of that blame.