Surviving HIV/AIDS in the Inner City: How Resourceful Latinas Beat the Odds (Studies in Medical Anthropology) Review

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Surviving HIV/AIDS in the Inner City: How Resourceful Latinas Beat the Odds (Studies in Medical Anthropology) ReviewAlmost everyone has a story about a run-in with the health care establishment. If you don't have one, one of your friends or co-workers does- whether just a tale of frustration, or a full-blown nightmare. But how much worse would it be if you had a stigmatized condition, *and* the culture, language, and basic function of the Western health care system was foreign to you? Sabrina Chase provides one answer to that question with her masterful and compassionate study of seventeen poor, HIV-positive Puerto Rican women and the struggles they faced in dealing with the health care and social service networks in Newark, New Jersey.
These women, as Chase demonstrates, faced different and worse challenges than many higher-profile HIV/AIDS victims in other parts of the country. The Puerto Rican community (especially women) in America is economically and socially disadvantaged compared to other ethnic groups. Newark's HIV epidemic is embedded in a larger context often referred to as SAVA or "substance abuse, violence and AIDS." Newark's authorities were extremely slow to respond to the threat (especially amongst the heterosexual community), and its health and social care networks at first broadly failed to serve the underprivileged HIV-positive residents of the area. And also significantly, heterosexual minority women who were HIV-positive were initially stigmatized (in the media and in the medical and social work communities) as drug-using prostitutes.
All the above factors led to a situation of "structural violence" that added further difficulty to the exhausting, frustrating, but critical task these women faced: dealing successfully with health care and social service systems based on a worldview that was foreign and confusing to them. Chase tracked the women of her study group as they navigated (with varying degrees of success) the complexities that were vital to their survival.
The women who did best were the ones who could "work the system" by cultivating and using broad social and cultural capital. These women were more flexible in their behavior, readily adapting to expectations and presenting images designed to evoke the most helpful responses from medical and social service workers. Women in this group tended to have more years of formal education; perhaps more surprisingly, they also were more likely to have been institutionalized and/or to have spent time in recovery programs; Chase posits that these experiences led to a wider exposure to people and groups different from themselves (especially middle-class professionals), which aided them in developing their flexibility and capital.
Chase chose a storytelling approach, which makes her study eminently readable without detracting from its scientific impact at all. She makes clear her involvement in the lives of these women, showing a heartfelt affection for and interest in them while demonstrating that her friendship and reciprocity with them was essential to the success of her work. She includes an epilogue telling what she could find out about their lives years after the active part of the study, concluding the book with stories of "sorrows and joys".
This is a story of how some HIV-positive Latina women in the Newark area used their resources and flexibility to exploit facets of the local health and social care network and get better than average care. And in the end, Chase also asks possibly the most vital questions of all- why do they have to do this in the first place? What is wrong with our health-care system and how can we help it work for people (like those in her study) who need it so desperately?Surviving HIV/AIDS in the Inner City: How Resourceful Latinas Beat the Odds (Studies in Medical Anthropology) Overview

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