In the Journals

Special Issue: “Beyond Biological Citizenship”

Critical Public Health’s first issue of the year is a special issue titled “Beyond Biological Citizenship,” edited by Marsha Rosengarten, Todd Sekuler, Beate Binder, Agata Dziuban and Peter-Paul Bänziger. These articles “offer insight into the evolving conceptions of state–citizenship relations in the complex and entangled histories of HIV/AIDS in Europe.”

Beyond biological citizenship: HIV/AIDS, health, and activism in Europe reconsidered (open access)
Marsha Rosengarten, Todd Sekuler, Beate Binder, Agata Dziuban & Peter-Paul Bänziger

This special section reflects on the challenges and achievements of HIV/AIDS activism in the historico-political context of the European region. While there is substantial literature on activist-driven policy shifts in the different and, particularly, the early stages of the epidemic, much of this has studied Western Europe (see e.g., Berridge, 1996; Klöppel, 2016). Considerably less attention has been given to the broader European region and its constituent countries, especially those along its economic, social, and political peripheries. Against this background, through a series of case-studies from differing disciplinary perspectives, this collection offers insights into the evolving conceptions of state–citizenship relations in the complex and entangled histories of HIV/AIDS in Europe.

The temporal regimes of HIV/AIDS activism in Europe: chrono-citizenship, biomedicine and its others (open access)
Agata Dziuban & Todd Sekuler

HIV/AIDS is known to have fundamentally transformed fields of biomedical research, the governance of health, and state–citizen relations. Based on research that was developed to analyze these transformations within HIV/AIDS activism at the European-level, we offer the term chrono-citizenship to describe the influence of time in constructs of citizenship. We argue that the temporal regime of biomedicine, or modes of governance that depend on biomedical understandings of time, have come to dominate HIV/AIDS narratives, policies and programs. Building on oral histories and three years of fieldwork in spaces of European-level networks and health-governing bodies, we suggest that citizenship in the field of HIV/AIDS has been defined through multiple, intersecting and, at times, antagonistic temporal regimes. To illustrate this, we expose the regime of loss, through which mourning, often denied space in the present, bears potential for new forms of subjectivity and community; the regime of sustainability, which centers the planning and surveillance of budgets over service provision in a climate unfriendly to human rights; and the regime of chronic crisis, in which persistence becomes a form of political agency against ongoing exclusion and disappointment. As we show, unearthing varied temporalities helps to denaturalize biomedical understandings of time, and invites a rethinking of the foundations needed to reach the ‘end of AIDS’ sought by civil society, UNAIDS and other health-governing bodies.

The prisoner citizen: juridification and the AIDS activist struggle for harm reduction in German prisons (open access)
Friederike Faust

For more than 30 years, AIDS activists have been fighting for harm reduction – i.e. needle and syringe programs, and opioid substitution treatment – in German prisons. From the 1990s onwards, international and national legal contexts emerged around HIV/AIDS, prisons, and drug use, significantly impacting activists’ engagements with the law. Based on archival research, interviews and observations of AIDS prison activism in (West) Germany, this paper explores how activism focused on enhancing access to a right to health for imprisoned people who inject drugs (PWID) has shifted from medical disobedience and radical critique to judicial action. Building on anthropological debates about biological citizenship and juridification, I argue that the citizenship status of prisoners has transformed with the juridification of health activism. Disobedient acceptance-based activism, morally calling upon human rights, evoked imprisoned PWID as self-determined and worthy members of the body politic. As judicialized activism adopts the biomedical discourse on drug ‘addiction’, the prisoner is reconfigured into a deserving patient, whose rights are bound to the responsibility to normalize. Accounting for the varied means and channels through which prisoner biological citizenship is negotiated allows for better understanding the different and shifting responses to the unfolding epidemic from a heterogeneous European civil society.

Citizenship and pleasure: a study on harm reduction assemblages in Poland (open access)
Justyna Struzik

In 2013 and 2019 harm reduction projects were at the centre of attacks and smear campaigns coming from both the media and authorities in Poland. These programs were criticized for their alleged promotion of activities that were perceived as socially controversial (for example, sex work, drug use, and sex between men) and that went beyond a normative vision of ‘good citizenship’. Drawing on public discussions provoked by the attacks on harm reduction projects, and embedding them in the history of HIV/AIDS activism in post-transition Poland, the article explores the ways in which pleasure is, or might be, embraced within the notion of citizenship – a citizenship that is understood in terms of subjects’ rights and responsibilities. Based on extended fieldwork, including qualitative interviews with activists, experts, and people living with HIV, this article examines different strategies of enacting and navigating harm reduction activism in Poland by various actors. The article demonstrates that punitive political environments produce three strategies for responding to, framing, and managing pleasure. Hyperbolization and silencing are the two dominant strategies pursued by public institutions, the media, and politicians. The third strategy, skillful maneuvering, appears as a way of overcoming this opposition on the part of harm reduction activists.

Biological citizenship and geopolitical power play. Health rights of refugees living with HIV in Turkey
Peter-Paul Bänziger & Zülfukar Çetin

Based on policy documents and interviews with health activists we ask how Syrian refugees living with HIV/AIDS (RLWHA) gain access to health services in Turkey and, more generally, how they are supported in or prevented from exercising their right to health. Legally, refugees and people with Turkish citizenship have equal rights. Yet there is a multitude of factors that influence the access that RLWHA have to health facilities and thus their health outcomes. A variety of socio-political phenomena in contemporary Turkey and its health system affect the situation of RLWHA. Additionally, factors that account for the general living conditions of Syrian refugees must be taken into consideration. This particularly applies to migration policies and related geopolitics. Against this background, we conclude that health activism in Turkey must combine two strategies: doing advocacy work for the RLWHA and claiming fundamental civil rights, most notably the freedom of movement and residence. In this respect, Turkish citizens do not differ much from refugees. As ‘statizens‘, their status ultimately depends on the shifting rationales of government.

In addition, the issue features the following articles:

‘We will soon be dead’: stigma and cascades of looping effects in a collaborative Ebola vaccine trial (open access)
Arsenii Alenichev

Can the careful implementation of global health research reduce the stigmatization of involved human subjects? This study analyses stigma in an Ebola vaccine clinical trial in West Africa that deployed complex community engagement strategies including a sensitization component. Qualitative research found that stigma against trial subjects manifested in various forms beyond the reach of these anti-stigma interventions. Drawing on and advancing Hacking’s notion of ‘looping effects’, this paper argues that stigma was a product of a wider socio-historical context beyond the control of community-based interventions. This case prompts global health practitioners to think through the limitations of community-based interventions in practice.

‘Go hard or go home’: a social practice theory approach to young people’s ‘risky’ alcohol consumption practices
Kath Hennell, Maria Piacentini & Mark Limmer

Developing a deep and contextualised understanding of risk is important for public health responses to young people’s alcohol consumption, which is frequently positioned as an outcome of risky behaviour. This paper expands conceptualisations of risk to encompass its wider social and cultural context through a social practice exploration of young people’s controlled and managed intoxicated alcohol consumption practice. We report data from a fourteen-month qualitative study of the alcohol consumption practices of 23 young people in England, drawing on group interviews and social media interactions. Our findings provide a nuanced understanding of risk-taking, demonstrating that risk is an important aspect of the ongoing participation and performance in alcohol consumption practice and that health information and advice can be and was frequently incorporated into drinking practice without contributing to fundamental change. This raises new questions about the effectiveness of health interventions that focus on the individual, discussed in the final section of the paper.

The family meals imperative and everyday family life: an analysis of children’s photos and videos
Jo Lindsay, Claire Tanner, Deana Leahy, Sian Supski, Jan Wright & Janemaree Maher

At a time of increasing diversity in family forms and family practices the evening family meal is promoted as an imperative; a straightforward solution to complex social problems such as childhood obesity, family breakdown and depression. In this paper we discuss the challenges faced by families in achieving this imperative on an everyday basis drawing on visual data generated by children from a qualitative research project with 50 diverse families in Victoria, Australia. We demonstrate the complex and messy realities of everyday family food consumption which is shaped by social structures such as gender, work and care interacting with micro level elements such as food preferences and child agency. We argue the family meals imperative is a biopedagogy that should be decentred. We suggest that recognising and supporting diverse modes of family interaction and belonging beyond the shared table may be a more fruitful strategy for promoting public health.

‘We’re all brave pioneers on this road’: a Bourdieusian analysis of field creation for public health adaptation to climate change in Ontario, Canada
Chris G Buse, Blake Poland, Josephine Wong & Randolph Haluza-Delay

Despite significant engagement with new and emerging issues in public health practice, the public health literature has few theoretical explanations for how new practices emerge, take root, and become institutionalized. In this contribution, we utilize Pierre Bourdieu’s sociological concepts of field, habitus and capital, and in-depth interviews with public health practitioners to document and describe the emerging field of public health adaptation to climate change Ontario, Canada. In doing so, we identify and explain three types of climate change action and associated practices – ‘wait and see’, repackaging existing actions and championing new actions – that practitioners relate to climate change adaptation in Ontario (i.e. business as usual, repackaging existing actions and championing climate new actions). We discuss the typology in relation to the dominant and emerging logics that practitioners ascribe to promoting practical action on this sub-field of environmental health practice to promote a discussion of how social change occurs within a well-established field of professional practice. Findings suggest, that change and innovation can result from exogenous shocks that force practitioners to adopt new practices (e.g. the increasing frequency and intensity of climate-related impacts on health), how the ‘rules’ of a given field are interpreted by practitioners and made actionable, and through the negotiation of new rules by practitioners with a ‘radical habitus’ who champion particular issues, albeit resulting in significant professional risk. We discuss these findings in relation to Bourdieu’s theory, concluding there is significant room for practitioner agency to cultivate normative dispositions and influence the adoption of policy and practice-change.

Individualisation in public health: reflections from life narratives in a disadvantaged neighbourhood
Jonathan Berg, Janneke Harting & Karien Stronks

There is a dualism in current policy discourses on public health between neoliberal conceptions of health, and health as a product of social conditions. These conceptions also co-exist in the narratives of citizens. In this qualitative study carried out in the Netherlands, we analysed how people living in structural vulnerability perceive the potential tension of this dualism. Whereas the respondents’ narratives undoubtedly reflect the neoliberal view on health responsibility, their life stories revealed how health was a product of intergenerational transmission of poverty, violence and ill health. Neoliberal policies that expect citizens to minimise health risks were seen as unrealistic and raised feelings of apathy and fatalism. Behavioural messages were considered to oppose personal autonomy. Instead, the respondents appeared to envision health as a joint, balanced effort by themselves, their social network and public services. The tension between their own view on responsibility and the neoliberal view negatively affected their sense of self. These feelings were strengthened by the fact that the respondents felt abandoned by a government that calls upon self-sufficiency to deal with problems outside their control. On the other hand, they also stressed the importance of agency, particularly in breaking vicious transgenerational cycles. These findings indicate that the views of people living in disadvantaged neighbourhoods require further elucidation to develop a more nuanced and balanced view on responsibilities for health in public policies, and thus to prevent ignoring the problems faced by people who do not meet the expectations of current neoliberal policies.

Fizzy foibles: examining attitudes toward sugar-sweetened beverages in Michigan
Andrea E. Bombak, Taylor Colotti, Natalie D. Riediger, Dolapo Raji & Nicholas Eckhart

Health educators are increasingly publicizing the noxious health effects of sugar-sweetened beverages (SSB). American counties are implementing SSB taxes, as modeled after the ‘success’ of tobacco policies, to address the ‘obesity crisis’. Under-explored is how the linking of SSB to a stigmatized condition, ‘obesity’, has affected attitudes toward the purchasing and consumption of SSB and those individuals who purchase and consume SSB. This study sought to explore individuals’ attitudes and experiences with SSB in rural Michigan. Three themes emerged: Negativity, Egregious beverages and Implicated imbibers. These attitudes were situated within a context of increased exposure to SSB health discourses, particularly among younger participants. Additional themes arose regarding which SSB were labelled especially problematic, who should or should not be drinking SSB, as well as the consequences of drinking SSB. Pop/soda, energy drinks, and diet pop/soda were identified as particularly harmful, albeit for different reasons – sugar, caffeine, and unnatural additives. Many participants reported reacting negatively when they saw children of higher weights drinking SSB, though judgement was reserved for parents. Ultimately, SSB and their consumers appear increasingly stigmatized in ways that carry important equity implications for already marginalized groups.

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