People living with HIV/AIDS (PLWHAs) in South Africa experience a stigmatised HIV status which threatens to supplant their prior identities. This compounds the marginalization on multiple social levels experienced by those most vulnerable to infection as they cope with associations of death and disease, as well as perceptions of guilt, shame and personal responsibility built into the moral discourse with which the subject of HIV is laden. My thesis explores the grassroots activism of groups and individuals in South Africa who musically advocate for support and social acceptance of PLWHAs within a volatile post-apartheid sociopolitical environment where government intervention has been controversial, inconsistent and, in terms of advocacy, largely absent. I argue, using Thomas Turinos Peircian theory of semiotics, that my research participants draw upon the indexical characteristics of their music to assert social, religious and ethnic identities in the construction of alternative, healthy HIV-positive identities.

Thesis (Ph. D.)--Dept. of Community Medicine, University of Adelaide, 1992. / Typescript (Photocopy). Includes bibliographical references (leaves 307-320).

Thesis (Ph.D.)--Flinders University, School of Nursing and Midwifery. / Typescript bound. Includes bibliographical references: (leaves 358-375) Also available online.

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 173-183). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Thesis (Ph. D.)--University of Oregon, 2004. / Typescript. Includes vita and abstract. Includes bibliographical references (leaves 300-341). Also available for download via the World Wide Web; free to University of Oregon users.

Thesis (Ph. D. in History)--Vanderbilt University, Aug. 2010. / Title from title screen. Includes bibliographical references.

abstract: Medical practice surrounding tuberculosis (TB) treatment in two nineteenth-century Scottish charitable hospitals reveals that in developing empirically-positioned constructs of this and related diseases, medical practitioners drew upon social assumptions about women and the working classes, thus reinforcing rather than shedding cultural notions of who becomes ill and why. TB is a social disease, its distribution determined by relationships among human groups; primary among these is the patient-practitioner relationship, owing to the social role of medical treatment in restoring the ill to both health and society. To clarify the influence of cultural context upon the evolution of medical constructs of TB, I examined Glasgow Royal Infirmary (GRI) and Royal Infirmary of Edinburgh (RIE) ward journals, admissions registers, and institution management records from 1794 through 1905. Medical practice at the turn of the nineteenth century was dominated by observation and questioning of the patient, concordant with conceptions of physicians' labor as mental rather than physical. This changed with the introduction of the stethoscope in the 1820s, which together with the dissection of the poor allowed by the 1832 Anatomy Act ushered in disease concepts emphasizing pathological anatomy. Relationships between patient and practitioner also altered at this time, exhibiting distrust and medical dominance. The mid-Victorian era was notable for clinicians' increasing interest in immorality's contributions to ill health, absent in earlier practice and linked to conceptions of women and the working classes as inherently pathological. In 1882, discovery of the tubercle bacillus challenged existing nutritional, hereditary, and environmental explanations for TB. Although practitioners utilized bacteriological methods, this discovery did not revolutionize diagnosis or treatment. Rather, these older models were incorporated with perceived behavioral, environmental, and biological degradation of the working classes, rendering marginalized groups "soil" prepared for the "seeds" of disease -- at risk, but also to blame. This framework, in which marginalized groups contribute to their increased risk for disease through refusal to accord with hegemonically-established "healthy" behavior, persists. As a result, meaningful change in TB rates will need to address these longstanding contributions of social inequality to Western medical treatment. / Dissertation/Thesis / Ph.D. Anthropology 2013

A Fibrose Cística (FC) é uma doença genética, até o momento incurável, que junto às demais condições crônicas, exigem cuidados que transcendem a esfera biológica da doença e do cuidado e necessita de estratégias inovadoras para seu manejo. Esse estudo teve por objetivo compreender o itinerário terapêutico de crianças com Fibrose Cística, a partir da perspectiva deles próprios. Para tanto, nos apoiamos no quadro teórico e metodológico conformado pela antropologia médica, etnografia e a hermenêutica interpretativa. Participaram do estudo, 7 crianças entre 8 a 10 anos, em tratamento em um hospital escola do interior do estado de São Paulo e seus familiares. Os dados foram coletados por quatro meses com cada criança partindo-se do referencial da etnografia, mediante observação participante, entrevistas e confecções de materiais que permitiram a participação infantil. Os resultados foram compreendidos em três atos interpretativos que conformam o círculo hermenêutico: As várias facetas da Fibrose Cística; Caminhos e cuidados: avaliações sobre o tratamento e Escolhas, caminhos e cuidados: o itinerário terapêutico de crianças com Fibrose Cística. A partir dos resultados, interpretamos que os modelos explicativos existentes na FC atualmente estão circunscritos em círculos concêntricos dentro dos setores e entre os diferentes atores envolvidos gerando avaliações fragmentadas e diferentes possibilidades de tratamento. As interpretações nos levaram a refletir a respeito da hegemonia do paradigma da saúde pautado no positivismo e suas implicações para o cuidado integral. As possibilidades de mudança aparecem ao considerarmos a etnografia e a hermenêutica enquanto referenciais para a prática bem como a centralidade e a potencialidade da criança como agente da mudança. / Cystic Fibrosis (CF) is a genetic disease which, along with other chronic conditions, calls for care that transcends the biological aspects of the disease and requires innovative strategies for its management. The aim of this study was to understand the therapeutic itinerary of children with cystic fibrosis through their point of view. To achieve this, we were supported by theoretical and methodological framework composed by medical anthropology, ethnography and interpretative hermeneutic. The participants were 7 children between the ages of 8 and 10 who were in treatment for CF at a University Hospital in the state of São Paulo and their relatives. Data were obtained during 4 months with each child using the ethnography method through participant observation, interviews and handmade materials that allowed children to participate. The results were understood in 3 interpretative acts that shaped the hermeneutic circle: Plenty faces of Cystic Fibrosis; Paths and care:treatment evaluations and Choices, paths and care: the therapeutic itinerary of children with Cystic Fibrosis. After analyzing the results, we interpreted that the explanatory models currently available in Cystic Fibrosis are limited in circles in the sectors and between the different actors involved what causes fragmented evaluations and different possibilities of treatment. Those interpretations lead us to reflect the hegemony of the health paradigm that is based on positivism and its implication for integral care. The possibilities of change appear when using the ethnography and the hermeneutic theories in the clinical practice and when considering the centrality and the potentiality of the children as transition agents.

Orientador: Ana Maria Canesqui / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-08T02:33:53Z (GMT). No. of bitstreams: 1 Barsaglini_ReniAparecida_D.pdf: 2563294 bytes, checksum: 459d247bf4af378f145f27acb0b7dc16 (MD5) Previous issue date: 2006 / Resumo: Este estudo analisa as representações sociais e a experiência com o diabetes mellitus, articulando a dimensão simbólica, a partir dos significados e do sentido atribuído à enfermidade, e a dimensão concreta do seu gerenciamento. A investigação é pertinente devido à importância epidemiológica do diabetes no quadro sanitário brasileiro, à escassez de pesquisas sobre as enfermidades ou as condições crônicas na área de Antropologia e Saúde, além de se constituir em oportunidade para articular os planos micro e macroanalíticos no estudo do adoecimento. Foi empregada a metodologia qualitativa, na perspectiva socioantropológica, combinando as técnicas da pesquisa documental, da entrevista, do relato oral e da observação em campo (bairros, residências, serviços de saúde) para coletar as informações sobre as quais se procedeu, posteriormente, a análise temática. A análise dos dados sobre o saber biomédico e os modelos de intervenção baseou-se em textos básicos sobre o assunto e em documentos oficiais normativos sobre a atenção dirigida ao diabetes, complementando-se com os discursos dos adoecidos com a enfermidade, de não-adoecidos e de profissionais de saúde que atendem os diabéticos. Pela abordagem que se designou ¿construtivista integradora¿, para a qual a realidade social é constituída pelas práticas interacionais e interpretativas, mas também pela participação de elementos da estrutura social, as representações sociais e a experiência da enfermidade foram tomadas articuladamente numa relação de influência circular como componentes do processo de adoecimento, relativizando, dessa forma, tanto a determinação social ou cultural quanto a total autonomia/liberdade do indivíduo. O conceito de representações sociais valeu-se da sociologia francesa com a abordagem herzlichiana, e a experiência da doença respaldou-se no suporte fenomenológico. Concluiu-se, neste estudo, que as formas como o adoecido pensa e lida com o diabetes envolvem fatores de ordem estrutural, simbólica, do contexto da vida diária, da biografia do sujeito, da experiência (prévia e atual, pessoal e de outras pessoas) e do próprio curso da doença. Os profissionais de saúde, embora imbuídos pelo discurso médico-científico, reinterpretam o saber erudito sobre o diabetes no exercício de sua prática, a partir da experiência (profissional e pessoal), passando-a pelo crivo das representações. Em ambos os segmentos, o adoecimento mobiliza saberes e práticas que, reciprocamente, são reelaborados em função da experiência, das representações e pela intermediação dos elementos contextuais / Abstract: The study analyzed the social representations and experience with diabetes, articulating the symbolic dimension based on the signification and the sense attributed to the illness, and the real dimension of its management. The investigation is pertinent to the epidemiological importance of diabetes regarding the condition of the public health in Brazil, the scarcity of researches on illnesses or chronic conditions in the Anthropology and Health area, besides the fact that it represents an opportunity to elaborate the macro and micro analytical plans in the study of the illness. The study applied the qualitative methodology through a social-anthropological perspective combining the techniques of documental research, interview, oral account and field observation (districts, households, health services) to gather the information which gave grounds for the thematic analysis. The analysis of the data on the biomedical knowledge and on the intervention models was based on basic texts on the issue, and on official normative documents about the attention given to diabetes, including the accounts of diabetics, non-diabetics and of health professionals who treat the illness. Through this ¿integrating constructivist¿ approach, to which social reality consists of interactional and interpretative practices and, also, of the participation of social structure elements; the social representations and the illness experience were articulately taken in a relation of circular influence as components of the illness onset process, making, this way, both the social and cultural determination and the individual¿s total autonomy/freedom relative. The concept of social representations is grounded in the French Sociology with the Claudine Herzlich approach, whereas the illness experience found grounds in the phenomenological support. The study concluded that the way a person suffering from diabetes thinks and deals with it involves material and symbolic factors of social context, of the day-to-day life, of the biography of the patient, of experience (current and previous, personal and of other¿s) and of the history of the disease itself. Health professionals, though imbued with the medical-scientific speech reinterpret the erudite knowledge on diabetes in their practice based on their personal and professional experience mediated by the representations. In both segments, the illness mobilizes knowledge and practices which are reciprocally redesigned in relation to the experience, to the representations mediated by the contextual elements / Doutorado / Saude Coletiva / Doutor em Saude Coletiva

A doença falciforme (DF) é caracterizada pela presença de uma Hemoglobina S (HbS), a qual confere a célula um formato de foice. Esta doença é considerada uma hemoglobinopatia por ser uma alteração genética humana com alta frequência populacional que requer tratamento precoce para que os pacientes possam sobreviver. As doenças falciformes mais comuns são: HbSC, HbSD, S beta talassemia e a forma homozigota HbSS, também denominada de Anemia Falciforme (AF). Para que se possam minimizar as internações, as complicações clínicas e aumentar a qualidade de vida dos pacientes são necessários compreender suas experiências com a doença. Nesta investigação o objetivo foi analisar os sentidos da experiência com a AF atribuídos pelos adoecidos. Para alcançar este objetivo, realizou-se estudo com abordagem metodológica qualitativa, adotando o referencial teórico da Antropologia Médica e a narrativa como método. Após aprovação ética da pesquisa, foram convidadas a participar do estudo onze pessoas com AF, em acompanhamento terapêutico em um Hemocentro do interior do estado de São Paulo. As técnicas de coleta de dados foram as entrevistas semiestruturadas gravadas, a observação direta e registros nos diários de imersão, realizadas no Hemocentro e no domicílio de alguns dos participantes. A partir das entrevistas foram construídas as narrativas individuais e identificação dos códigos. Para a análise dos dados provenientes das narrativas, utilizou-se a análise temática indutiva. Integrou-se os aspectos comuns e distintos das narrativas individuais em gerais classificadas por unidades de sentidos. Os resultados foram analisados e apresentados a partir de três narrativas: Narrativa 1. Importância do conhecimento sobre a doença e os tratamentos para o controle do corpo com a doença, na qual o sentido atribuído ao conhecimento sobre a doença, medicações, efeitos e complicações é de controle do corpo; Narrativa 2. Repercussões da doença, tratamentos e complicações para a vida, e os quatro subtemas: 2.1 Limitações físicas pelas complicações foi um dos aspectos mais destacados nas narrativas individuais. O sentido atribuído à estas limitações é de desesperança, pois alteram todas as dimensões da vida. 2.2 Vida atual e futuro, os participantes discorrem sobre as dificuldades na formação educacional e no trabalho e atribuem o sentido de normalidade da vida, 2.3 Estigma pela doença e preconceito pela cor da pele, neste subtema as descrições e justificativas atribuídas ao estigma e ao preconceito definem sentidos de vulnerabilidade pessoal e social, 2.4 Importância dos suportes familiar e religioso, os sentidos atribuídos à participação da família e da religião em suas vidas é de suporte emocional, proteção e esperança e Narrativa 3. Desafios para a gestação e maternidade, pelo qual compreende-se que para estas mulheres, o sentido de ser mãe é a de concretização da identidade feminina, mas com ambiguidade entre desejo e medo. Essas narrativas expõem as questões que foram significativas pela pessoa com AF na experiência com a doença e os tratamentos, integrando o presente ao passado e futuro. Por meio de estórias, o enredo da vida com a doença e tratamentos foi sendo construído, expondo conhecimentos, crenças, valores e práticas que os ajudaram a lidar com as situações. A análise das narrativas centradas na experiência de um grupo de pessoas com AF, a partir do sistema cultural, permitiu-nos explicar como a cultura influencia a doença e os tratamentos, por meio dos sentidos. Esta análise fornece conhecimento para além do modelo biomédico e pode ser aplicado em pesquisas futuras e no processo de trabalho em saúde / Sickle cell disease (SCD) is characterized by the presence of Hemoglobin S (HbS) which gives to cell a sickle shape. This disease is considered a hemoglobinopathy because it is a human genetic alteration highly frequent in the population and it requires early treatment so patients can survive. The most common sickle cell diseases are: HbSC, HbSD, S beta-thalassemia and the homozygous form HbSS, also named Sickle Cell Anemia (SCA). To minimize hospital admissions, clinical complications and increase patients\' life quality it is necessary to understand their experiences with the disease. In this investigation, the aim was to analyze the senses of the experience with SCA attributed by sick patients. To reach this goal, we conducted a study with a qualitative methodological approach, adopting the theoretical reference of Medical Anthropology and narrative as a method. After the ethical approval of the research, eleven people with SCA were invited to participate in the study, they were receiving therapeutic follow-up in a Blood Center in the countryside of São Paulo State. The techniques for data collection were semi- structured recorded interviews, direct observation and registers in diaries and immersion, done in the Blood Center and in the house of some participants. From the interviews, individual narratives and identification of codes were built. For the analysis of data from the narratives, we used an inductive theme analysis. We integrated common and distinct aspects of individual narratives in general aspects classified by units of senses. Results were analyzed and presented based on three narratives: Narrative 1. Importance of knowledge of the disease and treatments for body control with the disease, to which the sense attributed to the knowledge of the disease, medication, effects and complications is body control; Narrative 2. Repercussions of the disease, treatments and complications for life, and the four sub-themes: 2.1 Physical limitations by complications was one of the most highlighted aspects in individual narratives. The sense attributed to these limitations was lack of hope, because they alter all life dimensions. 2.2 Life today and future, participants talk about their difficulties in education and at work and they attribute the sense of life normality, 2.3 Stigma of the disease and prejudice against skin color, in this sub-theme the descriptions and justifications attributed to stigma and prejudice define the senses of personal and social vulnerability, 2.4 Importance of family and religious support, the senses attributed to the participation of family and religion in their lives is emotional support, protection and hope and Narrative 3. Challenges for pregnancy and motherhood, by which we understand that for these women the sense of being a mother is the solidification of the feminine identity, but with the ambiguity between fear and desire. These narratives expose questions that were significant for AF patient in the experience with the disease and treatments, integrating present into past and future. Through stories, the plot of life with the disease and treatments has been built, exposing knowledge, beliefs, values and practices that helped them to deal with situations. The analysis of the narratives centered in the experience of a group of people with SCA, from a cultural system, allowed us to explain how culture influences the disease and treatments, by the senses. This analysis provides knowledge beyond the biomedical model and can be applied in future research and in the work process in health