Reviews: Birth in the Age of AIDS

Marcia C. Inhorn, Yale University

"This path-breaking volume is the first to examine HIV within the contours of women's reproductive lives—both as pregnant wives and birthing mothers—in the low-income communities of southern India. Van Hollen's compassionate, humanizing account sheds light on women's strength and resilience in the midst of a cruel epidemic."

Robert Clay. USAID’s Bureau of Global Health

“Van Hollen in her book, Birth in the Age of AIDS vividly brings out the stark realities that women living with HIV face during their reproductive years…. Birth in the Age of AIDS provides a new perspective on the history of the international and domestic response to the AIDS epidemic in India from its inception in Tamil Nadu.  By meticulously dissecting each case from a variety of perspectives, Van Hollen uncovers layer after layer the patterns that create stigma, exacerbate gender inequalities, undermine women’s decision-making about their own health and treatment, and lead to family discord.  The book unfolds for policy-makers, program managers and service providers a profound understand of the complexities that underlie seemingly irrational decisions about what experts know as global best practices and evidence-based interventions.”

Kaveri Qureshi, University of Oxford. Pacific Affairs

“This book is a ground-breaking investigation into the reproductive lives of HIV-positive women…. Each chapter of the book tells an important story about the ways in which global health standards and practices are refracted by the state, kinship, and gender in Tamil Nadu….Van Hollen contributes significantly to debates about the athoritarianism of reproductive medicine and the state in South Asia, and women’s gendered agency in negotiating these structures, as well as the ambivalence and destructive guises of kinship….this is an important and accessible book, and an essential teaching resource for reading lists in medical anthropology and sociology, and global health.”

Kristin Francoeur. Tarshi

“Birth in the Age of AIDS is a quick, compelling read that will appeal to readers working in a number of related fields. Her work does not dismiss funded NGOs and other civil society organizations as having succumbed to ‘NGO-isation’ that puts donor interests first. Rather, she hints at the delicate balance advocates have to strike in relation to rapidly shifting policy imperatives and local needs, and provides a poignant reminder that there are often unintended consequences of activism that only come into focus in hindsight.”

Lily Shapiro. Somatosphere: Science, Medicine, and Anthropology

“Cecilia Van Hollen’s latest book, Birth in the Age of AIDS: Women, Reproduction, and HIV/AIDS in India, provides a nuanced, readable, and extremely compelling exploration of the lived experiences of women enrolled in prevention of parent to child transmission (PPTCT) programs in Tamil Nadu, India in the first decade of the 21st century…This book is an excellent and very accessible example of the ethnography of HIV/AIDS, and will be of interest to scholars and students of medical anthropology, global health, feminist anthropology, and India.”

Koumari Mitra. American Anthropologist

“Birth in the Age of AIDS is a very timely book that brings together the voices of those most concerned with the impact of HIV/AIDS on women and children in India….Van Hollen draws on a gender-based analytic framework deeply rooted in medical anthropological theories that allows us to appreciate the intersection of gender and other determinants of health in HIV prevention research, policy, and programmatic responses. …Birth in the Age of AIDS makes an important contribution in the fields of medical anthropology, gender studies, international development studies, and understandings of HIV/AIDS in a global context. I strongly recommend this book particularly to public health professionals, nurses, physicians, women’s health advocates, and policy makers involved in HIV/AIDS prevention and control strategies in India and elsewhere.”

Angela Kelly-Hanku. Asian Pacific Journal of Anthropology

“Van Hollen’s greatest contribution (apart from bearing witness to the lives of these women and their families) is that she shows repeatedly how women—even poor, illiterate and HIV-infected Indian women—can and do claim citizenship. It is often uncritically argued that women, such as those who are the focus of Birth in the Age of AIDS, lack agency, particularly in relation to intimate issues such as sexual and reproductive matters. Many of these women, long before their exposure and incorporation into national movements of people with HIV, showed that they had agency.”

Choice

“[Van Hollen's] comprehensive analysis of how HIV+ women fare in a fiercely androcentric part of India sheds light on how the vicious stigma of HIV/AIDS impacts their lives and can result in blatant discrimination…Van Hollen even-handedly analyzes many facets of South Indian culture, such as the gender role system, the medical establishment, and even the influence of NGOs. Although she focuses on some of the more negative aspects, she also provides descriptions of Indian daily life seldom seen by outsiders… Recommended. All academic levels…”

Sarah Lamb, Brandeis University

"Birth in the Age of AIDs is an important and beautifully written ethnography of women dealing with HIV/AIDS in India. Van Hollen delves into the life stories and narratives of young HIV-positive mothers, illuminating the lived nature of the epidemic as well as the intricate workings of gender and family, sexuality, biomedicine, stigma, and poverty. This original and riveting book will make a major impact in medical anthropology, gender studies, South Asian studies, and understandings of HIV/AIDS in global context."

Jacqueline Potvin, University of Western Ontario. Canadian Journal of Development Studies

“…an informative and much-needed account of the effects of HIV prevention programming on women’s day-to-day lives, as well as a nuanced analysis of the processes by which global initiatives are implemented in local contexts...Van Hollen’s inclusion of diverse accounts is also indicative of her commitment to acknowledging women’s agency and resistance in the face of the tremendous challenges posed by HIV/AIDS. Drawing on the work of post-structural feminists, Van Hollen deftly walks the line between romanticising women’s resistance and denying their agency, acknowledging the ways in which women negotiate and resist systemic oppression without downplaying the severity of the challenges and barriers faced. Her nuanced approach to agency allows her to illustrate how women’s experiences challenge conventional wisdom that women in India have little, if any, reproductive autonomy. Her book is refreshing in its pragmatic recognition of the need for both short-term survival strategies and large-scale, structural change.”

Joseph Alter, University of Pittsburgh. American Ethnologist

“Perhaps the single most powerful feature of Cecilia Van Hollen’s deeply empathic, elegantly crafted, incisive, and thoroughly engaging analysis is the way in which women’s voices are manifested with all of the profound feeling, complexity, and nuance that is attendant on struggles for adequate and meaningful self-representation in contexts of inequality, marginalization, poverty, and stigmatization… This is a profound, important, and wonderfully accessible book that provides deep insight on the way in which medicine, humanitarian aid, and social and cultural practices produce an embodied politics of self-determination at the heart of an epidemic and in the very soul of those with HIV who live positive lives while giving birth in an age of risk.”

Claire Wendland, University of Wisconsin-Madison

"Poor pregnant women targeted by HIV-prevention programs in Tamil Nadu understand their decisions about testing to signify empowerment, assert their superior maternity through the unlikely sacrifice of not breastfeeding, and mobilize power through HIV-support networks. Van Hollen's meticulous and fascinating study reveals how 'global' health practices create unexpected local effects."

Sharmila Rudrappa. Global Public Health

“The book joins a growing body of scholarship charting public health programmes organized around HIV/AIDS health care delivery in these neoliberal time (Biehl, 2007; Decoteau, 2013; Fassin, 2007; Nguyen, 2010)… Cecilia Van Hollen’s insightful Birth in the Age of AIDS is a sorely needed intervention in the literature. Part of why the book is so compelling is that it is informed by the author’s long history of intellectual and compassionate engagement with reproductive health care in the southern Indian state of Tamil Nadu. As a result, she negotiates the health care terrain, understands the nuances of Tamil colloquial idioms and interprets the multiplicity of meanings of gestures and events which she presents in captivating detail. The end result is a rich ethnography of how women in low income settings cope with deviant motherhood and disempowerment jointly bestowed upon them through HIV/AIDS intervention programmes…Cecilia Van Hollen delivers beautifully.”

Manjari Mahajan, New School University. Bulletin of the History of Medicine

“Van Hollen’s remarkable book is as much about global health as it is about India’s national health policy and local experiences. The author situates her work firmly within the growing annals of medical anthropology that document how discourses of global health intersect with local realities. There is insightful analysis of how global health techniques—such as of informed consent—are implemented in Tamil Nadu hospitals. While acknowledging some of the problematic reasons for the centrality of informed consent procedures, she nonetheless focuses on them in order to highlight the gap between global policy on the one hand and local practice on the other hand. But the analysis of informed consent does more work than just highlighting the gap between policy and practice. In choosing to study a practice that is central to the global health vernacular, the author renders the Indian epidemic recognizable across countries, inserting the experience of the women in Tamil Nadu into frameworks that can be understood beyond India. The author could have chosen to focus on a parochial ethical concern that was particular to Tamil Nadu. Instead by focusing on informed consent, she facilitates the understanding of India’s epidemic as part of a global phenomenon.”

João Biehl, Princeton University

"Birth in the Age of AIDS is a deeply sensitive and thoughtful account of global health interventions on the ground. The women in this stirring book not only fight AIDS, stigma, and economic insecurity but also craft possible futures, humanize policy debates, and make an unequivocal case for new practices of care."

Haripriya Narasimhan, IIT-Hyderabad. Anthropological Quarterly

“The strength of this multi-sited ethnography is the sustained theoretical rigor combined with deep empathy (21). Extending Goffman’s (1963) work on stigma, Van Hollen convincingly shows how the “triple stigma of being HIV-positive, an HIV-positive woman and a widow” (136) affects women with HIV/AIDS in India. This work is a significant contribution, not only to medical anthropology, the anthropology of South Asia, and gender studies, but to all those who agonize about how social science research could be made more meaningful, and anthropology more visible to public policy makers. It is also written in a very accessible manner and should capture the attention of advanced undergraduates and graduate students”

Lynn Morgan, Mount Holyoke College. Anthropology & Medicine

“How do HIV-positive, low-income women in Tamil Nadu, India, navigate the perils of pregnancy and childbirth? This question is at the heart of Cecilia Van Hollen’s brilliant, genre-crossing ethnography…Van Hollen proves that careful ethnographic research is indispensable to understanding the actual, lived effects of infectious disease control programs, an insight that will surely resonate with public and global health practitioners and other readers outside of anthropology. This is feminist medical anthropology at its best — an eminently teachable, lucid account that demonstrates the vitality of anthropological research in understanding the connections between gender and health.”

Shalini Rudra, Jawaharlal Nehru University. Economic and Political Weekly

“Birth in the Age of AIDS brings out the roles of policy and network activism in supporting pregnant HIV-positive women. This support structure has helped them deal with cultural stigmatisation and gender inequalities and seek social justice. Lucidly documented research findings along with discussion on policy insights make this book an important reading for all who are directly or indirectly engaged in the field of reproductive and child health.”

Lesley Doyal, University of Bristol

“This book begins to fill an important gap in the literature on women living with HIV. Based on an extensive and rigorous process of ethnographic fieldwork, it explores the pregnancy and childbearing experiences of a sample of Indian women from a variety of backgrounds. Treading carefully between the social constraints imposed on these women and their exercise of their own autonomy it provides a rich and textured account of what are too often invisible yet vital aspects of human life. It is clearly written and well referenced and will hopefully provide a model for similar studies in other parts of the world.”

Sarah Pinto. Journal of Asian Studies

“As in the best medical anthropology writing, attention to voices that diverge from expectation reveals the surprising, often detrimental, results of health programming, including vivid forms of exclusion and discrimination in hospitals, neighborhoods, and homes. With empathetic attention to the material, affective, and symbolic formulas of stigma, Van Hollen explores the work of creating new possibilities amid circumscribed worlds, work that ranges from delicate negotiations of knowledge within households to engaged public activism….this book offers a powerful and accessible portrayal of resilience, showing the richness of lives made and remade in moments of illness and discrimination as well as in interactions rich with care and hope. As in her earlier work, Van Hollen challenges received knowledge about Indian women’s agency, offering astute insights into the ways they find places for themselves in worlds made new by illness and intervention.”

Anthony Simpson, University of Manchester. Journal of the Royal Anthropological Institute

“These two volumes demonstrate the considerable contribution that anthropologists can make to the study of HIV transmission and the treatment and care of those suffering from AIDS. The authors write in a direct, down-to-earth style and their work offers many parallels in the quite different contexts of Mutare, Zimbabwe (Parsons), and Tamil Nadu, India (Van Hollen). Their aim is to render as accurately as possible the experience of HIV-positive children and women in the absence of adequate care and treatment and with the risks attendant upon their HIV status becoming known to others. They both make clear the value of ethnography as a mode of witnessing, and give poignant accounts of difficult lives, blighted by intense poverty in addition to HIV/AIDS stigma.”