Anthropological reflections on HIV prevention strategies: the case for targeting London's backrooms

Eight years ago the anthropologist Ralph Bolton (1995: 289) wrote: ‘Prevention efforts have enjoyed limited success – behaviours have changed to some degree in some places, but no thanks to our research’. Unfortunately, these words still hold true today. This chapter explores some of the reasons why anthropologists have struggled to contribute to public health programmes seeking to prevent the transmission of HIV. In particular, it shows that there has been a long-standing resistance to working within public health programmes that ‘target’ epidemiologically-defined groups of people (such as men who have sex with other men, intravenous drug users, sex workers) and risky behaviours (such as unprotected anal intercourse, unprotected vaginal intercourse). They have chosen, instead, to investigate HIV in the context of social, cultural, political and economic aspects of daily life; and to write about how HIV and AIDS relate to particular social settings, moral codes, political and economic relationships. Ideas about structural violence and processes of disempowerment have played a central role in this work; and research undertaken by applied anthropologists seeking to promote behavioural change by targeting high risk groups has typically been regarded as rather naive and not ‘real’ anthropology. This chapter suggests that it is a matter of some urgency that mainstream anthropologists revise their views. It is no longer enough to describe and analyse what is happening or to empathise with those affected by the pandemic.