Qualitative Health Research: Negotiating Life with HIV/AIDS

In this paper, I look at the use of qualitative methods in health geography. I focus on two projects using in-depth interviews with people with HIV/AIDS. Drawing from feminist work on qualitative methodologies and the production of knowledge, two questions are posed. First, what insights do interviews offer about people's daily experiences with HIV/AIDS? Second, given that interviews involve direct contact between interviewer and respondent, what are the implications of using this methodology? Projects reveal that living with HIV/AIDS involves a complex series of negotiations. These include negotiating one's own identity within medical discourse, dealing with health care professionals, and choosing how to use medication. The projects also indicate that qualitative research itself involves a process of negotiation. Researchers' preconceptions, interview settings and formats, and relationships established during research can effect research outcomes andresearch participants. I argue that a willingness to reflect critically on the use of qualitative methods is needed to safeguard against these unintended consequences.     

Voice Under Scrutiny: Feminist Methods,Anticolonial Responses,and New Methodological Tools

“Giving voice” to participants has been an important element of qualitative feminist research projects in geography. In this article, I explore scholarship that has questioned qualitative research's reliance on voice, arguing that implicit connections between voice, authenticity, and empowerment are beginning to be unpacked, particularly by scholars engaged in anticolonial work. I draw on anticolonial scholarship to build on and extend feminist debates centered on voice and participation. Feminist attention to voice must be situated within the colonial frameworks and histories of social science research. Scholarship focused on ongoing settler colonial relationships highlights methods both for cautiously proceeding with and consciously refusing incorporating voice within qualitative research. I draw on anticolonial approaches to frame research decisions, voice, and the ethical and methodological dilemmas of its use.     

Fluid Households,Complex Families: The Impacts of Children's Migration as a Response to HIV/AIDS in Southern Africa*

Abstract

The fluidity of southern African families is related to a long history of internal and external migration. Currently, HIV/AIDS is having a dramatic impact on extended family structures, with the migration of individual members employed as a coping strategy. Children's migration is one aspect of this that is often distinct from that undertaken by other household members. This article is based on qualitative research conducted in Lesotho and Malawi with young migrants and the households that receive them. It examines the processes of fragmentation and re-formation of households through the movements of children that are taking place in response to HIV/AIDS, and explores the impacts these processes have on young migrants and the households they join.     

Fluid Households,Complex Families: The Impacts of Children's Migration as a Response to HIV/AIDS in Southern Africa*

The fluidity of southern African families is related to a long history of internal and external migration. Currently, HIV/AIDS is having a dramatic impact on extended family structures, with the migration of individual members employed as a coping strategy. Children's migration is one aspect of this that is often distinct from that undertaken by other household members. This article is based on qualitative research conducted in Lesotho and Malawi with young migrants and the households that receive them. It examines the processes of fragmentation and re‐formation of households through the movements of children that are taking place in response to HIV/AIDS, and explores the impacts these processes have on young migrants and the households they join.     

Gender and local soil knowledge: Linking farmers' perceptions with soil fertility in two villages in the Philippines

Scientists often turn to farmers to understand soil management. This process reveals differences and overlaps between local and scientific soil knowledge but rarely considers women and gender issues. This paper examines men's and women's local knowledge of soils in upland, smallholder farms in two villages in Mindanao, the Philippines, using focus group discussions, semi‐structured household interviews, field visits, GIS and soil testing. Farmers' field areas were calculated and delineated based on their perceptions of the different types of soils on their land. Men and women chose the same plots for what they considered their best soil but differed on what they felt were their worst. The fertility of the soils that women considered to be the best and worst was not significantly different from that of the men's respective choices. There was a difference in fertility, however, between the best and worst soils regardless of gender. Although soil fertility analyses showed that the women's chosen soils were similar to men's, analyses of qualitative data showed that their knowledge of soils was different and was based in part on a gendered division of labour. A multidisciplinary approach helped bridge the gap between sociocultural and physical research.     

The Implications of Psychoanalysis for Qualitative Methodology: The Case of Interviews and Narrative Data Analysis*

In this article I ask to what extent geographers can draw on psychoanalytic theory when examining interview data. I consider Freud's theory of the mind and its unconscious processes to ask how bringing the unconscious to bear on identity studies potentially impacts qualitative research on subjectivity and identification. Existing geographic debate on psychoanalytic theory and methods provides an organizing framework for my argument. Although the article advocates an ontology of the psychoanalytic subject, I suggest that researchers must avoid psychoanalyzing research subjects. This distinction limits the ways in which scholars can “read” personal narratives for unconscious processes.     

The Politics of AIDS Surveillance

This paper examines the social construction of official HIV/AIDS surveillance data in San Francisco and the implications of this research for understanding the past and future trajectories of the epidemic in the United States. I employ a methodology of social constructivism in an analysis of the historical evolution of the epidemic and a critique of its quantitative representation by public health officials. I argue that medical geographers have erroneously interpreted AIDS surveillance data as evidence for an exponential growth in AIDS cases during the past 17 years, neglecting to critically explore the multiple and extensive revisions in the definition of the disease (in 1982, 1985, 1987, 1993) by which patients have been reported over time. In contrast, social constructivism exemplifies a method for elucidating the sociopolitical interests of public health institutions and community activists which underlie the constant metamorphosis of the subjects (e.g., patients) and object (e.g., ‘AIDS’) comprising this epidemic.     

Russia's Far East: A Region at Risk

Abstract

In this article I ask to what extent geographers can draw on psychoanalytic theory when examining interview data. I consider Freud's theory of the mind and its unconscious processes to ask how bringing the unconscious to bear on identity studies potentially impacts qualitative research on subjectivity and identification. Existing geographic debate on psychoanalytic theory and methods provides an organizing framework for my argument. Although the article advocates an ontology of the psychoanalytic subject, I suggest that researchers must avoid psychoanalyzing research subjects. This distinction limits the ways in which scholars can “read” personal narratives for unconscious processes.

     

Locating the Melody of the Drives

Psychoanalysis has profoundly influenced those social theories that inform qualitative methodology in human geography. Yet many geographers are skeptical about the value and viability of psychoanalytic methodology because of its alleged reductionist causal explanations and relativistic interpretations of data. Drawing on the work of Slavoj ?i?ek, which affirms Jacques Lacan's undermining of the dualism of causality versus sense, this article illustrates the potential value of Lacanian psychoanalysis as a qualitative methodology in geography. Using a methodological case study from my research on Jamaican tourism, I illustrate how we can locate a Lacanian understanding of the drives in the interactions between tourists and hotel workers. In so doing, the article provides new insights into the enduring allures of tourism's commodity-form by focusing on how the object petit a—a chimerical object that incites desire and an unattainable object that the drives encircle—takes place in customer service and entertainment activities.     

Eliciting emotions in HIV/AIDS research: a diary-based approach

Little attention has been given to understanding the emotional well-being of people living with HIV/AIDS in developing countries, despite the fact that emotions may impact on people's sense of purpose and value, and ultimately their ability and resolve to hold livelihood and familial responsibilities together. Drawing upon research undertaken in the Caprivi Region of Namibia, this paper examines the use of solicited text and photo diaries in enabling insight into the emotional impacts of HIV/AIDS. The advantages and constraints of diary methods are examined, focusing on informant-directed research and the ethical considerations surrounding their use.     

Community Development Approaches to Heart Health Promotion: A Geographical Perspective

This paper reports results of a qualitative study of community development approaches to heart health promotion in Ontario. Cardiovascular disease (CVD) represents a substantial proportion of the burden of illness experienced by western industrialized countries. Biomedical research has implicated lifestyle choices and socioeconomic conditions as primary determinants of CVD. There has been a resultant shift from curative to preventive/health promoting strategies to reduce this burden of illness. The Canadian Heart Health Initiative-Ontario Project (CHHIOP), a two-stage (quantitative and qualitative) longitudinal study, was designed to address issues of heart health promotion through the investigation and strengthening of community-based heart health activities in both the formal and informal public health systems. The study reported on in this paper forms one part of the qualitative stage and focuses on how community relationships and community development approaches play out in local contexts to shape the reality of (heart) health promotion practice. Analysis of key informant interviews using Ethnograph illustrates the centrality of community context, the lack of a common understanding of key concepts (e.g., community development), and the emergence of a shift in health agencies' ways of doing business characterized by increased partnering and collaboration in the delivery of (heart) health promotion programs. Local perspectives and the dynamics of intra-community relations were allowed to emerge through the use of qualitative approaches implying a need for place-sensitive (heart) health promotion strategies.     

Urban encounters and sexual health among gay and bisexual immigrant men: perspectives from the settlement and aids service sectors

Gay men's health researchers in North America have recently attended to sexual and mental health issues affecting ethnic minority men, many of whom are also immigrants. Most of this work is grounded in epidemiological models that focus on relationships between individual HIV risk and sexual behaviors. Consequently, they the frame the sexual health of gay and bisexual immigrants as the product of cultural issues (for example, family and religious homophobia, lack of health education) or gay community issues (prevalence of drug use and casual sex) that lead to self‐devaluation, depression, and unprotected sex with multiple partners. Few studies, however, examine these phenomena through the lens of migration and resettlement. Using the narratives from twelve in‐depth interviews with settlement and AIDS Service Organization (ASO) workers in Toronto, Ottawa, and London, Ontario, Canada, this article examines four types of post‐migration urban encounters that influence sexual health: negotiations of resettlement‐related stress, encounters with the urban gay community, encounters with the online gay community, and encounters with sexual health promotion itself. The findings suggest that these encounters are important intervening events that mediate the relationship between the attributes of the immigrant and his sexual health behaviors and outcomes.     

NEOTRADITIONALISM IN THE SUBURBAN LANDSCAPE: CULTURAL GEOGRAPHIES OF EXCLUSION IN VANCOUVER,CANADA

During the 1990s, urban geographers have become fascinated with what are termed “neotraditional landscapes,” yet have ignored the broader cultural contexts of neotraditionalism. In this paper, I use a more encompassing and culturally based conception of neotraditionalism to demonstrate a salience of neotraditionalism in the suburban landscape beyond strict neotraditional developments. My argument is that neotraditionalist beliefs are transforming “ordinary” suburban landscapes in subtle but distinctive ways beyond the presence of neotraditional developments. This different reading of suburban neotraditionalism is filtered through qualitative material collected during in-depth interviews in two suburban neighborhoods in Vancouver, Canada. Though the research is suggestive rather than definitive, I suggest that it has important implications for rethinking geographies of suburban exclusion.     

Post-Postmetropolis: Taking Stock of the Urban Condition

Sea changes generate tides of big ideas about cities. Postmodernity, like modernity before it, framed urban speculations spanning the gamut from liberation to purgatory and everything in between. And it is no accident that both focused the hopes and fears of the age on cities. For cities have long constituted the crucible of lived human experience vis-à-vis other humans, as well as the built and natural worlds. Taking stock involves a process of assessing what has come to pass, and what has not; in addition, it involves analyzing the topography of the present, always with an eye on that which is to come. This essay introduces the collection of articles published as a group in this symposium—and mark the first decade of the new millennium as well as the tenth anniversary of the publication of Edward Soja's Postmetropolis. At a decade's remove from both, how do urban geographers take stock of the urban condition?     

A Qualitative Study of the Professional Relationship between Family Physicians and Hospital Specialists

The professional relationships between family physicians (general practitioners or GPs) and specialist doctors are crucial in a referral-based national health service such as that in the United Kingdom. They may, for example, have a fundamental influence on what in the past have been assumed to be logical or proximity-based utilisation patterns of secondary and even tertiary hospital facilities if GPs refer to specialists with whom they have greater rapport. Until recently, research has identified a generally poor mutual understanding between the two key clinical branches of the National Health Service (NHS), and this research was conducted to determine the state of the current relationship. A range of qualitative methods was employed—including key informant interviews, focus groups, and in-depth interviews—with family doctors and specialists in the south and west region of the United Kingdom. The participants described a much better mutual relationship than that found in previous studies. Four major issues were identified relating to professional interaction. These included the reasons for choosing one of the two main branches of medicine in which to practice, the ways in which doctors interact over clinical issues, the effects of teaching and learning together on the relationship, and possible future models of professional interaction. In process terms, the theme of cooperation was more evident than that of conflict and there was minimal evidence of a struggle for power or status. If anything, the balance of influence within the profession seemed to be shifting in favour of the primary practitioners rather than the specialists. This research therefore indicates key variables for inclusion in future behavioural studies of the use of health services in physician referral-based systems. We illustrate the strengths and potential of qualitative methods in health care research and health care geography for investigating professional relationships which are likely to impact on patient care and service quality as well as being factors that might influence spatial patterns of patient behaviour.     

Systematic Inquiry into Barriers to Researcher Access: Evidence from a Homeless Shelter*

Geographers using qualitative methods face numerous challenges, including barriers to access to the research setting that emerge through the interactions among the researcher's identity, participants, and the research setting itself. However, few geographers have systematically traced, within a single research setting, (1) how barriers originate, (2) how they subsequently complicate the research enterprise, and (3) how they may potentially be overcome. Upon defining various generic barriers to access, I focus on the origins of, encounters with, and potential strategies to overcome two barriers (factions and spatiotemporal limits) during my research experiences at the Palms Mission, an emergency shelter in Central Los Angeles. Ultimately, understanding the negotiation of these barriers informs the broader research process.     

Developing Contradictions: Women's Participation as a Site of Struggle Within an Indian NGO*

Women are being hired in increasing numbers by development projects to facilitate women's participation components. Once employed, however, women often find themselves marginalized within their organizations. In this paper, I find that the women's participation component of an Indian drinking water project has enabled the exclusion of women fieldworkers employed by the project. Drawing on the work of Bakhtin, I show participatory approaches as multiple, partial, and contentious. Moves to thwart women fieldworkers and women's participation give rise to struggles over development geography. Analysis of project records, interviews with staff, and observation of staff activities provide evidence for results.     

Subversive formalization: efforts to (re)form land,labor, and behavior in a carioca favela

ABSTRACT

State entities in Brazil have rolled out numerous programs to “integrate” precarious settlements into the so-called formal city of Rio de Janeiro. Two of the most visceral integration projects in Rio’s favelas have been infrastructural upgrading and public security via military police occupation. Drawing on participant observation, interviews, and policy analysis, in this paper I trace how these projects attempt to formalize land, labor, and behavior in a complex of favelas called Complexo do Alemão. Inspired by postcolonial urban approaches to formalization, I argue that formality/informality as it operates through these projects is, in part, a performative distinction deployed by the state, echoing elite and popular socio-spatial imaginaries. I add, however, that non-state actors are also involved in their own practices of formalization. Residents themselves are re-making diverse forms of property, employment, and behavior through processes of subversive formalization, informed by their geographically-embedded and historical relationships with one another.