Power in the Blood: A Handbook on AIDS, Politics, and Communication. - Review - book review

Journal of Sex Research, Feb, 2000 by David W. Purcell

Power in the Blood: A Handbook on AIDS, Politics, and Communication. Edited by William N. Elwood. Mahwah, NJ: Lawrence Erlbaum Associates, 1999, 442 pages. Cloth $99.95.

For this volume, Elwood gathered together an impressive array of scholars to address the intersection of AIDS, politics, and communication. But where do these broad topics overlap? And how can the reader make sense of them together? For Elwood, the intersection of these themes is at the level of conversations between a wide variety of people and organizations. In the introduction, he states that "talk may be the most important component to HIV prevention and treatment" (p. xvii). Elwood proposes that all communication, or conversation, is in some way political, particularly discourse about HIV and AIDS. Thus, Elwood links his three themes by illuminating the variety of micro- and macro-level political conversations about AIDS.

Elwood focuses on the range of public and private conversations about HIV and AIDS that affect this continuing public health crisis, including one-on-one dialogues (e.g., individuals speaking with their drug-using and sex partners), scientific discourse (e.g., discussions among researchers from different disciplines), political rhetoric (e.g., politicians speaking to the public, constituents, or other politicians), and messages communicated through mass media (e.g., what television, newspapers, and other media say and do not say about HIV and AIDS). The book examines these communications and how they influence the way people think, act, and talk about HIV and AIDS. The book's thesis is clearly illustrated by providing many examples showing that how HIV and AIDS is talked about, both publicly and privately, can dramatically help or hinder HIV prevention efforts.

What makes this book challenging is that rather than grounding the book in one intellectual tradition, Elwood has brought together two very different research areas: public health and communications. Although this might be a difficult task for many researchers, Elwood's training, research, and professional interests emanate from both fields, lending credibility to his look at HIV and AIDS through a wide lens. Elwood provides a structure for examining the intersection of AIDS, politics, and communication by grouping the 30 chapters into seven sections. Each section addresses a different type of conversation, and then illuminates the implications for HIV prevention and public health. Four of the sections focus on very broad perspectives (the politics of illness and HIV, political campaigns and policy, mass media, and the relationship between individuals and institutions), two sections focus more at the individual level (an "intrapersonal" section on individual behavior, and an "interpersonal" section on relationships between individuals), and the final section tries to synthesize this diverse offering.

Depending on the reader's theoretical orientation or academic background, certain sections or chapters will likely be more interesting or relevant than others. In the section on individuals and behavior, the diversity of the topics highlights two important take-home messages; first, the need to understand the target population and their construction of risk, and second, the importance of tailoring HIV prevention interventions for specific communities--drug-using women, gay men who patronize public sex environments such as bathhouses, truckers along the Trans-Africa highway in Kenya. From these selections, the reader is left with the clear idea that an important first step to intervening with any population is to conduct formative research to illuminate the understanding of risk behavior. In fact, many of the chapters are based on formative research with various populations.

In the interpersonal section, the chapters highlight the importance of relationship dynamics in helping or hindering HIV prevention while reinforcing the message that targeted interventions are needed. For example, one chapter makes a strong case for tailoring intervention messages for adolescents. The research presented shows that youth may not protect themselves and their partners from HIV because they may fear romantic rejection more than death, thereby making some prevention messages for adults not as pertinent to youth. These chapters also start to make the important connection between more intimate relationships and the social structures in which they are embedded. Thus, this section provides a nice bridge to the other sections of the book, which focus on communications at a more macro level. For example, some of the interpersonal chapters focus on the experience of women by discussing the fact that although HIV is transmitted intimately, the social rules and conditions governing this intimacy may not rest solely with the couple or the woman. Many chapters in this book and in other publications make the point that the power of women to protect themselves from HIV risk can be hampered by a number of structural factors (e.g., the lack of availability of female-controlled prevention methods, the lack of power over sexual decision making, the lack of economic power).