Monday, May 29th, 2023

The Continuing Disingenuousness of Paul Farmer

AIDS and Accusation: Haiti and the Geography of Blame

by Paul Farmer

Published by University of California Press

Published August 26, 1992
Anthropology (health/ethnography)
338 pgs. • Find on Amazon.comWorldCat

Reviewed by Stephen O. Murray

December 12, 2017

Paul Farmer’s book, AIDS and Accusation: Haiti and the Geography of Blame (University of California Press), is a model of locating “native” explanatory models of illness within history and international political economy.

Although the ethnography of a rural Haitian village, Do Kay, and the historical account of Haitian exploitation are not seamlessly joined, there can be no doubt that Do Kay residents’ explanatory model of SIDA (AIDS) was affected by metropolitan representations and by consciousness of past afflictions caused or countenanced by colonial and neocolonial regimes.

Farmer’s work is also exemplary in showing changing conceptions as SIDA shifts from being a distant (urban) phenomenon to being a local disaster. Sensitively collected and analyzed longitudinal data explore the shifting vernacular understanding of a new malady and its incorporation into existing paradigms of knowledge about human suffering and about disease etiology. The explanations by the first three Do Kay cases of the maladies that were killing them are treated with great respect—and made available to (cosmopolitan) audiences that would not otherwise know that these people, lived, suffered, and died. Personally, I would have liked some longer pieces of Do Kay narrative. Although there is no lack of native testimony inscribed in the book, I think that at least a sample of longer, connected text would provide readers a better sense of the voices from Do Kay.

Besides providing a compelling exemplar of relating ethnographically studied phenomena with external (world systems) phenomena and showing cognitive change in process, the book also contains some compelling criticisms of the willingness of North American physicians, epidemiologists, and journalists to credit fantastic hypotheses and alleged descriptions of Haitian behavior patterns. Just as SIDA was the latest in a series of troubles thought by rural Haitians to be caused by Americans and by sorcerers, some North American conceptions of “black magic” (voudou(n)) uncritically accepted claims about uses of blood.

Farmer rightly derides the ready acceptance of retrospective conceptions about Haitian voudou(n), etc. It seems to me that he accepts similarly suspect and hyperbolic statements about gay tourism, such as:

During the 1970s, tourists [in Puerto Plata, the Dominican Republic, on the other side of the island of Hispaniola from Haiti] were predominantly gay, over-sixty males who engaged in sex with local teenaged male prostitutes. (p. 279)

As my deceased collaborator, Kenneth Payne, complained in a 1987 letter to JAMA (258:47 in regards to another causal inference Farmer repeats), the same journals that insist upon precision of measurement of substances in blood are satisfied with the most casual assertions about behavior—homosexual or Haitian.

Farmer also reproduced percentage of Haitian AIDS cases classified as “bisexual” that are not merely implausible (50% in 1983 to 1% in 1987) but impossible (see Murray and Payne 1989), and perpetuates the risk factor/kinds of persons analysis that has been so harmful to gays and to Haitian Americans. 1

Although in many ways innovative and path-breaking, Farmer remains a prisoner of the promiscuity paradigm of AIDS etiology, of knee-jerk homophobia, and of the simplistic economistic paradigm of “prostitution.” Readers can learn some things from this book, but not about homosexuality in Haiti (a not altogether blank page in Haitian ethnographies from before the recognition of AIDS—see the literature review in Murray 1987). Unfortunately, what they might learn about the relationship between homosexuality and AIDS in Haiti is based on suspect data and a failure to subject such data to the same critical standards as are applied to assertions about other kinds of Haitian behavior.

References Cited

Farmer, Paul. 1990. “The exotic and the mundane: Human Immunodeficiency Virus and the Caribbean,” Human Nature 1:415–45.

Guerin, Jean-Michel et al. 1984. “Acquired Immune Deficiency Syndrome: Specific aspects of the disease in Haiti.” Annals of the New York Academy of Sciences 437:254–61.

Landesman, Sheldon A. 1983. “The Haitian connection.” Pp. 28-37 in Kevin Cahill (ed.), The AIDS Epidemic. New York: St. Martin’s.

Murray, Stephen O. 1987. “Haitian (in?)tolerance of homosexuality.” Pp. 101–108 in Homosexuality: Which Homosexuality? Amsterdam: Free University Press. Also, pp. 92–100 in Male Homosexuality in Central and South America. Gai Saber Monograph 5 (1987).

Murray, Stephen O., and Kenneth W. Payne.1988 “Medical policy without scientific evidence: The promiscuity paradigm and AIDS.” California Sociologist 11:13–54.

——,——. 1989. “The social classification of AIDS in American epidemiology.” Medical Anthropology 10:115–28.

Pape, J. W. et al.. 1983. Characteristics of AIDS in Haiti. New England Journal of Medicine 309:945–50.

Payne, Kenneth W. 1987. “HIV infection in the Dominican Republic.” Journal of the American Medical Association 258:47–48. Originally published in SOLGAN 14.3 (1992):40–42.

2008 P.S. (from epinions posting no longer online)

At that time I had not absorbed the literature denying that innocent/primitive Africans could have engaged in same-sex sex except as corrupted by more sophisticated (debauched) outsiders, which in the case of sub-Saharan Africa meant Arabs before European colonialists (discussed by Will Roscoe and me in Boy Wives and Female Husbands and by Marc Epprecht in Heterosexual Africa?), so I did not recognize that the alien corruption of innocent/primitive was a recapitulation.

Instead of attacking Haitians (in Florida) being a “risk factor,” in 1992 Farmer could and in my opinions should have challenged the kinds of persons (risk groups) etiology rather than shepherding his people (Haitians) from being treated as one (earlier). He participated in blaming others (homosexuals) though criticizing blaming, as well as participating in the Haitian penchant for blaming everyone but themselves for the failed state that succeeded direct colonialism in 1804. (It is even a long time since the U.S. occupation of 1915–34 ended.)

Since then, strong evidence that HIV (the virus causing AIDS) was in Haiti before it was in the U.S. was provided in March 2007, at the Fourteenth Conference on Retroviruses and Opportunistic Infections (CROI) in Los Angeles. A group of international scientists presented data based on complex genetic analysis of 122 early samples of HIV-1, group M, subtype B (the most common strain found in the U.S. and in Haiti) showing that the strain had probably been brought to Haiti from Africa by a single person in around 1966; a time when many Haitians would have been returning from working in the Congo (then Zaire). Genetic analysis showed that subtype B spread slowly from person to person on the island, before being transferred to the U.S., again probably by a single individual, at some point between 1969 and 1972. University of Arizona biologists Joel Wertheim and Michael Worobey (2008) stated that there is a 99 percent certainty that HIV subtype B originated in Haiti before passing to the U.S. ( Also see references appended.

That research was reported after the purportedly “updated” version of Farmer’s book. More “natural” disasters exacerbated by the failed Haitian state (including building codes or lack of them) have struck Haitians, including a devastating (7-point) 2010 earthquake and now a cholera epidemic.

2017 Postscript:

There is now a substantial body of analysis of the path of HIV from African through Haiti to North America. No virologist has suggested HIV was transported from North America to Haiti by vacationing gay sex tourists or other Americans. It seems to me long past time for Farmer to retract what now feels like a blood libel somewhat akin to The Protocols of the Elders of Zion. The route of transmission never made any sense, not least in that gay tourists were far more likely to go to the other half of the island of Hispaniola (the Dominican Republic) than to Haiti.

I call upon Paul Farmer to retract the fantasy that he promoted and on the University of California Print to include notice of the virology history consensus that has rendered the speculations about homosexual tourists in Haiti moot.

Additional References

Gilbert M.T., A. Rambaut, G. Wlasiuk, T.J. Spira, A.E. Pitchenik, M. Worobey (2007). “The emergence of HIV/AIDS in the Americas and beyond”. Proceedings of the National Academy of Science 104: 18566–70.

Sharp P.M., Hahn B.H. (2010) “The evolution of HIV-1 and the origin of AIDS.” Philosophical Transactions of the Royal Society 365: 2487–2494

Faria, N.R., A. Rambaut, M.A. Suchard, G. Baele et al. (2014) “The early spread and epidemic ignition of HIV-1 in human populations.” Science 346:56–61

©2008, 2017 by  Stephen O. Murray


  1. In a point of personal privilege, I find Farmer’s contention on p. 148 that “interestingly, Murray and Payne” don’t cite Guerin et al. 1984 quite disingenuous, both in that we did cite it in our 1989 articles focused on risk groups and discussing Haitians with AIDS in the special issue on AIDS of Medical Anthropology (if not in the 1998 article in a sociology journal focused on San Francisco AIDS-rationalized public health politics which he cited instead), and that in a letter protesting the same statement in a 1990 article of his in Human Nature, I called attention to this, and to my not being impressed that 3 of 25 men in the Guerin study had at some point their lives had some sort of sex with American male tourists as explaining either AIDS in Haiti or even those three particular case. ”Interestingly” to me, having chided us for not attending to Guerin et al (1984), Farmer ignored Guerin et al.’s data that twice as many of the early cases were from the provinces as were from the environs of the capital city (Port-au-Prince). The 2006 “updated” paperback edition again failed to correct chiding us for what Farmer himself did (not using the more substantial published version, which we in fact did and he did not despite two attempts to call his attention to his doing what he criticized us in error for doing). Moreover, Guerin et al.’s paper ignored that despite the paucity of modern health facilities in rural Haiti, Landesman (1983:34) and Pape et al. (1983:948) had published reports of rural AIDS cases prior to the conference, and Moses and Moses (1983) had discussed probable rural cases beyond medical surveillance.

About The Author

Stephen O. Murray grew up in rural southern Minnesota, earned a B.A. from James Madison College (within Michigan State University), an M.A. from the University of Arizona, a Ph.D. from the University of Toronto (both in sociology), and was a postdoctoral fellow at Berkeley (in anthropology). He is the author of American Gay, Homosexualities, etc. and lives in San Francisco.