The next few months we’ll be highlighting authors who have published in Culture, Medicine, and Psychiatry.
Sarah Mars is an Associate Professional Researcher at the University of California, San Francisco. She is an anthropologist and historian who has been researching substance use and policy for several decades. Her current research focus is the US opioid/overdose epidemic and she is the author of The Politics of Addiction: Medical Conflict and Drug Dependence in England since the 1960s (Palgrave).
What is your article ‘The High Five Club’: Social relations and perspectives on HIV-related stigma during an HIV outbreak in West Virginia‘ about?
During our qualitative research in a West Virginia town where an outbreak of HIV was happening, we found strong agreement among people injecting drugs that HIV-related stigma had greatly diminished among their peers since the outbreak. Using Cultural Theory we considered the social and material mechanisms that might underlie this change. West Virginia’s drug overdose death rates are the highest in the US amidst widespread uptake of injecting. Although spending time together, people living homeless and injecting drugs were divided and constrained by extreme poverty and the demands of drug dependence, fostering a fatalistic approach to life events and decision-making. This fatalism undermined individuals’ aspirations to forming a mutually supportive group, the “High Five Club” of the title. (The name is an ingenious pun for ‘HIV’ where the V=5 in Roman numerals.) Yet this fatalism also contributed to mutual tolerance and acceptance of those diagnosed with HIV.
Tell us a little bit about yourself and your research interests.
Substance use and the social and political responses to it have long interested me. I moved to San Francisco from London almost two decades ago and, as a migrant, find that a comparative perspective always helps to spark questions about what we are encountering out in the field or in archives. While some of my research has focused on the urgent questions of emerging drug use during the opioid epidemic, I am also interested in developing under-used theoretical approaches, particularly Cultural Theory. The new online Opioid Industry Document Archive also promises exciting new opportunities for research. As well as work and family, I have spent many years researching cake making, particularly the chocolate varieties.
What drew you to this project?
Since reading Mary Douglas’ paper ‘The Self as Risk Taker: A Cultural Theory of Contagion in Relation to AIDS’ (1990), I have been intrigued about perceptions of risk and protection from HIV. During research in Baltimore, Maryland in 2015, an interviewee commented that although they were engaged in sex work, they only went in their own circle. They saw this boundary as protective against HIV risk and it resonated with Douglas’ ideas about community boundaries as a protective barrier to contagion. I then developed this project as a pilot for investigating the use of Cultural Theory among people who use drugs
What was one of the most interesting findings?
Reducing HIV-related stigma is not only a matter of educating people to be more caring and empathetic. How someone reacts to another’s diagnosis depends on how they see their own place in the world. When unable to control key aspects of their lives, such as where they sleep at night or because of the daily demands of drug dependence, a person may develop a fatalistic viewpoint. From a public health point of view, fatalism can make preventing HIV particularly challenging if people who are considered ‘at risk’ believe the spread of the virus is out of their hands but fatalism may also help them to live in harsh conditions without self-blame and reconcile themselves to difficult news.
What are you reading, listening to, and/or watching right now?
I have been enjoying the BBC podcast of ‘In Our Time’, a discussion with academics of wildly disparate topics from the electron to the origins of the Atlantis myth or George Orwell’s 1984. For viewing, Shetland, a crime drama set on remote Scottish islands, is good for relaxing at the end of the day. For the written word, I recently read an excellent paper by Allison Schlosser and Lee Hoffer that discusses grief after deaths from drug overdose, a previously overlooked subject. (Schlosser, A. V., & Hoffer, L. D. (2022). “I don’t go to funerals anymore”: how people who use opioids grieve drug-related death in the US overdose epidemic. Harm Reduction Journal, 19(1), 1-11.)
If there was one takeaway or action point you hope people will get from your work, what would it be?
There is usually an internal logic to even the most bewildering human behavior but it may take some persistence to discover it.