Reading Sexuality in Detroit from the Global South: Structural Lessons from HIV/AIDS in the developing world

Purpose: Popular interest in “global health” undergirds many new training initiatives and programs. Despite its widespread adoption, there is a lack of clarity regarding how global health is distinct from earlier constructs of “international health”, and how it might be applied to USA health research. In this paper we draw on global health experiences in Africa and Latin America to discuss their application to understanding HIV/AIDS and sexual health in Detroit, Michigan.

Approach: We analyze the convergences and divergences across sites in five structural features of the global health analysis of HIV/AIDS: demographic upheaval; under-employment; informal sexual labor; the fragility of governance and the health sector; and gender inequality. We draw on data from a large ethnographic and survey study on youth sexuality and health in Detroit.

Findings: Structural processes central to analysis of the HIV epidemic globally have numerous parallels in Detroit, including the spatial risks of informal and sub-standard housing; chronic under-employment and reliance on informal labor; sexual markets driven by the proximity of poverty and wealth; and diminished State investment in youth. Simultaneously, key health operations of the global south are lacking in Detroit.

Recommendations: We argue for the utility of global health approaches to HIV/AIDS in both theorizing and developing research methods on HIV/AIDS. We propose cross-border and hybrid models for analyzing health issues that self-consciously borrow from research in “global” sites, and highlight how global health approaches are particularly useful to domestic research in areas of concentrated urban poverty, widespread disenfranchisement, and sustained structural disadvantage.