A Novel, Bottom-up Approach to Promote Evidence-based HIV Prevention for Intravenous Drug Users

Red Ribbon Memorial, Kiev

Red Ribbon Memorial at the Kyiv
Institute of Epidemiology

My current major research program extends my focus on questions of health, disability and social justice in Ukraine to study HIV prevention among intravenous drug-using populations. Ukraine has one of the most severe HIV epidemics in Eastern Europe, with an estimated 1.6% of the adult population living with the virus, and an estimated 33% prevalence among drug users in certain regions.

Injection drug users (IDUs) account for 36% of new HIV cases in Ukraine. Access to substitution therapies and needle/syringe exchange programs is expanding, but systematic and legislative barriers remain, and such programs alone do not address sexual HIV risk among drug users. Therefore, current HIV prevention efforts among Ukrainian IDUs need to be expanded to include evidence-based strategies that seek to change risk behavior, do not require broad policy changes or political support, and that address the multiple HIV risks drug users face.

Conference of the Ukrainian Sociological Association, 2012

Conference of the Ukrainian Sociological Association,
Kharkiv National University, Ukraine, Nov. 2012

Towards this end, I am co-investigator with PI Dr. Jill Owczarzak on a four-year project, “A Novel, Bottom Up Approach to Promote Evidence Based HIV Prevention for Intravenous Drug Users,” funded by the National Institute on Drug Abuse (NIDA). The project investigates how to best promote the use of evidence based interventions among Ukrainian NGOs working with drug users.

Local service providers are being trained in the common factors of effective interventions and empowered to develop HIV prevention interventions that reflect their specific organizational contexts. Trainings, intervention design, implementation, and outcomes will be assessed and compared using qualitative and quantitative methods. This project applies the insights of medical anthropology to public health interventions with a focus on local knowledge and contextualization of health interventions.


» See a complete list of my publications on HIV prevention among injecting drug users (IDUs) in Ukraine


Stimulating the Student Body: A Mixed Methods Pilot Study of Students’ Illicit Use of Prescription Psychostimulants

I am supervising a research project designed and carried out by undergraduate and graduate students at Indiana University on undergraduate students’ illicit (“off-label,” or using Rx drugs without a prescription) use of prescription psychostimulants (e.g. Adderall, Vyvanse). Primary research methods have included an online student survey, focus groups, personal interviews, and media and discourse analysis. Besides shedding light on an important social and health issue, the project has provided students valuable experience designing a research project, carrying out qualitative and quantitative data collection procedures, data analysis (including the use of qualitative data analysis software), interview transcription, collaborating with co-researchers, and crafting scholarly articles for publication.

Students analyze psychostimulant drugs

Together, students analyze data on the use of psychostimulant
drugs such as Adderall and Vyvanse.

The project uses perspectives in medical anthropology and sociocultural anthropology and has two main aims: to investigate prescription drug misuse on campus as an important public health issue with implications for student safety and well-being, and to understand the social pressures and broad cultural context in which such behavior has become normalized.

The primary questions this study seeks to address include the following: What are the overall trends in off-label use of prescription stimulants by undergraduates at IUB?  How do different stakeholders understand and evaluate the use of prescription psychostimulants as study aids—students, faculty, health professionals, administrators, law enforcement, academic advisors, and resident assistants? How do individual students describe their own motivations for using (or refraining from using) stimulants off-label?  In what shared terms do students articulate their main concerns about off-label stimulant use on campus?  How closely are students’ perspectives and narratives associated with pervasive discourses on prescription psychostimulants in sources of mass media such as television, advertising, and the Internet? Finally, how does this particular campus culture of psychostimulant misues articulate to broader socio-cultural, economic, and political dynamics?

» To learn more about the project, visit the study's website:

Disability and Disability Rights in Ukraine

Fieldwork in Ukraine.

Meeting with women in the field during a trip to Ukraine.

My latest book, Disability and Mobile Citizenship in Postsocialist Ukraine (Indiana University Press, 2011), is the culmination of a long-term research project on the politics and poetics of disability.  The project focuses on persons with mobility disabilities (i.e. wheelchair users) as a group that has recently been targeted by a range of state and international interventions.  Part of this research includes documenting the history of the disability rights movement in the former Soviet Union from the 1960s to the present.  For this investigation, I followed the activities of several disability rights organizations in Ukraine for nearly a decade (1998 – 2006).

I have been especially interested to investigate how international interventions into the disability rights arena have shaped the empowerment strategies taken up by Ukrainian advocacy NGOs, and the factors that contribute to the success or failure of these “imported” agendas.  Also, through participant observation and personal interviews, I follow the development of new disability identities (or the rejection of a disability identity) as persons and groups accesses different narratives of and strategies for empowerment.  I focus especially on issues pertaining to the lived experience of disability after socialism, including the ways that disability intersects with other trajectories of identity, especially class, gender, and ethnicity.

In addition to the book I have published several articles and book chapters on disability issues in Eastern Europe.  These articles focus on disability and masculinity in post-Soviet Ukraine; disability, structural violence, and health; and disability rights in new EU states and candidate countries (Bulgaria, Romania, Croatia, and the Former Yugoslav Republic of Macedonia).

» See a complete list of my publications on Disability and Disability Rights in Ukraine


Women and Civil Society in post-Soviet Ukraine

Indiana University Press, 2008.

During 1998-2003, I conducted ethnographic fieldwork in Ukraine on gender and class differentiation in Ukrainian civil society.  This is the focus of my first book, Women’s Social Activism in the New Ukraine: Development and the Politics of Differentiation (Indiana University Press, 2008).  In this ethnography of the lives of eleven women NGO leaders in Kyiv (whom I followed over a two-year period during 1998-99), I examine the unexpected and ambiguous effects that social activism has produced for Ukraine’s women as they take up the “housework of politics.”  In Ukraine, as men have dominated in positions of political power, in the face of social welfare reform and the scaling back of the social safety net, it is women who have been left as leaders of service-oriented NGOs and mutual aid associations to care for the marginalized and destitute, with little or no support from the Ukrainian state.  This calls into question the supposed “empowering” effects of NGO activism, and also reveals how entire categories of people (the elderly, large families) are falling through the cracks in the new Ukraine. 

In this work I use the notion of “differentiation” (an indigenous term in Ukraine that drives social politics reforms) to explain and track the sharpening of social inequalities after socialism.  These women’s lives and the stories they tell reveal the NGO sector to be a key site for postsocialist differentiation of citizens, as criteria for productive citizenship are reworked, and the rights and needs of various categories of citizens redefined.  Yet even as some activists and their constituents have been ignored by the state and development programs and left to fend for themselves, other women NGO leaders have been able to propel themselves into prestigious careers in business and government.

These women have succeeded in tapping into lucrative social networks, and they have also taken up powerful neoliberal narratives of self-sufficiency, development, and self-realization to understand and construct themselves as a new kind of postsocialist subject.  I delineate three major sites of differentiation: state rhetoric and especially welfare policy; international development programs and NGOs; and differentiation as an interpersonal phenomenon driven by peoples’ changing perceptions of their own personal and social worth and that of others.  By placing informants’ experiences in the broader context of social change, social welfare reform, and international development programs, I investigate the intertwining processes of differentiation as certain types of claims, organizations, and NGO leaders are privileged over others, sharpening social inequalities in post-Soviet Ukraine.             

» See a complete list of my publications on Women and Civil Society in post-Soviet Ukraine


Ukrainian Folk Medicine

A Ukrainian folk healer—or babka—performs a ritual
to determine what is ailing her patient.

During the summers of 1998 and 1999 I took part in an ethnographic expedition down the Dnistr River in rural Western Ukraine to interview elderly women folk healers known as “babky.”  These healers perform rituals such as vylyvaty visk, or the pouring forth of wax, to treat maladies that elude the expertise of local doctors (fear, curses, the evil eye).  I produced an ethnographic video based on this work entitled “Shapes in the Wax: Tradition and Faith among Folk Medicine Practitioners in Rural Ukraine” (2004).  In the video the healers demonstrate their rituals and reflect on their lives as elders, healers, and women in Ukraine.  Besides introducing these folk medicine rituals, “Shapes in the Wax” is a useful tool to introduce students to ethnographic research methods and fundamental concepts in medical anthropology. 

» Read the ISS Newsletter's article about "Shapes in the Wax"

» See a complete list of my publications on Ukrainian Folk Medicine

Health and Healing after Chernobyl

Spirulina, a type of blue-green algae, is thought
to diminish the damage from Chernobyl's radiation.

During 1998-99 I also researched the various practices of “alternative” medicine that have become pervasive in post-Soviet Ukraine.  Interest in non-invasive, “natural” modes of healing became especially popular after the 1986 Chernobyl nuclear catastrophe.  One particularly interesting strategy for maintaining health after Chernobyl is the use of substances known as “radioprotectors” to flush radioactive particles from the organism.  I have found that using radioprotectors allows persons to establish particular class identities in the invention of their postsocialist, post-Chernobyl selves.  The case of radioprotectors also shows the uncertaintly people feel in making health-related decisions in the context of the new market economy.

» See all my publications on Health and Healing after Chernobyl

» Visit the Chernobyl Resource Page