Infectious disease is a focal point of urban medical anthropological literature in developing countries, and international health research. The poor in urban areas of developed countries and developing countries, often malnourished or with compromised immune systems, are vulnerable to infectious disease because of inadequate shelter, sanitation, and inaccess to basic heath care or lack of health insurance. For example, despite heightened attention, education, and improvements in sanitation, acute diarrhea remains a health threat, and a leading cause of death for young children worldwide (Kendall, 1991). Children with inadequate or no housing are especially at risk for diarrheal disease because of the unavailability of clean water and sanitation services (Glasser, 1994). Describing her ethnographic work in Brazilian favelas, Scheper-Hughes (1984, 1985) argues that rates of infant mortality are so common, and resources so scarce, that mothers have developed emotional strategies for coping with the awareness that some of their children may die. For example, mothers may not name their children immediately to prevent bonding to a child who may not survive, or they may favor children perceived as hardier and thus more likely to survive to the detriment of weaker more vulnerable children. Nation and Rebhun (1988) argue that mothers were far from inured to the death of children, but simply did not have the economic means of obtaining adequate health care for their children. The structural constraints influencing infant mortality are addressed in detail by Scheper-Hughes (1992). Tuberculosis, medically manageable with access to adequate health care, is often fatal to the poor in both rural and urban areas of the developing world (Farmer, 1999).
Increasingly, the impact of globalization, rapid sociocultural change, and increased mobility has proven ideal conditions for the global spread of relatively "new" diseases, such as HIV/AIDS (Jochelson, Mothibeli, & Leger, 1991). Increased mobility through air travel and the development of highways and local roads resulted in the rapid transmission of HIV worldwide (Armelagos et al., 1990). Despite some improvements to the infrastructures of developing countries, overall the rural and urban poor are still highly vulnerable to disease. Migration patterns based on availability of employment illustrate that the health of the rural poor is now fundamentally linked to the health of the urban poor. This heightened mobility—though at one level increasing job opportunities for the unemployed, and theoretically, access to health care—is disruptive to local economies and family structure. In addition, structural adjustment programs in developing countries, predicated on the export of locally produced goods and the increasing importation of corporate products, has often resulted in the decreased availability of health care, social services, and HIV-prevention tools such as condoms (Parker, Easton, & Klein, 2000). In the United States, undocumented immigrants may resort to underground or street economies for survival (Baer et al., 1997). Street youth, homeless men, and women trying to support themselves or their children sometimes resort to trading sex or selling drugs—high-risk activities for HIV (Clatts et al., 1998; Clatts & Davis, 1999; Schoepf, 1992; Schoepf, Engundu, Wa Nkera, Ntsomo, & Schoepf, 1991; Susser & Stein, 2000).
Recounting data from over 12 years of fieldwork in Yabucoa, Puerto Rico, Susser and Kreniske (1997) describe how some Puerto Rican migrants looking for greater financial opportunity may experience urban U.S. living when they have no relatives for emotional or financial support. Unable to find profitable work, some migrants began using drugs, and sometimes supporting drug use through commercial sex work. Clearly, HIV can be rapidly transmitted among these migrants, both on the mainland and upon return trips to Puerto Rico.
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