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Choosing Methadone:

Managing Addiction and the Body Politic in Ukraine!

Jennifer Carroll, Ph.C.! Department of Anthropology! University of Washington! Dissertation Colloquium! 3 December 2012!

Acknowledgements.

University.of.Washington.

Laada.Bilaniuk.

Central.European.University.

Daniel.Monterescu.

Janelle.Taylor.

Noel.Chrisman.

Jared.Baeten.

Lorna.Rhodes.

. PATH.
.
PATH.

Amie.Bishop.

Kataryna.Gamazina.

Alexandra.Kowalski.

Acknowledgements. University.of.Washington. Laada.Bilaniuk. Central.European.University. Daniel.Monterescu. Janelle.Taylor. Noel.Chrisman. Jared.Baeten. Lorna.Rhodes. . PATH. Amie.Bishop. Kataryna.Gamazina. Alexandra.Kowalski.

Acknowledgements.

Acknowledgements. Deborah.Jones .. Edit.Szenassy. Elizabeth.Peacock. Ema .Hresanova. Erin.Koch. Eugene. Raikhel. Heidi.Bludau. Jonathan. SLllo . Marta. Korduba

Deborah.Jones .. Edit.Szenassy. Elizabeth.Peacock. Ema.Hresanova. Erin.Koch. Eugene.Raikhel. Heidi.Bludau. Jonathan.SLllo. Marta.Korduba. Maryna.Bazylevych. Michael.Rassell. Sarah.Phillips.

Acknowledgements..

Funding.Provided.By:.

Department.of.Sociology,.

Central.European.University.

Department.of.Anthropology,.

University.of.Washington.

InternaLonal.Research.

&Exchanges.Board.(IREX).

The.WennerUGren.FoundaLon.

Acknowledgements.. Funding.Provided.By: . Department.of.Sociology,. Central.European.University. Department.of.Anthropology,. University.of.Washington. InternaLonal.Research. &Exchanges.Board.(IREX). The. WennerUGren .FoundaLon.

PresentaLon.Outline.

PresentaLon.Outline. Primary.Research.QuesLon. Opiate.AddicLon.and. Treatment. The.Ukrainian.Context. TheoreLcal.Frames. Methodology. Preliminary.Findings.

Primary.Research.QuesLon.

Opiate.AddicLon.and.

Treatment.

The.Ukrainian.Context.

TheoreLcal.Frames.

Methodology.

Preliminary.Findings.

Primary Research Question!

My.Research.QuesLons ..

Primary. Why.do.people.(addicts.or.drug.users.in.parLcular).in. Ukraine.seek.treatment.for.their.addicLon.or.for. infecLous.diseases?. Secondary. What.factors.are.shaping.treatment.seeking.behaviors?. What.supporLve.or.protecLve.factors.exist?. What.obstacles.or.risk.factors.exist?. How.do.addicts.understand.their.own.behaviors,.which. an.epidemiologist.or.clinician.would.call.“treatment. seeking”? ...What%do%they%think%they%are%“up%to”?% (Geertz.1973,.9) ...

Opiate Addiction and Treatment!

1898:.Bayer.Brings.Heroin™.to.Market.

1898:.Bayer.Brings.Heroin™.to.Market.

…And.Then.Heroin.Went.Bad.

…And.Then.Heroin.Went.Bad.
…And.Then.Heroin.Went.Bad.

The.MedicalizaLon.of.AddicLon.

Two.different.‘disorders’. are.defined.

Substance.Abuse.

Substance.Dependence.

Two.different.standards. of.diagnosis.

DiagnosLc.and.StaLsLcal.

Manual.of.Mental.

Disorders,.4 th .ed.(DSMUIV).

InternaLonal.

ClassificaLon.of.Diseases,.

10 th .ed (ICDU10).

..

The. MedicalizaLon .of.AddicLon. •   Two.different.‘disorders’. are.defined. –   Substance.Abuse. –   Substance.Dependence. •   Two.different.standards.

The.MedicalizaLon.of.AddicLon.

The.MedicalizaLon.of.AddicLon.

Medical.Problem,.Medical.SoluLon.

Subs6tu6on%therapy%

ShortUterm.assisted.

detox OR.

..

LongUterm.maintenance ..

LongUterm.use.is.

considered.a.harm%

reduc6on%tac6c.%.

Medical.Problem,.Medical.SoluLon. •   Subs6tu6on%therapy% •   ShortUterm.assisted. detox OR. .. •   LongUterm.maintenance .. •  
Medical.Problem,.Medical.SoluLon. •   Subs6tu6on%therapy% •   ShortUterm.assisted. detox OR. .. •   LongUterm.maintenance .. •  

SubsLtuLon.Therapy.Drugs.

Methadone%HCl %%

SubsLtuLon.Therapy.Drugs. Methadone% HCl %% Schedule.II.drug. Taken.daily. Levo @alpha@acetyl@ methadol % (LAAM)% Schedule.II.drug. Taken.three. Lmes.per.week ... Buprenorphine%

Schedule.II.drug.

Taken.daily.

Levo@alpha@acetyl@methadol%

(LAAM)%

Schedule.II.drug.

Taken.three. Lmes.per.week ...

SubsLtuLon.Therapy.Drugs. Methadone% HCl %% Schedule.II.drug. Taken.daily. Levo @alpha@acetyl@ methadol % (LAAM)% Schedule.II.drug. Taken.three. Lmes.per.week ... Buprenorphine%
 
 

Buprenorphine%

 
 

Schedule.III.drug.

Taken.daily.

Addiction Treatment in the Ukrainian Context!

The.Soviet.Medical.System.

The.Soviet.Medical.System. •   Based.on.Marxist.and. Leninist.principles. •   All.disease.is.social.disease. •   A.unique.system.“divorced. from.medical. developments.and.progress. in.other.socieLes.”. (Mark.Field,.1967).

Based.on.Marxist.and. Leninist.principles.

All.disease.is.social.disease.

A.unique.system.“divorced. from.medical. developments.and.progress. in.other.socieLes.”.

(Mark.Field,.1967).

Parallel.Systems.of.SpecializaLon.

.

Narcology:%

specializaLon.in. narcoLc.use.and.other. addicLve.behaviors ..

..

Parallel.Systems.of.SpecializaLon. . Narcology :% specializaLon.in. narcoLc.use.and.other. addicLve.behaviors .. ..

Placebo/Coding.Therapy.

Uses.the.power.of. suggesLon.to.‘cure’.people. of.addicLve.behaviors.

Based.on.Pavlov’s.theories. of.higher.order.cogniLon ..

The.treatment.hinges.on. the.doctor’s.performance ..

.(Raikhel,.2010).

. .

Placebo/Coding.Therapy. •   Uses.the.power.of. suggesLon.to.‘cure’.people. of.addicLve.behaviors. •   Based.on.Pavlov’s.theories. of.higher.order.cogniLon .. •   The.treatment.hinges.on. the.doctor’s.performance ..

Kai.Risdal’s.interview.with.Eugene.Raikhel.

about.coding.therapy.in.Russia:.

hnp://www.marketplace.org/topics/

world/russiaUrx/killerUcureUalcoholismU

russia.

Ukraine’s.Medical.System.Today.

Ukraine’s.Medical.System.Today. •   Severe.lack.of. resources. •   Burdened.by.state. responsibiliLes.to. Chernobyl.sufferers .. •   FeminizaLon.of.the. medical.industry. •

Severe.lack.of.

resources.

Burdened.by.state.

responsibiliLes.to.

Chernobyl.sufferers ..

FeminizaLon.of.the.

medical.industry.

DeUprofessionalizaLon.

of.doctors.

Informal.payments.and.

“gios”.ooen.necessary.

to.receive.services.

Ukraine’s.Medical.System.Today.

Ukraine’s.Medical.System.Today. •   Poor.medical.reporLng. and.infecLous.disease. surveillance. •   Heavy.emphasis.on. outcome.staLsLcs. •   Strong.incenLves.to. manipulate.these. staLsLcs. •

Poor.medical.reporLng. and.infecLous.disease. surveillance. Heavy.emphasis.on. outcome.staLsLcs. Strong.incenLves.to. manipulate.these. staLsLcs. Extreme.distrust.

Funding.and.Control.of.HIVUprevenLon.

2002:.$90.million.to. Ukraine’s.Ministry.of. Health ..

2004:.The.Global.Fund. disenfranchised.the. Ministry.of.Health.

2010:.The.Global.Fund.

pledged.$305.million.

to.Ukraine’s.Country.

CoordinaLng.

Mechanism.(CCM).

Funding.and.Control.of.HIVUprevenLon. •   2002:.$90.million.to. Ukraine’s.Ministry.of. Health .. •   2004:.The.Global.Fund. disenfranchised.the. Ministry.of.Health. •   2010:.The.Global.Fund. pledged.$305.million.

“This.isn’t.American.heroin.”.

“This.isn’t.American.heroin.”. •   InUhouse.processing.of. raw.opium.extract .. •   demerol Ubased. mixtures.(“ shirka ”).are. common .. •

InUhouse.processing.of. raw.opium.extract ..

demerolUbased. mixtures.(“shirka”).are. common ..

Batch.processing.and. frontloading ..

PreUpacking.syringes.for. sale.or.trade ..

Theoretical Frames!

Explanatory.Models.of.Illness.

Explanatory.Models.of.Illness. What.is.it?. What.Causes.it?. How.do.I.know.I.have.it?. How.do.I.treat.it?. How.do.I.know.I’m.gerng. bener?. ( Kleinman ,.1988). ...............

What.is.it?.

What.Causes.it?.

How.do.I.know.I.have.it?.

How.do.I.treat.it?.

How.do.I.know.I’m.gerng.

bener?.

(Kleinman,.1988).

...............

Biopower.(and.its.discontents).

Diffuse.social.power.disciplines.people.

into.certain.behaviors (Foucault,.1975).

..

Public.health.programs.ask.us.to.be.

‘responsible.ciLzens’ (Lupton,.1995).

..

 
But.can.we.escape.these. subjecLviLes?. It’s.a.trap !.(Bourgois,.2000). There.are. some . emergent .theories.that. explain.structure.and.agency. differently..(cf..Carr,.2011).
 

But.can.we.escape.these.

subjecLviLes?.

It’s.a.trap!.(Bourgois,.2000).

 
 

There.are.some.emergent.theories.that.

explain.structure.and.agency.

differently..(cf..Carr,.2011).

 
Biopower .(and.its.discontents). Diffuse.social.power.disciplines.people. into.certain.behaviors (Foucault,.1975). .. Public.health.programs.ask.us.to.be. ‘responsible.ciLzens’ (Lupton,.1995). .. But.can.we.escape.these. subjecLviLes?. It’s.a.trap !.(Bourgois,.2000). There.are. some

Ethnographies.of.AddicLon.

The%Classic:.

Cultural/interpreLve.theories.

.(Dai.1937;.Lindesmith.1947) ..

Drug.use.and.social.idenLty.

.(Becker.1963;.Spradley.1968) ..

CogniLve/linguisLc.approaches.

.(Spradley.1968;.Agar.1973)..

Ethnographies.of.AddicLon. The%Classic :. Cultural/interpreLve.theories. . (Dai.1937;.Lindesmith .1947) .. Drug.use.and.social.idenLty. . (Becker.1963;. Spradley .1968) .. CogniLve/linguisLc.approaches. .

Ethnographies.of.AddicLon.

The%Foucauldian:.

CriLcism.of.the.disease.model.

.(Singer.et

..

al

..

1992)

..

Drug.use.and.risk.as.a.discourse.

.(Beck.1992;.GlickUSchiller.1994) ..

NeoUMarxist.approaches ..

.(Bourgois.1995,.2000;.Bourgois.and.

.Schonberg.2009) ..

Ethnographies.of.AddicLon. The% Foucauldian :. CriLcism.of.the.disease.model. . (Singer.et .. al .. 1992) .. Drug.use.and.risk.as.a.discourse. . (Beck.1992;.GlickUSchiller.1994) ..

Ethnographies.of.AddicLon.

Ethnographies.of.AddicLon. The%New : .. Historical.Trauma.Theory .. .(Brave.Heart,.2003). NarraLves.of. melancholia* * (Garcia,.2010). AnLcipatory.interpellaLon .. .(Carr.2011). Even.more.new.things! ..

The%New: .. Historical.Trauma.Theory ..

.(Brave.Heart,.2003).

NarraLves.of.melancholia*

*(Garcia,.2010).

AnLcipatory.interpellaLon ..

.(Carr.2011).

Even.more.new.things! ..

.(Raikhel.and.Garrion,.eds.,.2013).

.

Gendered.IdenLty..

and.Ukrainian.Personhood.

Gendered.IdenLty .. and.Ukrainian.Personhood.

Biological%Ci6zenship.

 

Adriana.Petryna.(2002).Life*

Exposed:*Biological*Ci6zens*

a8er*Chernobyl."%

 

“AIDS.ciLzenship”.

 

(Biehl,.2004) ..

“TherapeuLc.ciLzenship” ...

 

(Nguyen,.2010)

..

 

“The.more.common.

outcome,.whether.one.is.a.

homeless.AIDS.paLent.in.

Brazil,.or.a.poor.Romanian.TB.

paLent.is.death,.not.

ciLzenshipUrelated.

redempLon.” ..

....(SLllo,.2012).

Biological%Ci6zenship . Adriana.Petryna .(2002). Life* Exposed:*Biological*Ci6zens* a8er*Chernobyl ." % “AIDS.ciLzenship”. ( Biehl ,.2004) .. “TherapeuLc.ciLzenship” ...

Methodology!

LocaLon.

LocaLon. “In.2009.surveys. were.conducted. for.the.first.Lme.in. such.oblast.centers. as.Vinnytsia , .. IvanoUFrankivsk ,. Zaporizhia ,. Zhytomyr , .. Rivne

“In.2009.surveys.

were.conducted.

for.the.first.Lme.in.

such.oblast.centers.

as.Vinnytsia, ..

IvanoUFrankivsk,.

Zaporizhia,.

Zhytomyr, ..Rivne,.

Chernivtsi,.

Uzhhorod,.and.

Chernihiv.” ..

(Ministry.of.Health,.

2010).

LocaLon.

LocaLon. The.vast.majority. of. epidemiological. studies.on.HIV. among.IDUs.are. conducted.in. Odesa , .... Donetsk,. Dnipropetrovsk ,. and.Mykolaiv ..

The.vast.majority. of. epidemiological. studies.on.HIV. among.IDUs.are. conducted.in. Odesa, .... Donetsk,. Dnipropetrovsk,. and.Mykolaiv..

Recruitment ..

PHASE%1%(Sept@Nov%2012)%

Convenience%Sample:%

.

I.talk.to.the.people.who.

are.easiest.to.contact,.

regardless.of.how.

representaLve.my.

sample.is ...

PHASE%2%(Jan@Dec%2013)%

Targeted%Snowball%

Sampling:.

Move.through.the.target.

populaLon.through.

chains.of.

recommendaLon ..

Especially.work.to.target.

key.and/or.hard.to.reach.

groups ...

Data.CollecLon ..

Primary.data.collecLon:.Semi@structured%interviews%

Begin.the.interview.with.some.general.or.broad.quesLons ..

Adapt.the.interview.script.according.to.what.the.subject.

finds.most.interesLng.or.important ..

Let.the.subject.control.the.direcLon.of.the.interview ...

Let"the"subject"teach"you"how"they"think"about"that"topic."

PotenLal.Piwalls.and.Challenges.

PotenLal.Piwalls.and.Challenges. I.need.to.gain.basic.linguisLc.and. narraLve.vocabulary .. I.need.to.learn.how.to.bring.up. certain.subjects.(like.rule. breaking) .. Someone.could.“flip.a.script”.(Carr,. 2011) .. This.is.a.longUstanding.problem. among.ethnographers.working.in. harm.reducLon.serngs.(Campbell. and.Shaw,.2008) ..

I.need.to.gain.basic.linguisLc.and. narraLve.vocabulary ..

I.need.to.learn.how.to.bring.up. certain.subjects.(like.rule. breaking) ..

Someone.could.“flip.a.script”.(Carr,. 2011) ..

This.is.a.longUstanding.problem. among.ethnographers.working.in. harm.reducLon.serngs.(Campbell. and.Shaw,.2008) ..

Analysis:.Grounded.Theory.

Analysis:.Grounded.Theory. The.researcher.remains. “constantly.alert.to. emergent.perspecLves.that. will.change.and.develop.his. [sic].theory”.(Glaser.and. Straus.1967,.40) ...

The.researcher.remains. “constantly.alert.to. emergent.perspecLves.that. will.change.and.develop.his. [sic].theory”.(Glaser.and. Straus.1967,.40) ...

Analysis:.Grounded.Theory.

Produce.whole.or.parLal.transcripts.of.

interviews.

Read.through.them.and.idenLfy.major.themes.

and.narraLves Code.the.texts.for.these.

..

themes.

Build.these.themes.into.your.next.set.of.

interviews Test.out.your.theory.

..

Refine.your.theory.and.your.codes.based.on.

the.new.informaLon.you.have.gathered ..

ReUcode.everything.and.repeat ..

Using.MaxQDA.(not.Atlas.L).

Preliminary Findings!

Some%things%I’ve%learned%so%far%that%I%

can%explain%and%even%more%that%I%can’t.%

New.‘Addict’.IdenLLes.Are.Emerging.

New.‘Addict’.IdenLLes.Are.Emerging. “This.social.construct. that.defines.who.and. what.an.injecLon.drug. user.is.has.primarily. incorporated. masculine.tropes.of. idenLty.”. .(Carroll,.2011a).

“This.social.construct.

that.defines.who.and.

what.an.injecLon.drug.

user.is.has.primarily.

incorporated.

masculine.tropes.of.

idenLty.”.

.(Carroll,.2011a).

Gendered.ELology.of.AddicLon.

.Common%assump6ons:.

....Men.selfUmedicate.their.

.
.

depression Their.problem.is.

..

psychological.and.medical ..

.Women.are.too.strong,.too.

focused,.“too.serious”.to.

fool.around.with.drugs ..

Their.problem.is.not.

Film.sLll.from.Balka:*Three*Stories** (Meskin,.Meskin,.and.Pinkham.2010) ..

psychological,.it’s.personal ..

(Carroll,.2011b).

...................

Discourses.of.Evidence.in.EvidenceU

Based.PracLce.

Discourses.of.Evidence.in.EvidenceU Based.PracLce.

Discourses.of.Evidence.in.EvidenceU

Based.PracLce.

“…The.validity.of.evidence.is.something.that.is.

“discursively.managed”.(Carr.2011,.p.68).by.

professionals.in.Ukraine’s.HIVUprevenLon.sphere…

[making.them].able.to.claim.agency.by.strategically.

situaLng.themselves.as.“socially.and.morally.

appropriate.persons”.(Zigon.2008,.p.90).within.the.

larger.structure.of.public.health,.[which.is].guided.by.

the.ideology.of.EBM.” .......................

(Carroll,.in.press).

...........

Tropicamide.

Tropicamide. Tropicamide.are.eye.drops. used.to.dilate.the.pupil .. . It.is. allegedly .used.to.amplify. the.effects.of.opiates ..

Tropicamide.are.eye.drops.

used.to.dilate.the.pupil ..

.

It.is.allegedly.used.to.amplify.

the.effects.of.opiates ..

Methadone.Mythology.

“These.aren’t.easy.drugs.like.

heroin.or.shirka.”*

*

“I.used.to.be.on.Methadikt,.

and.that.was.fine Then.they.

..

switched.me.to.Methadol,.

and.now.I’m.gerng.

headaches.at.night I.can’t.

..

tell.the.difference.between.

this.stuff.and.what.I.used.to.

inject.”.

Methadone.Mythology. “These.aren’t.easy.drugs.like. heroin.or. shirka .”* * “I.used.to.be.on.Methadikt ,. and.that.was.fine Then.they. .. switched.me.to.Methadol ,. and.now.I’m.gerng. headaches.at.night I.can’t.

The.PoliLcs.of.Last.Resort.

The.PoliLcs.of.Last.Resort. “This.is.the.last.stop.on.their.way.to.death.”. .

“This.is.the.last.stop.on.their.way.to.death.”.

.

Rumors.

Rapid.rehabilitaLon.

programs.designed.

to.fail.

Are.HIV.rates.in.the.

western.regions.

underesLmated?.

Are.wait.lists.

decreasing?.

General.poliLcal.

uncertainty.

Rumors. •   Rapid.rehabilitaLon. programs.designed. to.fail. •   Are.HIV.rates.in.the. western.regions. underesLmated?. •   Are.wait.lists. decreasing?. •

Agar,.M

..

1973

..Ripping*and*Running:*A*Formal*Ethnography*of*Urban*Heroin*Addicts..New.York:.

Academic.Press ...

 

Becker,.H

..

1963

..Outsiders:*Studies*in*the*Sociology*of*Deviance..New.York:.The.Free.Press..

Biehl,.J

..

2004

..

“The.AcLvist.State:.Global.PharmaceuLcals,.AIDS,.and.CiLzenship.in.Brazil.”.Social*Text*22

(3):.105U132 ..

Bourgois,.P.*1995.*In*Search*of*Respect:*Selling*Crack*in*El*Barrio.*New*York*:*Cambridge*University*Press.*.

Bourgois,.P

..

2000

..

“Disciplining.AddicLons”.Culture,*Medicine*and*Psychiatry*24:.165–195

...

Bourgois,.P

..

and.J

..

Schonberg 2009.*Righteous*Dopefiend..Berkeley:.University.of.California.Press..*.

..

Brave.Heart,.M

..

Y

H

2003 “The.Historical.Trauma.Response.Among.NaLves.and.Its.RelaLonship.with.

..

Substance.Abuse:.a.Lakota.IllustraLon.”.Journal*of*Psychoac6ve*Drugs.35(1):.7U13 ....

 

Campbell,.N

..

D

and.S

J

Shaw

..

2008 “Incitements.to.Discourse:.Illicit.Drugs,.Harm.ReducLon,.and.the.

..

ProducLon.of.Ethnographic.Subjects”.Cultural*Anthropology.23(4):.688U717 ..

Carr,.S

..

E 2010

 

Princeton.University.Press ..

 

Carroll,.J

..

2011a

..

“A.Woman.Among.Addicts:.the.ProducLon.and.Management.of.IdenLLes.in.a.

Ukrainian.Harm.ReducLon.OrganizaLon.”.Anthropology*of*East*Europe*Review.29(1):.23U34 ..

Carroll,.J

..

2011b

..Addic6on,*Gender,*and*the*Limits*to*Public*Health*Solu6ons*to*IV*Drug*Use*in*Ukraine..

Research.Competency.Paper,.presented.to.the.University.of.Washington.Department.of.Anthropology ..

Carroll,.J ..In*Press.*“Evidence.Based.Medicine.and.the.ConstrucLon.of.Moral.Agency.in.Ukraine,”.in.

CARGO:*Journal*for*Cultural*and*Social*Anthropology ..

 

Dai,.B

..

1937

..

Opium.AddicLon.in.Chicago

..

Montclair,.NJ:.Panerson.Smith

..

Field,.M

..

1967

...Soviet*Socialized*Medicine:*An*introduc6on..New.York:.The.Free.Press..

Foucault,.M

..

1975

..The*birth*of*the*clinic:*An*archaeology*of*medical*percep6on..New.York:.Vintage.

Books ...

 
 

Garcia,.A 2010.*The*Pastoral*Clinic:*Addic6on*and*Dispossession*along*the*Rio*Grande Berkeley:.

..

..

University.of.California.Press ...

Geertz,.C

..

1973

..The*Interpreta6on*of*Cultures..New.York:.Basic.Books...

Glaser,.B

..

G

and.A

..

L Strauss

..

1967

..The*discovery*of*grounded*theory:*Strategies*for*qualita6ve*

research..Chicago:.Aldine.Publishing.Company.

GlickUSchiller,.N

..

1992

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“What’s.Wrong.with.This.Picture?.The.Hegemonic.ConstrucLon.of.Culture.in.

AIDS.Research.in.the.United.States ..Medical*Anthropology.6(3):.237U254..

Kleinman,.A

..

1988

..The*illness*narra6ves:*Suffering,*healing,*and*the*human*condi6on..Basic.Books..

Lindesmith,.A R 1968 ..

..

..Addic6on*and*Opiates..Chicago:.Aldine..

Lupton,.D 1995.*The*Impera6ve*of*Health:*Public*Health*and*the*Regulated*Body London:.Sage ..

..

..

Ministry.of.Health.of.Ukraine

..

(2010)

..Ukraine:*Na6onal*Report*on*Monitoring*Progress*Towards*the*

ANGASS*Declara6on*of*Commitment*on*HIV/AIDS.*Repor6ng*Period:*January*2008–December*2009 Kyiv.

..

U2010 ...

Nguyen,.V.UK

..

2010

..The*Republic*of*Therapy:*Triage*and*Sovereignty*in*West*Africa’s*Time*of*AIDS.*

Durham:.Duke.University.Press ..

Petryna,.A

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THANK.YOU!.

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