Papers by Caroline Parker
Incarceration, 2024
This study presents the first ever comparative regional portrait of racial inequality and incarce... more This study presents the first ever comparative regional portrait of racial inequality and incarceration across the Americas, using census data from Brazil, Cuba, Puerto Rico, and the United States mainland. While racism is known to pervade criminal justice across the US mainland, Latin American prisons remain understudied, with the entire region often construed as racially harmonious and uniformly "mixed" rather than racially plural or stratified. Our findings reveal consistent underrepresentation of white individuals and overrepresentation of Black individuals in all countries. Mixed-race individuals in Brazil, Cuba, and Puerto Rico experience higher incarceration rates than whites but lower rates than Blacks. These findings challenge the conception that the US mainland is unique in its historically entrenched profile of structural racism, while highlighting varying degrees of racial inequality internationally. Whereas Cuba and the US mainland display relatively higher levels of racial inequality in imprisonment, Puerto Rico and Brazil display relatively lower levels.
Global Public Health, 2019
The Dominican Republic is thought to have significant epidemics of illicit drug use but lacks sur... more The Dominican Republic is thought to have significant epidemics of illicit drug use but lacks surveillance and formal analyses of the policy context of drug prevention and treatment services. We conducted an institutional ethnography of 15 drug service organisations in Santo Domingo and Boca Chica, Dominican Republic, to explore barriers and resources for drug abuse prevention and treatment. Here, we present a typology of drug service organisations based on their services, methods, and approach. We then draw on interviews with representatives of drug service institutions to describe the primary barriers to drug treatment and prevention services for drug users. We conclude with a focus on the policy priorities that could improve the conditions of health care for marginalised drug users in the Dominican Republic.
Journal of urban health : bulletin of the New York Academy of Medicine, Jan 2, 2018
This paper advances research on racism and health by presenting a conceptual model that delineate... more This paper advances research on racism and health by presenting a conceptual model that delineates pathways linking policing practices to HIV vulnerability among Black men who have sex with men in the urban USA. Pathways include perceived discrimination based on race, sexuality and gender performance, mental health, and condom-carrying behaviors. The model, intended to stimulate future empirical work, is based on a review of the literature and on ethnographic data collected in 2014 in New York City. This paper contributes to a growing body of work that examines policing practices as drivers of racial health disparities extending far beyond violence-related deaths.
Culture, health & sexuality, Jan 23, 2016
Black men who have sex with men in the USA face disproportionate incidence rates of HIV. This pap... more Black men who have sex with men in the USA face disproportionate incidence rates of HIV. This paper presents findings from an ethnographic study conducted in New York City that explored the structural and socio-cultural factors shaping men's sexual relationships with the goal of furthering understandings of their HIV-related vulnerability. Methods included participant observation and in-depth interviews with 31 Black men who have sex with men (three times each) and 17 key informants. We found that HIV vulnerability is perceived as produced through structural inequalities including economic insecurity, housing instability, and stigma and discrimination. The theoretical concepts of social risk, intersectional stigma, and the social production of space are offered as lenses through which to analyse how structural inequalities shape HIV vulnerability. We found that social risk shaped HIV vulnerability by influencing men's decisions in four domains: 1) where to find sexual partne...
Culture, Health & Sexuality, 2019
In Vietnam, HIV continues disproportionately to affect men who have sex with men and transgender ... more In Vietnam, HIV continues disproportionately to affect men who have sex with men and transgender women, and the increase in HIV prevalence in these populations may be related to a lack of tailoring of current prevention approaches, which often fail to address social diversity within these populations. To effectively respond to HIV in Vietnam, it is imperative to identify sub-populations within the broad category of 'men who have sex with men' (MSM), a term which in Vietnam as in many other sites frequently subsumes transgender women. In this paper, we document the different categories used to describe people who engage in same-sex sexual practices and/or non-normative gender performances drawing on data collected via in-depth interviews and focus groups with a total of 79 participants in Hanoi. We identified over 40 different categories used to describe men who have sex with men and/or transgender women. These categories could be described as behaviourally-based, identity-based, or emic, and each carried different meanings, uses (based on age and geography) and levels of stigma. The categories shine light on the complexity of identities among men who have sex with men and transgender women and have utility for future research and programming to more comprehensively address HIV in Vietnam.
European Review of Latin American and Caribbean Studies
The punitive turn in crime control has radically altered the shape and meaning of citizenship acr... more The punitive turn in crime control has radically altered the shape and meaning of citizenship across the Americas. Imprisonment, compulsory drug rehabilitation, and alternative forms of penal control have multiplied, circumscribing citizens’ options for social and political participation while also leading to striking new modes of social, political, and economic membership across the region. While criminalization is ordinarily viewed as something that threatens ‘full’ citizenship, this special collection explores the new and differentiated kinds of political, economic, and social belonging being devised by the region’s criminalized men and women. In paying close attention to how penal power and its subversion articulate with existing stratifications of citizenship, we illuminate how distinct kinds of carceral citizenship are emerging in various locales across Latin America and the Caribbean. In this article, we also introduce the other contributions to this Special Collection.
European Review of Latin American and Caribbean Studies
The predominant criminological view of ‘carceral citizenship’ takes citizenship as a purely jurid... more The predominant criminological view of ‘carceral citizenship’ takes citizenship as a purely juridical matter, overlooking key social dimensions of citizenship as a human practice. To understand how the carceral turn is reconfiguring citizenship in Puerto Rico, I explore how formerly incarcerated people carve out a place for themselves in Puerto Rican society under the shadow of the prison. Focusing on one couple and their efforts to operate a therapeutic community, I show how self-help supplies a subset of former prisoners with a publicly recognized form of social belonging. Though more stable and encompassing than the stigmatized exile that awaits many people returning from prison, this carceral citizenship invites formerly incarcerated people to assume critical roles in the confinement, punishment, and care of people convicted of drug offences. Overall, this article highlights how self-help and punishment have emerged as intertwined mediums through which formerly incarcerated people assert their citizenship.
Global Public Health, 2023
Journal of community health, Jan 11, 2018
Policy makers and public health practitioners rarely consider public libraries to be part of the ... more Policy makers and public health practitioners rarely consider public libraries to be part of the health system, even though they possess several characteristics that suggest unrealized potential to advance population health. This scoping review uses an adapted social determinants framework to categorize current health-related work conducted by public libraries in the United States and to discuss libraries' potential as 'meso-level' community resources to improve population health. Our discussion of libraries contributes to scholarship on place-based health disparities, by emphasizing the potential impact of institutions that are modifiable through social policy-e.g., parks, community centers, schools-and which have a conceptually clear or empirically documented relationship to health.
Contemporary clinical trials, Jan 14, 2015
Although HIV interventions and clinical trials increasingly report the use of mixed methods, stud... more Although HIV interventions and clinical trials increasingly report the use of mixed methods, studies have not reported on the process through which ethnographic or qualitative findings are incorporated into RCT designs. We conducted a community-based ethnography on social and structural factors that may affect the acceptance of and adherence to oral pre-exposure prophylaxis (PrEP) among Black men who have sex with men (BMSM). We then devised the treatment arm of an adherence clinical trial drawing on findings from the community-based ethnography. This article describes how ethnographic findings informed the RCT and identifies distilled themes and findings that could be included as part of an RCT. The enhanced intervention includes in-person support groups, online support groups, peer navigation, and text message reminders. By describing key process-related facilitators and barriers to conducting meaningful mixed methods research, we provide important insights for the practice of des...
PloS one, 2015
Black men who have sex with men (BMSM) experience among the highest rates of HIV infection in the... more Black men who have sex with men (BMSM) experience among the highest rates of HIV infection in the United States. We conducted a community-based ethnography in New York City to identify the structural and environmental factors that influence BMSMs vulnerability to HIV and their engagement with HIV prevention services. Methods included participant observation at community-based organizations (CBOs) in New York City, in-depth interviews with 31 BMSM, and 17 key informant interviews. Our conceptual framework shows how creating and sustaining safe spaces could be a critical environmental approach to reduce vulnerability to HIV among BMSM. Participant observation, in-depth and key informant interviews revealed that fear and mistrust characterized men's relation to social and public institutions, such as churches, schools, and the police. This fear and mistrust created HIV vulnerability among the BMSM in our sample by challenging engagement with services. Our findings suggest that to b...
Global public health, 2016
The USA faces disproportionate and increasing HIV incidence rates among Black men who have sex wi... more The USA faces disproportionate and increasing HIV incidence rates among Black men who have sex with men (BMSM). New biomedical technologies such as pre-exposure prophylaxis (PrEP) have been developed to address their HIV risk. Very little consideration, however, has been given to the diversity obscured by 'BMSM' as a category, to how this diversity relates to men's sexual partnering strategies, or to the relevance of these issues for new HIV prevention methods. We conducted a community-based ethnography from June 2013 to May 2014 documenting factors that affect the acceptance of and adherence to PrEP among BMSM. We conducted in-depth interviews with 31 BMSM and 17 community stakeholders, and participant observation. To demonstrate the diversity of social identities, we present a taxonomy of indigenous categories organised along the axes of sexual identity, sexual positioning, and gender performance. We analyse how HIV prevention strategies, such as PrEP, may be more effe...
Science, Technology, & Human Values
This paper traces the unspoken, implicit white racial logic of the brain disease model of addicti... more This paper traces the unspoken, implicit white racial logic of the brain disease model of addiction, which is based on seemingly universal, disembodied brains devoid of social or environmental influences. In the United States, this implicit white logic led to “context-free” neuroscience that made the social hierarchies of addiction and its consequences invisible to, and thus exacerbated by, national policies on opioids. The brain disease model of addiction was selectively deployed among the white middle-class population that had long accessed narcotics and pharmaceutical treatments for narcotics disorders from biomedical clinics, as opposed to from illegal sources subject to law enforcement. In turn, new treatments for opioid addiction were racially marketed to the same white clientele to which newly patented opioid analgesics were marketed, tapping into a circumscribed but highly lucrative consumer base that has long benefited from a legally protected, racially segregated safe spac...
The Journal of adolescent health : official publication of the Society for Adolescent Medicine, Jan 23, 2018
This scoping study sought to provide an overview of existing interventions, programs and policies... more This scoping study sought to provide an overview of existing interventions, programs and policies that address family-based stigma and discrimination against LGBTQ youth. A keyword search in three online databases identified relevant scientific publications. Because it located a relatively small number of peer-reviewed publications, additional grey literature references were included, identified through consultation with specialists and through anonymous peer-review. Research, policies and interventions were categorized using an adapted ecological framework. There is very little peer-reviewed research on interventions to reduce family stigma and discrimination against LGBTQ youth. Most on-going work to improve family environments for LGBTQ youth appears to be currently conducted by city governments and non-governmental organizations. Very few interventions or programs provide any outcome data. Theoretical frameworks and approaches vary widely. Given the widely recognized importance ...
Archives of sexual behavior, Jan 20, 2018
Research on gender and health, including research conducted among Black men who have sex with men... more Research on gender and health, including research conducted among Black men who have sex with men (BMSM), has primarily focused on how gender norms and roles shape healthcare engagement. Here we advance that work by demonstrating how a broader theorization of gender, particularly one that moves beyond gender norms and performance to incorporate structures such as the healthcare system and the labor market, can facilitate an understanding of how gender affects preventive healthcare seeking among BMSM, particularly the uptake of pre-exposure prophylaxis (PrEP), a promising approach to alleviate HIV disparities. This article is based on a year-long ethnographic study conducted in New York City with BMSM (n = 31; three interviews each) and community stakeholders (n = 17). Two primary findings emerged: (1) the labor market systematically excluded the men in our sample, which limited their ability to access employer-sponsored healthcare. Such discrimination may promote overt demonstration...
AIDS patient care and STDs, Jun 24, 2016
Research has demonstrated the clinical effectiveness of pre-exposure prophylaxis (PrEP) for HIV p... more Research has demonstrated the clinical effectiveness of pre-exposure prophylaxis (PrEP) for HIV prevention, but little is known about how factors at the individual-, interpersonal-, community-, and structural levels impact PrEP use for black men who have sex with men (BMSM). We advance existing work by examining how all levels of the ecological framework must be addressed for PrEP to be successfully implemented as an effective HIV prevention approach. We interviewed 31 BMSM three times each and 17 community stakeholders once each; interviews were taped, transcribed, and analyzed using the constant comparative method. Factors that influence how BMSM experienced PrEP emerged across all levels of the ecological framework: At the individual level, respondents were wary of giving medication to healthy people and of the potential side-effects. At the interpersonal level, BMSM believed that PrEP use would discourage condom use and that PrEP should only be one option for HIV prevention, not...
Background: Black men who have sex with men (BMSM) have the highest HIV incidence rates in the U.... more Background: Black men who have sex with men (BMSM) have the highest HIV incidence rates in the U.S. and it is vital to explore how new prevention approaches might reduce those rates. Research has demonstrated the clinical effectiveness of pre-exposure prophylaxis (PrEP), but little is known about how BMSM understand, talk about, and experience PrEP. Methods: BMSM in New York City (n=28) completed three in-depth interviews each for a total of 270 minutes of data. Fourteen key informants (e.g. community leaders and service providers) also participated. We taped, transcribed, and analyzed interviews to explore how individuals talked about their understanding of, and potential barriers to, using PrEP. Results: Individuals reported a number of factors influencing the likelihood of PrEP use. First, men disliked taking medication and felt a daily pill was “too much commitment” just for sex, particularly when they were healthy. Second, men reported that taking a medication associated with H...
Medical anthropology quarterly, Dec 17, 2018
In this article, we use syndemic theory to examine socio-structural factors that result in height... more In this article, we use syndemic theory to examine socio-structural factors that result in heightened vulnerability to HIV infection and drug addiction among Dominican deportees who survive post-deportation through informal tourism labor. Through an ongoing NIDA-funded ethnographic study of the syndemic of HIV and problematic drug use among men involved in tourism labor in the Dominican Republic, we argue that the legal and political-economic context of the global deportation regime contributes to structural vulnerabilities among deportees in the Dominican Republic, most of whom are men with histories of incarceration in the United States and/or Puerto Rico. While Dominican laws and institutional practices work conjointly with foreign policies to reconfigure non-criminal deportees as hardened criminals unworthy of full citizenship rights, the informal tourism economy provides one of the few absorption points for male deportee labor, linking the deportation regime directly to the Car...
American Ethnologist, 2021
At an addiction shelter called La Casita, in Puerto Rico, male residents espouse an ethic of busy... more At an addiction shelter called La Casita, in Puerto Rico, male residents espouse an ethic of busyness. Initially, La Casita's ideology of moralized work patterns and time discipline seems like a throwback to the 19th-century factory floor: a tool of market discipline. But a closer look at residents’ experiences reveals that busyness has less to do with capitalist subject formation than with finding an alternative way of living when one is excluded from the labor market. If the capitalist project turns on the productive commodification of time, La Casita's work ethic—despite official avowals to the contrary—aims to convert unproductive time into an ascetic practice of ceaseless self-work. Though not always successful, keeping busy becomes a way for residents to carve out a meaningful way of living from an overabundance of time. [labor, work ethic, boredom, time, addiction treatment, Puerto Rico]
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Papers by Caroline Parker