The social life of ivermectin: Socio-cultural and political constructions of a Western pharmaceutical and its mass distribution in onchocerciasis-endemic communities in sub-Saharan Africa.

摘要

The biomedical model explains onchocerciasis as a disease caused by Onchocerca volvulus, a nematode transmitted to humans through the bite of the blackfly Similium. Physical symptoms of onchocerciasis include vision impairment, total blindness, severe itching, skin lesions, and skin atrophy. Social consequences include: inability to work due to extreme fatigue from sleeplessness, reduced libido, low self-esteem from social stigma, and inability to engage in social activities. Nearly 100 million people, 99% of whom live in remote subsistence farming villages in Africa, are at risk of contracting onchocerciasis.Ivermectin is a pharmaceutical used to treat onchocerciasis. Since 1987, it has been provided by Merck & Co. Inc. free of charge to all onchocerciasis-endemic countries worldwide. In 2000, more than 90 million Mectizan tablets were distributed in 22 African countries through a mass distribution strategy. More than 30 million people in Africa take Mectizan treatment every year.The dissertation research was conducted between 2000 and 2002 in five African countries implementing mass distribution of ivermectin to treat onchocerciasis. It applied the theoretical frameworks of pharmaceutical anthropology within a praxis approach. Rapid research methods were used to describe local explanations of the drug, including how ivermectin works in the body and the interpretation of side effects, exploring ways in which the symbolism, meanings, and commoditization of ivermectin reinforce hierarchical structures of power in communities, national programs, and international organizations.Most residents of endemic communities appreciated the benefits of ivermectin treatment and were eager to participate in the mass distribution. Although men's and women's underlying ivermectin treatment attitudes and behaviors were very different and influenced by social constructions of gender, their overall treatment rates were similar. Mass distribution strategies would benefit by increasing women's access to information and engagement in decision-making, and empowering families, who play critical roles in the management of serious adverse events, to more effectively access emergency care and services through the government health system.