Catherine Benoît

*Au Cœur des ténèbres de la* friendly island: *Migrations, culture et sida à St. Martin*.

Paris: Éditions Hermann, 2015. xviii + 209 pp. (Paper € 28.00)

This study by Catherine Benoît reflects nearly two decades of research on health, mobility, and inequalities in the Caribbean (and to a lesser degree in North America and Europe). Like impoverished migrants elsewhere, the migrants she studied—principally HIV-infected persons of Haitian origin in the French overseas department of Saint-Martin—face discrimination, limited access to treatment, and ongoing threats of deportation. Benoît combines close attention to ethnographic detail with a range of conceptual lenses in medical anthropology to craft a sobering analysis of an epidemic whose impacts continue to emerge and shift in the wake of political and economic changes, and in response to new treatment modalities.

The book draws heavily from individual case studies and Benoît's detailed field notes. In a style reminiscent of Paul Farmer's *AIDS and Accusation: Haiti and the Geography of Blame* (1992), it traces (in Chapters 1 and 3 and the coda) the migration patterns, diagnostic strategies and therapeutic itineraries of individual patients and their kin networks. In the second chapter, Benoît juxtaposes the conflicting identities of Saint-Martin as both an offshore tax haven for the wealthy and a “migratory hell” for those seeking low-wage employment in the construction industry or as domestic servants. The expansion of tourism (in particular the increase in the number of cruise ships visiting the island) also created new opportunities for employment, but labor in this sector is often low wage and precarious.

Chapter 4 examines how factors such as exclusion and stigma shape the encounters of HIV-AIDS patients with both biomedicine and spiritually-based treatments (often used in combination), and includes excerpts from Haitian and European informants living in Saint-Martin. Chapter 5 traces the history of viral epidemiology in Saint-Martin and the adjacent Dutch territory of Sint-Maarten, which was marked by deficient infrastructure and contested definitions that rendered the disease “invisible” until the 1990s. Finally, Chapter 6 describes the complex relationship between Haitian Vodou and biomedicine, drawing from interviews with over a hundred *oungans* and *manbos* (Vodou ritual specialists and healers) and repeated interviews with 31 HIV patients. It offers a critique of “culturalist” HIV prevention interventions that reify and oversimplify “culture,” in this case Haitian culture and Vodou. Benoît calls for public health approaches that would “conceptualize culture as the expression of social and political relations” (p. 144, my translation).
For a study situated in the Francophone Caribbean, Benoît’s use of concepts and theories from both Francophone and Anglophone (primarily U.S.-based) medical anthropology is particularly appealing. She also highlights the contribution of Caribbean scholars. Her interest in mobility and migration, combined with the diversity of her field sites, which include four locations (Saint-Martin, Haiti, metropolitan France, and the United States), captures the ever-present transnational dimensions that characterize the Caribbean. At times, however, the links between the individual case studies presented and the larger structural context are not made explicit. This may be in part due to the diversity and range of themes addressed in the book. Religion and spirituality are a recurring theme throughout the volume. Benoît is particularly deft at tracing the influence that Vodou has both in patients’ therapeutic itineraries and in the imagination of those creating programs to counter HIV. While the influence of Vodou and other Afro-diasporic religions (and the negative reactions to them) on the health sector in the Caribbean should not be minimized, Benoît seems less interested in the dramatic expansion and increasingly strong influence of Protestant Christian cosmologies and epistemologies, even when they appear explicitly in the discourses of her informants. Further work in this area could contribute to a better understanding of Protestant healing practices and the interplay between evangelism and biomedicine in transnational healing networks.

Benoît’s volume is an important contribution to medical anthropology, Caribbean studies, and the study of transnational migration. The breadth and range of her data are impressive, and a testament to her long-standing engagements with the Caribbean region. Most importantly, her text will be of particular interest to Francophone Caribbean scholars, who often face challenges in accessing English-language anthropological texts.

Pierre Minn

Département d’anthropologie, Université de Montréal,
Montréal H3C 3J7, Canada

pierre.minn@umontreal.ca