RESEARCH Open Access

Globalization and its methodological discontents:Contextualizing globalization through the studyof HIV/AIDSGarrett W Brown1 and Ronald Labonté2*

Abstract

There remains considerable discontent between globalization scholars about how to conceptualize its meaningand in regards to epistemological and methodological questions concerning how we can come to understandhow these processes ultimately operate, intersect and transform our lives. This article argues that to betterunderstand what globalization is and how it affects issues such as global health, we must take a differentiatingapproach, which focuses on how the multiple processes of globalization are encountered and informed bydifferent social groups and with how these encounters are experienced within particular contexts. The articleexamines the heuristic properties of qualitative field research as a means to help better understand how theintersections of globalization are manifested within particular locations. To do so, the article focuses on threerecent case studies conducted on globalization and HIV/AIDS and explores how these cases can help us tounderstand the contextual permutations involved within the processes of globalization.

IntroductionAcademics generally add the suffix ‘ization’ to a wordwhen they wish to denote that something is a process.When customary law becomes codified positive law, wecall this a process of constitutionalization. When press-ing issues are increasingly framed in terms of a securitythreat, we call this a process of securitization. Conse-quently, when we refer to increasing interconnectionsbetween peoples, economies, cultures, governments,environments and other various networks at the globallevel, we call this a process of globalization. In terms ofetymology, globalization literally refers to the idea of‘global process’ and the term originally surfaced in thelate 1960s as a conceptual device to help us betterunderstand the growing perception that the world wasbecoming increasingly interconnected economically,financially, technologically, culturally, politically andenvironmentally. As it is generally defined in any stan-dard dictionary, the term globalization refers to ‘anumbrella concept that seeks to capture the growing

interconnectedness and integration of human society atthe planetary scale [1] [p.112].’However, as with any word ending in ‘ization’ there

remains considerable discontent between globalizationscholars about how to conceptualize its meaning and inregards to epistemological and methodological questionsconcerning how we can come to understand how theseprocesses ultimately operate, intersect and transformour lives. In trying to provide answers to such questions,most scholars have traditionally engaged in the study ofglobalization from a methodological standpoint thatgenerally relies on two foundational approaches: locatingone feature of globalization as representing its definingproperty [2-4]; and approaching the study of globaliza-tion from the assumption that it is an epistemologicallyunderstandable phenomenon about which we can reachdefinite conclusions as to its processes [5,6], its positiveor negative effects [7-11], its transformative capacity[12-14,6] or its irrelevance [15,16].While yielding important knowledge claims about glo-

balization, traditional approaches to the study of globali-zation often fail to capture many facets involved withinits multifarious and complex processes: that whateverglobalization is, it is not something that is easily defin-able or reasonably encapsulated by a single trend (or

* Correspondence: rlabonte@uottawa.ca2Institute of Population Health, University of Ottawa, Ottawa, Ontario,CanadaFull list of author information is available at the end of the article

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bundle of trends) associated with global interconnection.It is more appropriate to think of globalization as apluralistic phenomenon with indeterminate idiosyncra-sies [17,18] and anomalistic permutations [19]. AsDaniel Cohen contends, there is a key dialectical dimen-sion to globalization that is often missed by traditionalapproaches and these contradictions are illustrated sim-ply by the fact that the concept of globalization has‘altered people’s expectations more than it has increasedtheir ability to act [20] [p.166].’ Methodologically, therehas been a tendency for scholars of globalization tofocus largely on macro-level quantitative research inorder to illustrate how the world is becoming more orless interconnected. These macro-level models are lar-gely preoccupied with the analysis of economic trends,usually ignoring other key aspects involved with the pro-cesses of globalization. They also suffer the limitation ofbeing stylized regressions which may (or may not)inform us of the causal direction of the correlates underinvestigation, and little about how the effects of thesetrends are distributed within national populations.Although macro-level methods remain useful for locat-ing many interconnected networks involved with globa-lization, they are weak in explaining how theseprocesses are experienced or understood by thoseinvolved, bypassing idiosyncratic interfacings that takeplace between the global and the local.In response to these limitations, some researchers have

argued that ‘when thinking about globalization we need topay closer attention to how its numerous flows and processare encountered and informed by different actors and agen-cies in a range of cultural, political and social contexts [21][p.1].’ To better understand what globalization is and howit affects our lives, we must take a differentiating approach,which focuses on how the multiple processes of globaliza-tion are ‘encountered and informed by different socialgroups’ and with how these encounters are experiencedwithin particular contexts [21] [p.139]. It is thus increas-ingly important to incorporate a qualitative and ethno-graphic component to globalization research to bettercapture its multidimensional, contradictory and at timesempirically and conceptually indeterminate processes.As a means to engage with this approach, this article

examines some heuristic properties of qualitative fieldresearch as a means to help better understand how theintersections of globalization are manifested within par-ticular locations. Its focus is on three recent case studieson globalization and HIV/AIDS and explores how thesecases can help us to understand the dialectical permuta-tions involved within the processes of globalization.

The Conceptualization of GlobalizationBefore examining a contextual approach to the study ofglobalization, it is useful to provide further discussion

about how globalization has been traditionally concep-tualized and studied. Borrowing from the typology pro-vided by David Held et al. [22], it is possible to locateapproximately three traditional approaches involvedwith how globalization has been conceptualized: global-ist, sceptic and transformationalist. Presenting globaliza-tion theory in these general terms will not fully capturethe nuance, difference and sophistication of argumentcontained within each category. The typology is never-theless useful in that it provides a heuristic device thatcan help us understand the general themes associatedwith various approaches in the study of globalization aswell as highlight the various ways scholars see the pro-cesses of globalization impacting upon our lives.To begin, a globalist approach (also sometimes

referred to as hyperglobalist) to the study of globaliza-tion tends to conceptualize globalization as a progressiveprocess of market interconnectedness that is ushering ina radically ‘globalized’ era in human history. This newglobal epoch is constituted by a systematic breakdownof economic barriers, of sovereign borders, denationali-zation and of traditional ideological disagreements invol-ving economics and politics. From this ‘globalized’ontology, most globalists view the process of globaliza-tion as a positive expansion of the global market, whichis supported by an exponential growth in economictransactions [5], trade [23], foreign investment [24],labor mobility and the growth of multinational corpora-tions [25]. Because of this increased economic integra-tion, some scholars like Kinichi Ohmae maintain thatglobal capitalism holds the promise of creating globalinterdependence to the point where territorial bound-aries and state sovereignty are weakened in favor of amore economically, politically and culturally unifiedworld [7]. Other scholars have preferred to focus on theinherent qualities of global capitalism in order to sug-gest that globalization represents a process of progres-sive global economic advancement and that marketcapitalism has both the capacity to create global pros-perity as well as the ability to overcome existing nega-tive externalities [6,26]. What is common within theglobalist position is the conceptualization of globaliza-tion as an economically driven process that is movinghumanity closer to a more unified world, one in whichthe disparities between borders, markets, economies andcultures are radically reduced in favor of a more com-mon global condition.Conversely, if the globalist argument is one that

roughly perceives globalization as a process of progres-sive economic and liberal ideological advancement, thenit is possible to understand a sceptical approach as onethat challenges the positive elements involved with thisglobalist reading. However, to be clear, the sceptic posi-tion is a fairly broad church and it maintains roughly

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three sub-categories. First, many sceptics believe thatglobalization is an actual phenomenon and that itencompasses several economic, political and culturaldimensions that have profound impacts on people’slives. Nevertheless, sceptics disagree with globalistsabout the positive ‘nature’ of globalization (at least itseconomic dimension and the politics that support it),arguing that the benefits of globalization are largelyrestricted to, or asymmetrically skewed towards, thethree trading blocks of North America, Europe andJapan [8]. Because of this, sceptics view globalization assomething of a misnomer and believe that it is moreappropriate to speak of globalization in terms of triadi-zation [8], globalism [27], exploitation [28,29], depen-dency [30], neo-liberalism [10,31], neo-imperialism[32,33] or simply the global diffusion of capitalism withits traditional crises of over-production/under-consump-tion compounded by the increased financialization ofglobal markets in which currency and investment specu-lation affords more opportunity for capital accumulationthan participation in the ‘real’ economy [34]. Second,some sceptics have in the past challenged the use of glo-balization as a conceptual device by arguing that globali-zation is nothing more than ‘a term used by a lot ofwooly thinkers who lump together all sorts of superfi-cially converging trends [16]’ and that it is so concep-tually impoverished as to ‘not even have existed [15].’ Inthis regard, some sceptics have suggested that globaliza-tion is an over-hyped and over-inflated concept in thesocial science lexicon that has little analytical and socialscientific purchase, at least as a wholly new or distinctphenomenon. Others have argued that different con-structions of globalization are leading politicians andbusinesses to act as if the globalized world exists associally imagined, and in doing so are actively creatingthat to which they assume they are only responding[35]. Waldon Bello, a Marxist-inspired sceptic of globali-zation’s economic inequalities, is one of a number ofwriters who argue for a ‘deglobalization.’ Unlike moreextreme localists [36], Bello acknowledges the impor-tance of international economic engagement andexchange, but calls for a deliberative reorienting ofnational economies from an emphasis on export for for-eign markets to production for domestic consumption; astrategy that China is, in fact, now pursuing to over-come the decline in its US and European export mar-kets. Illustrative of the blurring between these threetypologies, however, Bello argues the necessity of a plur-alist system of global economic governance in order fornational economies to successfully de-globalize [37].Lastly, some sceptics, as if to reinforce Bello’s point,have presented a ‘post-globalist’ challenge to globaliza-tion, by suggesting that globalization represents a dyingphase in human history that is ‘unexpectedly over [14]’

and that globalization has been replaced with a new eraof reinvigorated nationalism and religious fundamental-ism [10].The third conceptualization of globalization focuses

less on locating a specific ‘driver’ involved with its pro-cesses and, instead, it attempts to locate the variousways in which globalization symbolizes an unprece-dented period of global interconnectedness and socialtransformation. In this regard, globalization is not inher-ently good or bad, or primarily related to a single globalimpetus, but is seen as the result of incalculable eco-nomic, cultural and political ‘transformations’ that are‘restructuring the ways in which we live... in a very pro-found manner [38].’ According to Anthony Giddens,these transformative processes are intrinsically asso-ciated with conditions of modernity in that contempor-ary social systems are increasingly ‘stretched’ acrossterritories, identities, economies and cultural life-worlds[39], even if huge asymmetries in the pace of, controlover and benefits of such ‘stretching’ persist. Because ofthis spatial-temporal distanciation, globalization hascome to affect every dimension of contemporary lifefrom the creation of new global narratives regardingeconomic integration to more mundane aspects ofeveryday living. Although many of the world’s peoples,particularly in low-income countries, are marginal actorsin such processes, they can be dramatically affected bythem, as in the disproportionate burdens of poverty andunemployment experienced by many poor countries inthe wake of the ‘first world’ global financial crisis of2008. Consequently, many transformationalists believethere are compelling arguments offered by globalists aswell as sceptics and that any study of globalization willdeliver evidence to support both positions [22]. There-fore, as an alternative, the transformationalists try tonavigate a middle position by focusing on how the pro-cesses of globalization are changing our social structuresand to examine what negative and positive impactsthese processes have when they further ‘stretch’ socialrelations beyond traditional borders. The global diffu-sion of digital technologies, as one example, permits theglobal market integration economies favored by global-ists; while creating new forms of oppositional socialmobilization by those sceptics who focus on the negativeexternalities of such integration. Unlike the sceptics andglobalists, transformationalists do not conceive globali-zation as inherently good or bad, or as being primarilyeconomic or cultural.As this brief sketch illustrates, there is little consensus

between globalization scholars about what globalizationis and about what impacts it ultimately has on our lives.At a minimum, apart from a few sceptics, there is agree-ment that the definition of globalization involves therecognition of some form of greater integration and

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interconnection at the global level. Furthermore, there isalso fairly widespread consensus that the new languageof globalization is necessary to help describe geographi-cal and political issues of denationalization, the diminu-tion of the significance of territorial boundaries anddeterritorialization [40]. However, as Manfred Stegerpoints out, this broad definitional agreement and use ofcommon language remains extremely abstract and ‘tellsus little about [globalization’s] remaining qualities [2].’These conceptual difficulties are compounded by thefact that there is widespread disagreement about whatkey processes or properties underwrite globalization. Inthis regard, not only do globalization scholars disagreeabout how to understand the ‘nature’ of globalization ona meta-theoretical level, but there are also fundamentaldisagreements about what empirical processes (eco-nomic, cultural, political, territorial) should be studiedas a means to try and define its character and its effects.Furthermore, as will be discussed below, there is alsodiscontent about what research methods are mostappropriate to ‘capture’ the empirical characteristics ofglobalization and how to best incorporate this metho-dology as a means to substantiate any one particularconceptualization of globalization. The key point is thatthe following methodological orientations often arisedirectly out of how globalization has been conceptua-lized, which then transfers existing conceptual disagree-ments onto debates concerning what empiricalproperties constitute the processes of globalization andwhat methodological tools are best suited to capturethese processes.

Methodological Traditions to the Study of GlobalizationFour methodological traditions are discernable in theglobalization literature. First, as alluded to in the Intro-duction, most scholars have tried to locate one domi-nant trend involved with the process of globalinterconnectedness and to then single this aspect out asrepresenting its primary defining property. The focushas largely been on global economic and financialtrends, isolating this feature of growing interdependenceas the key empirical driver behind how we should studyas well as conceptualize globalization. Although thereare scholars who continue to defend the significance ofcultural globalization [19,41], technological globalization[42,43] and political globalization [40,44,45], for themost part, and largely en-masse, mainstream globaliza-tion scholars have tended to reduce these other pro-cesses as ‘derivable’ or as ‘satellite externalities,’ arguingthat ‘economic globalization has been the driving forcebehind the overall process of globalization over the lasttwo decades [46].’ This has been applied to the study ofglobalization and health, as much as it has to other sec-toral concerns [47,48]. Although the global economy is

clearly a powerful driver involved with whatever globali-zation is, this does not mean that everything can bereduced to economic argument. Equating globalizationsolely with processes of economic integration or with aparticular (neo-liberal) vision of market capitalism inevi-tably sidesteps key sociological and historical aspectsinvolved with globalization that are transforming oursocial life-worlds in culturally and politically sensitiveways. What is often missing, and what will be exploredin the next section, is a multidimensional approach tothe study of globalization that, while incorporating itseconomic dimensions, can also help to make sense ofthe many localized, idiosyncratic and pluralistic qualities.Second, most globalization scholars focus largely on

macro-level analysis relying on quantitative data andlongitudinal economic analysis to prove how convergingtrends are creating interconnection and integration (ornot) at the global level. Of course, globalization by itsvery etymology suggests a macro ‘global process,’ imply-ing that the essence of our understanding should movefrom the global to the local. In this way, the study ofglobalization necessarily requires an element of macro-level quantitative analysis in order for us to understandmany of its large-scale processes and as a means to helpexplain how these transform issues of global cohabita-tion. Nevertheless, to say that macro-level quantitativeanalysis is a necessary component to understanding glo-balization is not to say that such analysis is by itself suf-ficient. This is because macro analysis is best suited forlocating global trends, broad global interconnectionsand large-scale networks, but is insufficient in telling usabout how these phenomena specifically affect localcommunities or how these trends are interpreted andencountered by various social groups and communities.We recognize that the same limitation applies tonational or even sub-national population studies thatrely upon large-scale survey or panel data; indeed, ourarguments for a broader approach to globalization stu-dies that use both quantitative and qualitative/ethno-graphic data and methods have long been made forsocial science studies at lower levels of aggregation[49,50]. Therefore, as the next section will examine, it isalso useful to supplement macro-level research withmore micro-level contextual qualitative analysis that canhelp to capture processes of ‘glocalization’, the intersub-jective transformations that take place at the interfacebetween the global and the local [51].Third, there has been a strong tendency by globaliza-

tion scholars to adopt a deductive methodologicalapproach. When surveying the literature on globaliza-tion, it is common to see studies that start by producinga theory about what specific and isolated ‘global process’is key to understanding globalization and to then gener-ate a hypothesis about how this variable can confirm a

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particular positive or negative effect. As with all socialscientific research, the generation of this hypothesis isusually based on a pre-formulated theoretical concep-tualization. From this theoretical frame we then judgethe worthiness of this conceptualization by how well itcan explain a particular phenomenon and by how well itcan ‘make sense’ of seemingly disparate empiricalexperiences. To be clear, deductive reasoning is anextremely useful research method. There is also no rea-son to suggest that deductive reasoning must remainmutually exclusive of a more inductive approach, inwhich analyses of observational data (fieldnotes, inter-views, focus groups, texts and other qualitative sources)lead to novel insights about social phenomena that maybe transferable (generalizable) and that can build new orchallenge/nuance existing theories. What remains trou-bling about a good deal of research on globalization isthat until recently it often failed to successfully incorpo-rate a more inductive element within its overall researchdesign, thereby lacking in applied and theoretical rele-vance when transposed to localized contexts.Lastly, many studies of globalization fail to properly

capture and express the dialectical features associatedwith globalization. This is because globalization is see-mingly both good and bad; it is dialectical in the Haber-masian sense in that it often presents both a thesis andan anti-thesis [52]. One thesis, for example, holds thatglobalization promotes more interconnectedness, result-ing in greater economic markets, the spread of demo-cratic values, and cooperation on issues of globalinterdependence; while these same processes simulta-neously produce an anti-thesis of greater economicinequality, ideological tension and an overall failure tosecure human development. Although this is less of aproblem for transformationalist approaches, globalistsand sceptics have tended to focus narrowly on a singletrend associated with globalization in order to come toa definitive judgment as to whether globalization repre-sents a good thing, a bad thing or a mythical aberration.Therefore one problem with this approach is that globa-lization can often reflect all of these properties simulta-neously and dialectically, a point we return to in theconclusion to our article.The argument presented here is not meant to suggest

that more traditional approaches to the study of globali-zation have necessarily failed to respond to the concernslisted above. Burawoy and colleagues, as one example,are sceptics who argued for, and undertook fieldresearch based in the experiences of globalization’s con-straining economic effects on the lives of diverse peoplesin different parts of the world [53]. Neither should thisarticle be viewed as advancing the sceptical positionwhich suggests that the study of globalization representsnothing more than a bunch of ‘superficially converging

trends’ with little social scientific value. On the contrary,the suggestion is that we need to supplement these tra-ditional approaches with a more inductive researchagenda that is open to the complexities involved withglobalization, especially as they are encountered in parti-cular contexts; that is, one that embraces many of theconceptual aspects of the transformationalist position.This requires adoption of a multidimensional, induc-tively driven and contextualized approach that buildsupon qualitative fieldwork and local ethnographic obser-vation in order to help connect localized experience‘upwards’ to various global trends (economic, politicaland cultural). It is in the next section that an approachof this kind will be explored in relation to three recentcase studies conducted on globalization and HIV/AIDS.

Contextualizing Globalization Through Studies in HIV/AIDSThe three case studies involved with the remainder ofthis article are part of a larger project on Economic Glo-balization and HIV/AIDS conducted in association withthe IDRC and HEARD at the University of KwaZulu-Natal, South Africa. Our goal here is to highlight someof the ways that these qualitative and ethnographicallydriven field studies improve our understanding of whatglobalization is and with how processes of globalizationcan transform particular social contexts and activitiespertaining to HIV/AIDS.A) Global Transformations of Transactional Sex inMbekweni Township South AfricaThe first study conducted for the HEARD/IDRC projectinvolved the examination of economic globalization andtransactional sex practices in Mbekweni Township inSouth Africa. Transactional sex refers to the exchangeof gifts (material, monetary) for sex framed outside ofprostitution or sex work by those who participate in theexchange.The study focused on transactional sexual behavior of

young women between the ages of 16-24. The studyincluded on-site ethnographical observation as well asinterviews conducted with community leaders, focusgroups, the young women involved with the sexualbehavior as well as with the men who provided goodsand services as transaction partners [54]. The rationalebehind the study was to help locate some of the keyunderlying factors that drive peoples’ pursuit of transac-tional sex and to inductively explore in what ways thesefactors could be connected to, or derived from, pro-cesses of globalization.The overall findings of the study demonstrated that

involvement in transactional sexual risk behavior wasmultidimensional and transformative in that it con-nected to the processes of globalization in both eco-nomic and cultural ways. In particular, the research

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indicates a strong connection between female aspira-tions for a modern lifestyle in line with popular imagesof global modernity, and a rationalization to satisfy thematerial basis for obtaining this image even at anincreased risk for HIV infection through transactionalsex. Through a blend of economic and cultural influ-ence, various images provided ‘global windows’ or ‘Wes-ternized dreams [55]’ to a promising ideal of modernity,of material success and an enhanced ‘globalized’ socialstatus. The problem, however, as Daniel Cohen argues,is that ‘for the majority of the poor inhabitants of ourplanet, globalization is only a fleeting image... what wetoo often ignore is how strong this image is, how preg-nant with promises yet to be fulfilled [20] [p.6].’ In thisregard, and in the case of the Mbekweni women studied,‘globalization creates a strange world where... it hasaltered people’s expectations more than it has increasedtheir ability to act [20] [p.166].’ In the case of those par-ticipating in transactional sex within the township ofMbekweni, it is possible to locate three multidimen-sional transformative features that have altered theirexpectations.First, in the past, the study of transactional sexual beha-

vior suggested that young women engaged in this activityas a means to secure basic needs and to obtain the mate-rial goods necessary for more immediate survival. Thissexual behavior has been linked to the increase of unsafesexual practices, a lack of condom use, and increasedsubstance abuse, multiple sexual partners, physical vio-lence and the spread of HIV [56-58]. However, as theMbekweni study shows, there is increasing evidence tosuggest that motivations for young women’s involvementin transactional sex is not confined solely to matters ofsustenance but include women’s pursuit of ‘materialgoods for pleasure and vanity [54]’ as a perceived ‘gate-way’ to modernity [59,60]. As the Mbekweni studyfurther finds, ‘the pursuit of money and material goodswas emphasized as being of great importance, far out-weighing fears of HIV infection [54].’ Thus, the meetingof basic survival needs was not the only primary motiva-tion for high-risk sexual behavior; or, alternatively, onecould argue that globalized images of modernity throughmaterial acquisition had subtly but pervasively alteredthese women’s perceptions of what needs should be con-sidered basic and what constituted meaningful survival.In addition, many of the women involved within thestudy considered themselves as ‘hunters’ who wereengaged in transactional sexual acts as a means for socialand material mobility. In order to obtain certain items ofvalue, the young women would actively seek out menwho had money or who were perceived to have a highlevel of social status and material sophistication [54].Second, the social indicators of whether a male satis-

fied this image of material and social status were

measured largely by globalized Western symbols ofmodern wealth and prosperity. For example, manywomen involved within the study specifically discussedhow they were going to ‘get the one driving the yellowKompressor’ Mercedes Benz and how a car like thatsymbolizes the right kind of ‘sugar daddy.’ This prefer-ence for seeking global icons of material wealth and suc-cess was also evident with male participants and oftenconcerned more mundane items such as the type ofbeer one drinks. As one participant suggested, ‘if I amthe boss I’ll be drinking Heineken. I will buy a Heine-ken, you see... then a second one, so that she’ll noticethat [name of participant] has a lot of money on him.’Again, like the Mercedes, the symbol of wealth andsophistication was often associated with an importeditem that had a certain level of global status, which inthe case of this one male participant, was seen to be themost successful means to obtain a sexual partner [54].Third, the material goods sought when engaging in

transactional sex by the female participants also reflectan aspiration to pursue items that capture the globalimage of modernity. In many cases, women were enga-ging in transactional sex in order to buy clothing fromrelatively cheap local South African retail stores such asMr. Price and Chinatown outlets. These particular retailstores specialize in providing cheap knock-off clothesthat capture the look and styling of the more famousdesigner products of Europe and the United States. Thewomen who participated in the study emphasized theneed to have a large selection of clothing and indicateda preference for quantity over quality. What is mostinteresting about this is that it supports Cohen’s argu-ment that the processes of globalization create a dialec-tical relationship between global imagery, productdesire, market availability and economic dependency. Ormore appropriately, it illustrates that despite being ableto pursue items that resemble the global imagery ofhigh-end fashion by engaging in transactional sex, theactual products that are available or within the eco-nomic reach of those involved are only cheap knock-offs. At the same time, for many of these women (andfor those in the Madagascar study as well, describedlater) the global ‘labeling’ of clothing was less importantthan having a large quantity of ‘the right look.’ Whathad become globalized was a capitalist modernity ofexcess consumption, in which women didn’t simplywant high fashion, regardless of label, but closets-full ofclothes they could change into a half dozen times a day.In addition, and in order to tie this relationship morebroadly into features of market globalization, theseclothes are mostly produced by large multinational Chi-nese textile and garment firms in the Far East andLesotho and are only available at a low cost due to thepoor quality of the product. As Cohen would suggest of

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this relationship, global images are dominant, but localeconomic restrictions persist.The transformations associated with these multidi-

mensional and dialectical qualities have significantimplications for how we understand the relationshipbetween the processes of globalization and HIV/AIDS.The Mbekweni study found that money and the pro-curement of material goods was of a ‘greater prioritythan ensuring safety against HIV [54].’ It further sug-gests that part of this behavior is due to an ‘over-emphasis on clothing and consumerism in general,through global communications that glamorize fashion-able images of beauty and success [54].’ This over-emphasis, and its creation of new forms of ‘social neces-sity,’ may have led in this case to poor quality purchases.But it remains a product of globalization’s economicunderpinnings: that is, the aggressive pursuit by transna-tional corporations through investment and advertise-ment of new consumers in new markets, aided byliberalized trade and investment treaties, to offset declin-ing rates of profit in already saturated higher-incomecountries [47]. In addition, the study found a growingfatalism among the female participants, where thestigma of HIV/AIDS had faded, where the virus waslikened to a brand of perfume that is popular in thecommunity. This suggests a certain level of normaliza-tion of HIV/AIDS in relation to high-risk sexual beha-vior and the legitimization of transactional sex as anappropriate means to satisfy material desires. As onefemale participant suggested, ‘it doesn’t matter if he’ssick... as long as he satisfies your needs for money andalcohol, you don’t really care [54].’ Transactional sexualbehavior is not a product of globalization and has cer-tainly existed as long as there has been written history;but as the case of Mbekweni illustrates, the processes ofcultural and economic globalization have transformedthe social dimensions of how transactional sex is prac-ticed, with serious implications for interventions intend-ing to prevent HIV/AIDS.B) Global Modernity Meets Traditional Resistance: MalagasyYouthThe second case study set out to understand the rela-tionship between an interest in the consumption ofdesigner goods and young people’s sexual behavior intwo regions of Madagascar: Antsiranana, a city in thenorth, and the capital city Antananarivo along with itsperi-urban and rural outskirts. This study was motivatedby former ethnographic research in the country thatpointed to urban youth using transactional sex as ameans by which to access images of modernity [61].Specifically, this past work examined youth in thecoastal city of Tamatave and made links between anincreasing importance placed on consumption (andtransactional sex as a means to consume) to the

liberalization of Madagascar’s economy. Furthermore,this research suggested that transactional sexual prac-tices, particularly among young urban Malagasy womenand foreign men, were playing a significant role in socialclass formation, ‘engender[ing] new hierarchies asso-ciated with globalization and neoliberal economicreform [61] [p.574].’Inspired by this former research, the Madagascar case

study used both qualitative and quantitative approachesto explore how youth (15-24) understood the symbols ofmodernity as well as to capture the extent to which theyperceived a relationship developing between sexualbehavior and the increased premium placed on acces-sing these symbols of modernity. To examine this rela-tionship, the project relied upon the use of focusgroups, a structured household survey and in-depthinterviews.The findings from Anatananarivo support a more

transformative understanding of how globalization maybe influencing behavior and capturing the imaginationsof Malagasy youth. One of the concepts explored indetail was that of ‘lamaody,’ which in the context ofAntananarivo, the capital city and its environs, is usedboth as a noun and an adverb to describe ones relation-ship with ‘modern’ living. From the French ‘la mode’(France having been the colonizing country), lamoadyrefers both to the material items of modernity in theform of fashionable clothes, technologies and acces-sories; and to a lifestyle which is marked by consump-tion of alcohol and cigarettes, having multiple sexualpartners, using the internet and other new technologies,and consuming media in the form of music and filmsfrom abroad. Lamaody was often referred to as originat-ing from outside of Madagascar; and those who wereable to keep up with it were described with bothadmiration and contempt.The very word, lamoady, captures a dialectical aspect

of globalization, for it signifies a meaning of global pro-gressiveness as well as a condition of poor judgmentover how one achieves it. On one hand, the strongChristian moral values on women’s chastity in Antana-narivo (arising from an earlier colonial epoch of globali-zation and pre-colonial religious conversion) temper thedraw toward the imagined modern life. The notions ofthese foreign values are considered dangerous, and asone participant explained, went ‘against the norms [62].’Consequently, unlike the case in Mbekweni, transac-tional sex in Antananarivo is not (yet) a commonlyreported practice, nor is it deemed an acceptable strat-egy toward achieving a modern lifestyle. On the otherhand, and at the same time, it was often described asone of the few reliable means by which young people,particularly women, can obtain the symbols of moder-nity. Because most people have to resort to such

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‘immoral’ practices in order to touch the ‘fleeting image’of modernity, the image becomes a tainted one ‘preg-nant with promises yet to be fulfilled [20] [p.166 & 6].’This duality led to a complicated understanding of

whether young women who followed lamaody were tobe respected or shamed and represents an interestingpermutation of ‘glocalization.’ On the one hand,lamoady was characterized in harshly negative terms:that Western influence with its emphasis on materialismand a consumer culture was associated with decayingmorals and what were deemed as venal interests, cap-tured by terminology depicting individuals as ‘sipa maté’(young materialistic woman) or ‘bandy maté’ (young,materialistic man). On the other hand, for those youngwomen engaging in transactional sex for lamoady, therewas also shame in not capturing aspects of this materialworld: appearing poor and shabbily dressed, reflectedbadly on the community from which she came. As oneparticipant suggested, ‘in our building, you’d feelashamed if you wear a torn sandal and mended slacks[62].’At issue may be the scale of consumption and the sur-

render to the globalized mythos of ‘modern living’through the acquisition of goods beyond those consid-ered socially necessary. The notion of being a ‘materia-liste’ was unambiguously negative for young men andwomen in Antananarivo. A materialiste was someonewhose primary motivation in pursuing sexual relationsis to access money or goods. Once again, a foreign termis used to describe a behavior that is seen largely as for-eign-inspired and driven by the desire to obtain foreigngoods. Here the negative emphasis was on one’s motiva-tion for seeking partners. In interviews with male uni-versity students, though more broadly representative ofyouth opinions, women who ‘lay down their body...forthe love of lamaody’ were contrasted with women whoengage in exchange relationships for their livelihood (e.g. to obtain school fees) [62]. As a result, most intervie-wees held a high level of tolerance for those engaged intransactional sex when it was used toward their childrenor self-improvement (i.e. education). As one young manput it, ‘if the girl does that only for lamaody, it’s not atall acceptable...if she were doing it to make a living,then I wouldn’t mind [62]’.C) Global Transformations of HIV/AIDS Funding and PublicPolicy in PeruA third study conducted for the HEARD/IDRC projectinvolved an examination of the relationship betweenglobal HIV/AIDS funding mechanisms and the develop-ment of public health policy in Peru. The study involvedthe collection and analysis of health budget information,a content analysis of official health policy documentsand key informant interviews with social actors, healthauthorities, non-governmental organizations and affected

communities [63]. As with the previous studies, a keyresearch question of the project was to explore the var-ious ways the formulation and practice of HIV/AIDSpolicy in Peru was connecting to, and being influencedby, processes of globalization.Similar to the Mbekweni case, the results of the Peru-

vian study demonstrate that the relationship betweenHIV/AIDS public policy formation in Peru and the pro-cesses of globalization are multidimensional and involvemore than just economic processes. It also highlights acontextually specific property of ‘glocalization’ in thatthe influence of global health funding mechanisms waseffectively amalgamated into Peruvian policy in uniquelynational terms. The complexities of this particularmixed-methods case study are discussed in more detailelsewhere [63]; we focus here on how this study helpsto demonstrate three of the multidimensional and trans-formative characteristics of globalization associated withglobal politics, economic trends and the cultural expan-sion of globalized health rights terminology.First, the Peruvian study highlights a key process of

political globalization and the ways global governancemechanisms intersect with localized HIV/AIDS policyformation and implementation. Although Peru hadestablished prevention-related programs prior to 2000, itwas not until Peruvian involvement with various globalhealth initiatives such as UNGASS and The GlobalFund to Fight AIDS, Tuberculosis and Malaria(GFATM) that greater resources and political mobiliza-tion were directed toward HIV/AIDS treatment. Thissuggests the existence of a correlative relationshipbetween local policy formation, the influence of globalgovernance processes, and available access to global‘seeding’ money for ramping up localized initiatives. Per-uvian engagement with GFATM funding policy alsotransformed a primary HIV/AIDS governance mechan-ism and how HIV/AIDS related policy was formulatedand funded. As the study outlines, part of the GFATMfunding grant stipulated that the Peruvian governmentwould make certain political and economic commit-ments to the formation and implementation of HIV/AIDS policy. For one, the grant application process ofthe GFATM required the establishment of a multisec-toral Country Coordination Mechanism (CCM) to facili-tate local stakeholder participation. The study showed adirect link between GFATM CCM policies and the for-mation of a Peruvian CCM mechanism that was even-tually incorporated into its overall health governancesystem. The GFATM grant was designed to cover ARVcosts for the first two years with a commitment by thePeruvian government to ramp up their coverage ofthose costs thereafter. The Peruvian government, theCCM grant design mechanism and the TechnicalReview Panel of the GFATM considered the grant as a

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form of seed money for establishing a sustainable andpurely internal Peruvian health treatment policy forHIV/AIDS.Second, there was an infiltration of the expanding glo-

bal language about stakeholder participation and atransfer of ‘health rights’ terminology into Peru’s generaldiscourse on health policy. As the study indicates, theglobal HIV discourse on health rights has started to‘expand to other diseases, primarily tuberculosis.’ In thisregard, much of the global language around HIV mobili-zation initiated by social movement activists in regionsas disparate as South Africa and the USA has helped tocreate a standardized benchmark in regards to thedefense of health rights of affected people and againststigma and discrimination. In limited ways this languagehas increasingly been incorporated into other policy dis-cussions involving Peruvian health professionals, civilsociety movements and some officials. However, interms of actual multisectoral participation, only theGFATM programs on HIV and tuberculosis have pro-duced procedures to ‘officially recognize the participa-tion of community based organizations [63].’ Onepossible explanation for this isolated infiltration of parti-cipatory governance is that GFATM policy provided astrong global ‘steer’ for accelerated inclusion of multi-sectoral governance in the case of HIV/AIDS and tuber-culosis; and that ‘it was difficult for people affected byother diseases to reach the achievements of HIV mobili-zation.’ Many interviewees considered ‘such response isunlikely for other diseases that will not have this kind ofsupport: a global movement, international interest andlarge resources [63].’This finding suggests an interesting dialectical rela-

tionship between GFATM policies and how they affectlocal mobilization for other diseases. Engagement withthe GFATM has established a double-edged condition:the increase in attention and funding for HIV/AIDS hashad tangible positive effects in terms of providing freeARTV treatment and in insuring multisectoral participa-tion, but has simultaneously ‘crowded out’ other diseasesin terms of generating a similar mobilized response. Oneimplication of this dialectic feature is that ‘HIV mobili-zation achievements challenge the concepts of equityand access in health, since the Peruvian governmentdoes not ensure access to free treatment for other dis-eases [63].’ Interviews conducted with non-HIV/AIDSrelated NGOs saw this condition as ‘unfair’. In otherwords, the discrimination now favoring HIV/AIDS inPeruvian health policy could form the basis of chal-lenges for greater equity in health care access across awider range of disease conditions.Third, although the seeding money from the GFATM

provided an initial financial and political motivation toformulate distinct health policies for the treatment of

HIV/AIDS, it was largely due to Peru’s economic growththat treatment expansion was sustainable. As the datasuggest, in a context of economic expansion, withincreased tax revenues enabling great fiscal expendingfrom public resources, the Government of Peru was ableto replace the withdrawal of resources from theGFATM, without affecting expending on other healthprograms. It was able to do so without a diversion fromother health expenditure categories, suggesting that, inthis particular instance, the sceptic concern about reli-ance on development health aid and sustainability ‘drop-offs’ after external funding evaporation was not a preva-lent feature. This was primarily due to Peru’s strongeconomic growth during the same period (somethingnot necessarily guaranteed into the future) as well as tothe political motivation to maintain treatment targets.Although it is not possible to generalize from this parti-cular case, the Peru study does highlight an interestingfeature involved with GFATM funding policy in nationaleconomic situations where capacity development mayhave a stronger chance of success. Unlike in many rela-tively poor economic countries, where debt managementand high levels of HIV/AIDS infection cripple mobiliza-tion and capacity building efforts, Peru’s economicgrowth and relatively small pandemic numbers allowedit to effectively sustain a near universal treatment andcomprehensive care program.This is not to say the globalization in other of its pro-

cesses is devoid of health effects, whether positive ornegative. A ‘sceptic’s’ one-year review of the Peru-USFree Trade Agreement (FTA), which came into effectFebruary 1, 2009, documented a number of rapidlydeclared decrees that failed to strengthen (as promised)labour rights but succeeded in weakening environmentaland land ownership protections to facilitate more rapidexploitation of natural resources of interest to Americaninvestors [64]. Both outcomes are more likely to worsenthan improve health inequities in Peru. The FTA hasled initially to lower drug prices on US imported pro-ducts, attributed to elimination of an international taxpreviously levied by Peru and increased retail competi-tion as international drug store chains expand acrossthe country [65]. Drug prices nonetheless could even-tually rise as extended intellectual property rights in theFTA begin to affect patented drugs, increasing the costsof providing ARVs and, importantly, treatments for dis-eases with advocacy groups which currently look withsome resentment to the special arrangements so far wonin treatment for HIV/AIDS [66]. What the Peruvianstudy nonetheless reveals is that processes of political,cultural and economic globalization can be conceptua-lized as having negative as well as positive effects.Furthermore, the discovery of these idiosyncratic quali-ties are best teased out and examined through an

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inductive and contextually focused approach that utilizesqualitative and ethnographic methods. Because of this,like the Mbekweni and Antananarivo studies, the Perustudy is able to locate striking idiosyncratic and dialecti-cal features involved with globalization while generatinginteresting new questions and complex implicationsabout how we might better understand the relationshipbetween global process and HIV/AIDS. In this regard,by incorporating a more differentiated and contextualapproach, these studies are able to supplement as wellas compliment more macro-level quantifiable studiesand to generate further insights about how globalizationoperates at both the global and local level.

ConclusionThe Importance of Understanding Globalization inContextThis article began by suggesting that the study of globa-lization required a more contextual approach that couldbetter capture the transformationalist dimensions ofhow the processes of globalization operate. To supportthis argument, this article examined three traditionalapproaches to the study of globalization and highlightedsome of the conceptual and methodological shortcom-ings that are generally involved with these efforts. Inorder to understand globalization and how it specificallyimpacts upon our lives, it is increasingly important tostudy globalization in terms of how its processes areencountered by various social groups in different socialcontexts. To do so, it was suggested that the study ofglobalization needed supplementation with more con-textual, inductive and qualitative approaches.To demonstrate how this approach could operate in

practice, this article examined three recent case studiesthat attempted to make ‘bottom-up’ links between localHIV/AIDS issues and globalization. These contexts pro-vided interesting and implicative insights into the multi-dimensional ways that globalization intersects with localsocial structures and how these processes effectively‘stretch’ social structures. In all three instances, globali-zation was a dialectical phenomenon that, depending onthe context, illustrated positive as well as negative quali-ties. In the case of Peru, this manifested itself throughthe empirical fact that near universal ARV treatmentwas now available in Peru and that through a combina-tion of local effort and external globalized mechanismsPeruvian programs were sustainable and effective. How-ever, at the same time, there was evidence to suggestthat these mobilization efforts also had negative effectsin regard to equitable funding mobilization for non-HIV/AIDS related diseases and that there were indica-tions that various participatory governance mechanismsinvolved with HIV were not transposed onto otherhealth risk policy debates.

Likewise, in the case of Mbekweni, a blend of multi-dimensional elements fused together to create someunique HIV/AIDS policy implications: limited eco-nomic avenues in conjunction with powerful globa-lized consumer images created idiosyncratictransformations in social sexual behavior. In this case,the heightened risks involved with transactional sexseemingly involve a glocalized [51] or hybridized [67]blend between local sociology, economic conditions,globalized expectation, new materialistic desires, andthe limited ability to act upon those expectations anddesires. In the context of Mbekweni, this uniqueblend of economic and cultural transformative processchallenges prior studies that have viewed transactionalsex as primarily a means for basic subsistence andsurvival. That basic needs may not in fact be the pri-mary motivator (or that they have been reconfiguredby globalized images to include certain forms of con-sumerism) has implications for both prevention andintervention strategies.The Madagascar case presents an even more nuanced

understanding of the same dimensions found in theMbekweni case. Straddling two different epochs of glo-balization (the Christian morality introduced by coloni-alism and the desirable baubles of today’s globalmodernity), transactional sex was acknowledged as ameans to the end of lamoady while lamented as a sym-bol of moral vicissitude. But all was understood or for-given if the woman so engaged had a ‘nobler’ intentthan merely acquiring universalized fashion or engagingin the status power of excess consumption, such as adesire to provide for her child’s education.Lastly, this article does not provide an exhaustive

study into what a differentiated and contextualapproach to globalization would entail and it could notsystematically explore the implications of this approachif applied more widely to global health research. In thisregard, the aim of this article was not to thoroughly setout a concrete research agenda, but to draw attentionto the importance of inductive methods to the study ofglobalization and to suggest that these approachesought to be more seriously considered. Furthermore,this article is not meant to suggest that this is a novelapproach per se, for other scholars have developed andpursued such research elsewhere. What is being sug-gested is that a more differentiated and contextualapproach to the study of globalization should supple-ment traditional methods in order to help captureunique and idiosyncratic elements involved with howsocial transformations take place between the local andthe global. And it is by looking at these intersections,that we can have a better chance of understandingwhat globalization is, how its processes work, and howthese processes transform our lives in profound and

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meaningful ways - both collectively and in particularsettings.

Author details1Department of Politics, University of Sheffield, Sheffield, England, UK.2Institute of Population Health, University of Ottawa, Ottawa, Ontario,Canada.

Authors’ contributionsGB and RL conceived the general outline of the article. GB wrote the firstdraft. RL revised and wrote sections of the second draft. Both authorsdiscussed and responded to the reviewers’ comments. Both authors readand approved the final manuscript.

Authors’ informationGarrett W. Brown is Senior Lecturer in Political Theory and Global Ethics inthe Department of Politics at the University of Sheffield. His publicationsinclude work on cosmopolitanism, globalization theory, international legaltheory and global health governance. He has recently published GroundingCosmopolitanism: From Kant to the Idea of a Cosmopolitan Constitution(Edinburgh University Press, 2009) and co-edited The Cosmopolitanism Reader(Polity, 2010) with David Held.Ronald Labonté is Canada Research Chair (Globalization and Health Equity)with the Institute of Population Health and Professor in the Faculty ofMedicine, University of Ottawa. His research interests include the healthequity impacts of contemporary globalization, health worker migration,medical tourism, health and human rights, global health diplomacy andcomprehensive primary health care reform. Recent co-edited books includeGlobal Health Volumes 1 -4 (Sage Major Works, 2011) and Globalization andHealth: Pathways, Evidence and Policy (Routledge, 2009).

Competing interestsThe authors declare that they have no competing interests.

Received: 17 May 2011 Accepted: 23 August 2011Published: 23 August 2011

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doi:10.1186/1744-8603-7-29Cite this article as: Brown and Labonté: Globalization and itsmethodological discontents: Contextualizing globalization through thestudy of HIV/AIDS. Globalization and Health 2011 7:29.

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