HIV/AIDS reporting systems in Mozambique: The theoretical and empirical challenges of “representations”

Acquired immunodeficiency syndrome is a disease with profound effects on the global society, as it affects individual lives, communities, societies, and even nations. As governments try to gear up on the war against this pandemic, an issue of importance pertains to the use of information systems. The systems are used to collect data on the prevalence of the disease, and analyze and transmit the data from the lower levels of the health administration where the testing is done to the higher levels of national policy making where different kinds of interventions are designed. In this article, we argue that the manner in which the representation of the disease is constructed is an important area of concern as it shapes the picture of the disease prevalence and influences how these statistics then get used for the planning of interventions such as supplying drugs and pro-health campaigns. Drawing from the domain of Science and Technology Studies (STS), with a focus on Bruno Latour's (1999) ideas of “circulating reference” we first develop the theoretical notion of representation, and then apply it to an empirical analysis of the reporting systems, both paper- and computer-based, of HIV/AIDS in Mozambique. The successive movements of information about HIV/AIDS prevalence across the various administrative levels are seen as translations that are being constructed through the communication and work practices of the health care workers at different levels, and are shaped by the political interests of the different stakeholders involved, including international agencies and national health authorities. Latour's notion of circulating reference is drawn upon to analyze the question of what is lost, what is gained, and what remains invariant through the successive stages of translation in the construction and use of the representation. © 2005 Wiley Periodicals, Inc.