Privileging prevention,gendering responsibility: an analysis of the Ghanaian campaign against HIV/AIDS

This article focuses on the discourses around HIV/AIDS in the national Ghanaian ‘Stop AIDS Love Life!’ public health campaign, within non-governmental HIV/AIDS publications, and the Ghanaian national print media. I have used critical discourse analysis to interpret and deconstruct a range of these social texts collected between June and September of 2001 and 2003 in and around Greater Accra, Ghana. I argue, firstly, that these discourses are shaped by an international politics of funding for HIV/AIDS that privileges prevention through behaviour change over treatment action under the premise that prevention is a more cost-effective option for the Global South. I critique this stance, highlighting the emerging possibilities for integrated prevention–treatment efforts in resource-poor settings such as Ghana. Secondly, I argue that the discourses around HIV/AIDS presented in prevention campaign materials powerfully construct normative and gendered subjectivities with assigned roles and responsibilities. The fight against HIV/AIDS is constructed as a national project in which an idealized, and often very young, female citizen is positioned as educator, volunteer, carer and protector of herself and society. This discursive coding of responsibility places the many burdens of HIV upon some of the most vulnerable in society, ignoring the structural constraints of gender, generational and economic inequality. I conclude my paper by arguing that efforts to reduce transmission rates, stigma, and the burden of care for those living with HIV/AIDS in Ghana must integrate both preventative efforts and treatment action. Where prevention campaigns are utilized I suggest that these must recognize the limitations of behaviour change initiatives that primarily target women and acknowledge the gendered constraints faced by those very subjects identified as responsible for the protection and education of the nation.     

AIDS Activism in Pakistan: Diminishing Funds,Evasive State

This article draws on a year of ethnographic fieldwork in the HIV/AIDS sector of Pakistan at the moment of rolling back a World Bank‐financed programme. Classified by UN agencies as at ‘high risk’ of a generalized HIV epidemic, Pakistan has an epidemiology driven by injecting drug use, and a Penal Code and Islamist legislation which criminalize non‐therapeutic drug use and extra‐marital sex. In recent years, a sharp increase in the numbers of registered HIV‐positive people has necessitated a shift from HIV prevention among ‘high risk groups’ to the provision of care to those living with HIV/AIDS. The rolling back of external funding, which was further compounded by the effects of devolution on the Ministry of Health, created challenges for AIDS activism in Pakistan, as reflected in the everyday lives — and deaths — of the patient‐activists and their community‐based organizations. This article recounts the story of one such aspiring AIDS activist caught in multiple dilemmas emanating from these macro‐processes. This story throws light on the limitations of the complex agency of actors in development, and shows how the shifting loci of power from the state to non‐state entities in the global neoliberal order impacts the provision of vital services like HIV prevention and AIDS control.     

‘Saving the Amazon’: Conservation,international covetousness,and the politics of research (Respond to this article at http://www.therai.org.uk/at/debate)

Many justifications have been made for ‘saving the Amazon’ from preserving the ‘lungs of the world’ to protecting unknown botanical wonders that might yield cures to deadly diseases. However, Amazonians have responded to these claims with charges of ‘international covetousness’, interpreting such foreign interest as a thinly‐masked desire to take control of the region's natural resources. In this article I examine some of the counter‐claims that have emerged in Brazil that reflect Amazonians’ uneasiness with such foreign interest in the region. Drawing from my own engagement with rural Amazonians, I share their critiques of the deep global inequalities that they see in conservation efforts and international research in Amazonia. To conclude, I discuss the value of ethnography and anthropological inquiry for encouraging grounded views of Amazonia that challenge abstracted notions of the region, including that of the monolithic rainforest in need of ‘saving’.     

Strange powers: Conservation,science, and transparency in an indigenous political project (Respond to this article at http://www.therai.org.uk/at/debate)

The Cofán people of Amazonian Ecuador are important players within global movements for indigenous rights and biodiversity conservation. Scholars, non‐governmental organizations, and donor agencies laud their efforts to protect more than 430,000 hectares of forestland from an expanding colonization front, the transnational petroleum industry, and the spillover of violence from the Colombian civil war and drug trade. In this article, I examine how a set of discourses surrounding indigenous politics enable and constrain Cofán projects. In the context of an ethnographic account of Cofán political practice, I differentiate between the ‘expressive’, ‘instrumental’, and ‘obstructive’ nature of ‘conservation’, ‘science’, and ‘transparency’, respectively. More specifically, I develop three arguments: first, that the discourse of conservation serves to express deeply held conceptions of the ties between Cofán culture, Cofán territory, and Cofán politics; second, that the discourse of science functions as an instrument that Cofán activists use to ground a political‐economic exchange with outside powers; and third, that the discourse of transparency stymies Cofán collective action and is neither locally meaningful nor politically useful. By analyzing the social life of these terms and concepts in Cofán activism, I argue for a more nuanced understanding of discursive power, which always exists in tension with the cultural sensibilities and political perspectives that it supposedly transforms.     

Feminizing risk at a distance: critical observations on the constitution of a preventive technology for HIV/AIDS

Distance is a key idea in contemporary literatures on geography and the government of risk, and it is central to the work presented in this paper, which focuses on Western media representations of an innovative ‘first-generation’ non-contraceptive microbicide, Carraguard. A preventive technology that has been developed under the auspices of the US Population Council and the Bill and Melinda Gates Foundation, Carraguard is represented in the media in ways that produce certain noteworthy cultural geographies of HIV/AIDS. Via an analysis of a selection of such media representations of Carraguard, and focusing on sexual citizenship, political subjectivity and three socio-spatial orderings of risk (displacement, replacement and reorientation), we posit that Carraguard has effected a feminization of the government of risk at a distance. Specifically, we contend that HIV/AIDS has been displaced from the marginalized spaces of metropolitan centres of the West and replaced at the world's under-developed margins, being reoriented from dangerousness/deviance and the masculine to risk and the feminine in that process. In this work, we have taken up Dean's (1999) call to use an analytics of government to highlight the effects of certain ways of thinking and acting, and have also sought to respond to observations by Craddock (2000) that the silences in geography about HIV/AIDS and the regional coordinates of risk and vulnerability need to be addressed. In the final analysis, it appears that media representations of Carraguard reproduce and intensify much older geopolitical and socio-spatial orderings and relations of power that give effect to conceptions and practices of political obligation and sexual citizenship.     

Welcome to Country … Not.

ABSTRACT It seems that every public function I attend includes a ‘welcome to country’ speech presented by a representative of a local Aboriginal group claiming traditional ownership of the land where the gathering is conducted. Indeed, while it was already becoming customary for white officials to acknowledge traditional Aboriginal ownership prior to introducing any kind of its own business in recent years, it seems to have become de rigueur since the 42nd Federal Parliament was opened with a ‘Welcome to Country’ speech from a Ngunnawal representative in February, 2008. As this paper demonstrates, welcome to country might be understood by whites as a ‘safe’ kind of inclusive gesture of recognition all the time knowing that such claims are not legally enforceable. But, as the two ethnographic examples I present in this article demonstrate, Indigenous agency, once acknowledged in performance, cannot be fully directed by the nation state to serve its own ends.     

EPIDEMICS AND CONTAINMENT: Cuba and the HIV/AIDS epidemic

The Cuban response to a new and little understood disease, HIV/AIDS, was swift. A ban on imported blood was followed by mass testing of HIV antibodies, beginning with Cubans who had travelled abroad. In 1986, a sanatorium – ‘Los Cocos’ – was opened to treat Cuban soldiers who had returned with AIDS from Angola. Soon after, Cubans who had never left the country began testing HIV positive, most of whom were gay and bisexual. ‘Los Cocos’ was neither a hospital nor a prison. The campus was large, and duplex apartments and sports areas were built. The director, Dr Jorge Perez Avila, an infectious disease expert, stepped in as the Dr Fauci of Cuba. His goal was to continue his research on AIDS while simultaneously ensuring that the sanatorium formed a safe refuge for patients while awaiting antivirus medicines. Through his work, Dr Perez managed to transform the sanatorium into a place where sex and sexual differences were accepted, and where a gay community could emerge to produce theatre, arts and sex education for Cuba's public schools. In 1994, the sanatorium became a voluntary institution and many of the patients opted to remain.     

The house gun: White writing,white fears and black justice (Respond to this article at http://www.therai.org.uk/at/debate)

One way of understanding the Pistorius case is through the powerful writings of white South African authors such as Nobel Prize laureate Nadine Gordimer's anticipatory post‐apartheid novel, The house gun, in which she imagined a scenario similar to the one played out in the Pistorius trial where white fears and black justice met in the courtroom. South Africa is not unique. The mobilization of white peoples' fear of black or brown ‘intruders’ has infected other divided nations, like the United States and Israel. Here the social and architectural construction of ‘white’ settler or settler‐like special enclosures fortified by the legal right to self‐defence with private weapons has reproduced a colonial ‘paranoid ethos’ and a dangerous denial of the violence that is nested like a coiled rattlesnake from within their own segregated and hypervigilant enclosures.     

The African bill: Chinese struggles with development assistance (Respond to this article at http://www.therai.org.uk/at/debate)

Chinese diplomats and politicians have sought to underline the mutually beneficial and cordial nature of Chinese engagement with Africa through the use of phrases such as ‘win‐win cooperation’ (huying huli hezuo) and ‘friendly collaboration’ (youhao hezuo). Avoiding the use of concepts such as ‘aid’, which suggest a hierarchical relationship between giver and receiver, they have argued that Chinese initiatives on the African continent are fundamentally different from Western development assistance. An anthropological glance at the situation on the ground however, shows that these statements are not only a part of political rhetoric, but that they also mask the similarities between Chinese and Western involvement with development in Africa.     

‘Turning Sex into a Game’: Gogodala Men's Response to the AIDS Epidemic and Condom Promotion in Rural Papua New Guinea

ABSTRACT Rugby league is the national sport of Papua New Guinea and the game's huge popularity and international profile has been used in recent condom promotion campaigns in the nation's fight against the HIV/AIDS epidemic. In this paper, I argue that the promotion of condom use through rugby league requires a national campaign strategy that includes understandings of condom use and masculinity at the rural level. I demonstrate this through a study of Gogodala men's understandings of the epidemic and condom use in Western Province. The Gogodala are a Christian‐based society and many blame the national condom promotion strategy for an increase in promiscuity and for ‘turning sex into a game’. Condom availability in this rural area continues to be restricted to a family planning program that promotes Christian values and excludes unmarried men. I explore the male condom dilemma where young men are more concerned with avoiding accusations that their sexual behaviour puts them at risk of contracting HIV despite acknowledging the preventative value of using condoms. In this context young men disassociate themselves from the disease and condom use through a process of calculated risk or risk minimisation.     

Population geography and HIV/AIDS: The challenge of a ‘wholly exceptional disease’

This paper justifies and elaborates Huw Jones’ identification of HIV/AIDS as a ‘wholly exceptional disease’. It identifies the global pattern of the disease and how geographers have dealt with it, and considers its exceptional character in respect of its medical, demographic and behavioural dimensions. Implications of these dimensions are integrated into discussions of geographers’ use of two major conceptualisations in population analysis: the demographic transition model and disease diffusion models. It is argued that HIV/AIDS is wholly exceptional in that its essentially behavioural character — both in terms of spread and control — must strengthen the case for more explicit behavioural perspectives in population geography.     

Counselling Citizens and Producing Patronage: AIDS Treatment in South African and Ugandan Clinics

Global health interventions to provide antiretroviral (ARV) drug treatment for people living with HIV/AIDS in developing countries have linked global and local actors in unprecedented ways. These uneven relationships have been described as creating new forms of citizenship that challenge the liberal understanding of rights and responsibilities bestowed by the state. A comparative case study based on fieldwork from South Africa and Uganda suggests different theoretical understandings of the link between technologies of AIDS treatment and relationships of belonging. Yet, ethnographic data from local clinics in both countries point to similarities that exist across AIDS interventions, and to the importance of counsellors in negotiating the rules of ARVs. Neither patients living with HIV nor the local providers of their AIDS treatment are ‘bare life’ subjects to be acted upon by a global development intervention. As ARV technologies are increasingly prescribed in developing country clinics, diverse social relationships are taught and negotiated as part of the pedagogy of biopolitics. The following discussion demonstrates how local counsellors and clients negotiate the rules of AIDS treatment together for mutual benefit. The article concludes that AIDS treatment creates relationships of therapeutic citizenship and clientship in ways that constrain the possibilities of citizenship and development.     

Epilogue: Homegrown in PNG — Rural Responses to HIV and AIDS

ABSTRACT A three‐years‐long, multi‐sited, multi‐method study conducted throughout Papua New Guinea by the Institute of Medical Research revealed a staggering prevalence of sexually transmitted disease (STD) that threatens an already fragile political‐economy and health services delivery system. Logistics, methodological complexities, and political and especially religious sensitivities hampered conduct of such research. Extremely little HIV social research has been allowed to inform interventions or serosurveillance protocols. Well‐ intended but ill‐conceived international initiatives have promoted a normative AIDS paradigm that misconstrues HIV transmission risk, incites greater fear, increases stigma, and promotes anti‐condom rhetoric. This collection ‘HIV/AIDS in Rural Papua New Guinea’ presents a sustained series of ethnographically based accounts of rural responses. In this epilogue I situate the importance of those responses in a discussion of the great divide between the lived realities of HIV infection and AIDS related suffering on the one hand, and the discursive practices and policies of media, public health, international donors and NGOs on the other.     

Warrior Women,the Holy Spirit and HIV/AIDS in Rural Papua New Guinea

ABSTRACT This article analyses a group of Gogodala Christian women in the Western Province of Papua New Guinea who are referred to as ‘Warrior women’ and who pray, sing and call upon the Holy Spirit to cleanse their own bodies and ‘turn their eyes’, so that they are able to see those who threaten the health and well‐being of the wider community. These women have focused primarily on bringing male practitioners of magic — iwai dala — shadowy and powerful men who operate covertly and away from the gaze of others, out into the open. Whilst this has been happening for many years, the spread of HIV and AIDS into the area, fuelled by what many in the area believe is the rise of unrestrained female and male sexuality and the waning of Christian practice and principles, has meant that those perceived to bring harm to the community through their sexual behaviour have become recent targets for Warrior women. HIV/AIDS, referred to in Gogodala as melesene bininapa gite tila gi — the ‘sickness without medicine’ — is understood as a hidden sickness, one that makes its way through the community without trace until people become visibly ill. Warrior women seek to make both AIDS and those who, through their behaviour, encourage or enable its spread more visible. In the process, however, a small number of them are overcome by the Holy Spirit, so much so that they become daeledaelenapa — mad ‐ their behaviour increasingly characterised by childishness and uncontrolled sexuality.     

South Africa,the world and AIDS (Respond to this article at http://www.therai.org.uk/at/debate)

South Africa has been at the centre of world history for over a century and it is now the focus of all eyes for the World Cup. The country has been a by‐word for racial inequality and more recently for crime and violence. But it is also notable for social progress and cultural vitality. The HIV/AIDS epidemic has claimed more victims there than anywhere else, a tragic sequel to apartheid. Successive political leaders highlight the contradictions of this historical moment in poignant, even Shakespearean ways. The author briefly reviews three books by anthropologists on AIDS there and suggests that South Africa is likely to remain a source of innovation for the discipline. But we need to take a broader view of world history than at present.     

Contextualising the AIDS epidemic in the South Pacific: orthodoxies,estimates and evidence

There is a growing consensus that HIV/AIDS is a ‘time bomb’ ticking in the South Pacific. This may, in fact, be the case. However, there are at least two major problems with this approach. First, analysis of the implications of the epidemic is based on supposedly concrete links between the epidemic and social, economic and political outcomes. Many of these apparent links have not been established (because the data is not available for the South Pacific). As such, much of the method for analysing the ramifications of the epidemic is borrowed from elsewhere, notably Africa, and the strength of these links is beginning to unravel. Second, research on the vectors of the epidemic that informs this consensus is only as good as the data that it relies on. There are major testing and surveillance gaps in the South Pacific that mean projections are often based on patchy and incomplete data. This can dramatically skew priorities. Reflecting on these problems is important because of the clear ramifications they pose for the development of good public policy in, and toward, the South Pacific.     

Of Sodomy and Cannibalism: Dehumanisation,Embodiment and the Rhetorics of Same‐Sex and Cross‐Species Contagion

This article explores ideas of the ‘human’ in discourses surrounding the AIDS epidemic, from the 1980s to the present. It compares two sequential lines of thought: first, the notion of AIDS as the result of ‘unnatural’ gender behaviours and queer sexualities; and second, the notion of AIDS and other zoonotics (cross‐species diseases) as the result of non‐western dietary practices and social mores. In the first case, the early years of the AIDS crisis are traced through the languages of sexual perversity utilised by the popular press and the Christian right. In the second case, the later years of the epidemic are traced, once the ‘roots’ of the virus became tied to Africa, and carriers became bestialised in narratives that located HIV as a consequence of unnatural, or inhuman, interactions with the animal world. The article argues that we have witnessed a paradigm shift in the didactics of the epidemic, from a narrative of sexual impropriety to one that also includes a narrative of dietary impropriety, each of which consistently relies upon a clear dichotomy between the human and the inhuman.     

Citizenship at war: Passports and nationality in the 2008 Russian‐Georgian conflict (Respond to this article at http://www.therai.org.uk/at/debate)

By analyzing the 2008 war between Russia and Georgia, this paper stretches the limits of the anthropology of war and citizenship. Trying to overcome anthropologists' usual unease about commenting on ‘big topics’, I examine citizenship policies ‘from above’ and ‘from below’ that potentially lead to conflict and war. Special attention is paid to the role of nationality as a crucial feature of post‐Soviet citizenship, and to citizenship as an effective means of neo‐imperial expansion. In my conclusion, I contextualize my findings within anthropological debates about citizenship and argue that the recent stress on rights and entitlements needs to be balanced by an analysis of the repressive dimensions of citizenship regimes.     

Scaling health and healthcare: re‐presenting Thailand's HIV/AIDS epidemic with world regional geography students

Authors of world regional geography textbooks have recently become more interested in the broader theoretical changes that have emerged in human geography. Relying on feminist and other critical perspectives, concepts such as space, place and scale are being re‐imagined in this ‘new world regional geography’. This paper intervenes on behalf of a more critical world regional geography by suggesting how world regional geography teachers can educate students about scale as a social construction through the use of empirical data. Relying on fieldwork conducted in Thailand, this paper lays out a lesson on the HIV/AIDS crisis and how different representations of that crisis, from the national to the individual, offer different ‘ways of knowing’ the epidemic. Furthermore, this paper examines how we can push students to consider the ways in which scales of analysis are constructed and constituted through our own geographic practices.