Abstract
This paper explores the implications of mass HIV treatment programmes in Africa, particularly when non-governmental organizations, American universities or European hospitals, directly govern the lives of populations (such as those living with HIV) and in fact have power of life or death over them. It explores a novel form of legitimate, therapeutic domination that results from framing the epidemic as a humanitarian emergency. That lives be saved requires enrolment: that a standardized population be called into being so that it may then be targeted, relying on the deployment of biological and political technologies for constituting populations and transforming bodies and subjectivities. These transformations that seek to direct consciousness and change bodily practice are governmentalities exceptionally directed at the biological existence of those living with or potentially at risk for HIV. And, in an inversion of the classical model whereby evidence of efficacy permits intervention, in this case intervention drives the need for self-validating evidence (that is, the intervention was effective). The conjugation of these standardized humanitarian problems and populations with the production of post-facto, self-validating knowledge (most often described as ‘lessons learned’ or ‘best practices’) is an ‘experimentality’ that leverages the deployment of these interventions across the globe.
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Notes
Michel Kazatachkine is quoted in a UN press release, Anonymous (2007).
These figures were taken from the websites of PEPFAR (www.PEPFAR.gov) and the Global Fund (www.theglobalfund.org) on 19 January 2009 and presented to indicate the scope of funds involved. More detailed, empirical tracking of actual funds allotted and disbursed can be found at www.resourceflows.org.
These debates can be followed on websites such as www.PEPFARwatch.org.
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Acknowledgements
The thinking behind this paper is heavily indebted to collaborations, conversations and the occasional spirited argument, which I have been privileged to have over the years with Judith Farquhar, Didier Fassin, Wenzel Geissler, Nancy Hunt, Lawrence McFalls, Michelle Murphy, Mariella Pandolfi, Kris Peterson, Lisa Richey, Shalini Randeria, Richard Rottenberg and Susan Reynolds Whyte. Hunt's work has informed my thinking of contemporary intervention in light of the residues of colonial biomedicine. McFalls has shown me the relevance of Weber's scholarship notably in the way he has drawn on Weber to develop the concept of therapeutic domination. In addition to being a friend and mentor, Pandolfi has opened this terrain of enquiry for me through her theoretical elaboration of the concepts of mobile sovereignty and humanitarian governmentality and her empirical work on this assemblage in the Balkans. Randeria's work on the transnationalization of law, scattered sovereignties and the cunning State has enriched immensely this work on the failings of modernity. Finally, Peterson has deeply influenced this discussion through her work on the political economy of AIDS relief and new forms of militarization and dispossession operant in Nigeria. Earlier versions of this work have benefited from comments by Steve Feierman, Wenzel Geissler and Kris Peterson and have been presented at the Kenya Medical Research Institute in Kilifi, the École des Hautes Études en Sciences Sociales (Paris), the Department of Anthropology at the University of Copenhagen, the Department of Anthropology, History and Social Medicine at the University of California San Francisco, the Wellcome Unit for the History of Medicine at University College London, the Biopolitics and Technoscience lectures at the University of Toronto, the Military Humanitarian Intervention Lectures at the Centre d’Études sur les Relations internationales at the Université de Montréal (CERIUM) and the Fellow Group at the Max Planck Institut für Ethnologische Forschung in Halle. The opportunity to present in these varied locations and to benefit from the engaged and critical comments of audiences have enormously enriched this paper. In Montréal, I am particularly grateful for the intellectual engagement and support of my colleagues at the Université de Montréal, Frank Runcie for vigorous editing any remaining failures of which are symptoms of my own recalcitrance, and two anonymous reviewers whose thoughtful and provoking engagement was extremely helpful for clarifying the argument. The research on which this paper draws has been funded by the Social Science and Humanities Research Council by an operating grant and its Aurora Prize, which are gratefully acknowledged.
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Nguyen, V. Government-by-exception: Enrolment and experimentality in mass HIV treatment programmes in Africa. Soc Theory Health 7, 196–217 (2009). https://doi.org/10.1057/sth.2009.12
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DOI: https://doi.org/10.1057/sth.2009.12