HIV Exceptionalism: Development through Disease in Sierra Leone

190 Pages·2015·2.108 MB·English

by  Adia Benton

HIV Exceptionalism
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HIV Exceptionalism
Development through Disease in Sierra Leone
Adia Benton
A Quadrant Book
University of Minnesota Press
Minneapolis
London
Quadrant, a joint initiative of the University of Minnesota Press and the Institute for
Advanced Study at the University of Minnesota, provides support for interdisciplinary
scholarship within a new, more collaborative model of research and publication.
http://quadrant.umn.edu.
Sponsored by Quadrant’s Health and Society group (advisory board: Susan Craddock, Jennifer Gunn,
Alex Rothman, and Karen- Sue Taussig) and by the Center for Bioethics at the University of Minnesota.
Quadrant is generously funded by the Andrew W. Mellon Foundation.
A different version of chapter 2 was previously published as “Exceptional Suffering?
Enumeration and Vernacular Accounting in the HIV- Positive Experience,” Medical
Anthropology 31, no. 4 (July 2012): 310−28. Medical Anthropology is available online at
http://www.informaworld.com.
Copyright 2015 by the Regents of the University of Minnesota
All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted, in any form or by any means, electronic, mechanical, photocopy-
ing, recording, or otherwise, without the prior written permission of the publisher.
Published by the University of Minnesota Press
111 Third Avenue South, Suite 290
Minneapolis, MN 55401– 2520
http://www.upress.umn.edu
Library of Congress Cataloging-in-Publication Data
Benton, Adia.
HIV exceptionalism : development through disease in Sierra Leone / Adia Benton.
Includes bibliographical references and index.
ISBN 978-0-8166-9242-2 (hc : alk. paper) — ISBN 978-0-8166-9243-9 (pb : alk. paper)
1. HIV-positive persons—Care—Government policy—Sierra Leone. 2. AIDS (Dis-
ease)—Government policy—Sierra Leone. 3. Health facilities—Sierra Leone—Finance.
4. Federal aid to health facilities—Sierra Leone. 5. Public health—Anthropological
aspects—Sierra Leone. I. Title.
RA643.86.SSB46 2015
362.1969792009664—dc23
2014019918
Printed in the United States of America on acid- free paper
The University of Minnesota is an equal- opportunity educator and employer.
21 20 19 18 17 16 15 10 9 8 7 6 5 4 3 2 1
For Salma, Pauline, and Bessie Mae
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Contents
Preface ix
Introduction. HIV Exceptionalism in Sierra Leone:
Christiana’s Story 1
I. The Exceptional Life of HIV in Sierra Leone
1. The HIV Industry in Postwar Sierra Leone 27
2. Exceptional Life, Exceptional Suffering:
Enumerating HIV’s Truths 42
II. Becoming HIV- Positive
3. The Imperative to Talk: Disclosure and Its Preoccupations 61
4. Positive Living: Hierarchies of Visibility, Vulnerability,
and Self- Reliance 89
III. HIV and Governance
5. For Love of Country: Model Citizens, Good Governance,
and the Nationalization of HIV 117
Conclusion: The Future of HIV Exceptionalism 138
Acknowledgments 147
Notes 151
Bibliography 159
Index 173
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Preface
The civil war in Sierra Leone (1991– 2002) lasted more than eleven years
and left over 50,000 people dead. In early 2003, in the war’s aftermath,
500,000 Sierra Leoneans— 10 percent of the population— were still living
outside the country, and hundreds of thousands were displaced from
their homes. More than 3,000 houses in 300 towns and villages were de-
stroyed by the war. Nearly 80 percent of health posts needed rehabilitation
or reconstruction and more than 60 aid agencies and nongovernmental
organizations (NGOs) were on the ground, trying to facilitate and assist
in this process.
Post- conflict Sierra Leone witnessed an influx of aid from the interna-
tional community. Leading agencies, such as the United Kingdom’s De-
partment for International Development (DfID), United Nations High
Commissioner for Refugees (UNHCR), United Nations Development
Program (UNDP), and United Nations Mission in Sierra Leone (UNAM-
SIL), devised a four- Rs plan— repatriation, reintegration, rehabilitation,
and reconstruction— for rebuilding the country. Reconstruction costs
were estimated to be more than $16 billion per year beginning in 2002
(Baker and May 2004, 36– 37). Approximately $45 million was allotted
for reintegrating former combatants and improving the management of
the diamond sector (www.usaid.gov). Through the efforts of a number of
NGOs— who acted as subcontractors to the United Nations and Western
donor governments— health clinics and educational facilities were re-
built and staff were trained. Education for younger women and men was
instituted in camps, but many were unable to afford the primary and sec-
ondary schools that were reestablished in the post- conflict period. Shorter-
term vocational education and skills training initiatives were often pack-
aged with demobilization and reintegration projects.
At the end of the war, Sierra Leone ranked second from the bottom of
the UNDP Human Development Index (176th out of 177 countries).
Post- conflict recovery has been a slow process, but many development
ix