Reading Notes on Vinh-Kim Nguyen

About the Author

Vinh-Kim Nguyen is a medical anthropologist and an HIV physician. He is a researcher at the CRCHUM (Centre de recherches du Centre hospitalier de l’Université de Montréal) and is an associate professor in the Department of Social and Preventative Medicine at the University of Montreal where he heads the PhD program in Health Promotion. He is the author of The Republic of Therapy: Triage and Sovereignty in West Africa’s Time of AIDS.

Methods

Qualitative methods (Nguyen does not write about methods explicitly, I guess it is critical ethnography , including participant observation or  fieldwork and  interviews).

Arguments

  • “[H]ow the humanitarian / development complex that has emerged around the HIV / AIDS issue has grown to encompass a heterogeneous and uneven congeries of practices and techniques, present and active in everyday life, to produce particular kind of subjects and forms of life – AIDS activists, resistant viruses, and therapeutic citizens “(p. 126).

Therapeutic Citizenship

  • Therapeutic citizenship: “a biological citizenship, a system of claims and ethical projects that arises out of the conjugation of techniques used of govern populations and manage individual bodies” (p. 126). It is a form of stateless citizenship “whereby a biological construct –such as being HIV positive – is used to ascribe an essentialized identity, as in earlier forms of eugenics and racial ordering” (p. 126). It is the dialectic between a global therapeutic economy, local tactics for mobilizing resources, and the biopolitical process through which humanitarian interventions particular subjectivities that gives birth to it.
  • [In The Republic of Therapy: Triage and Sovereignty in West Africa’s Time of AIDS, therapeutic citizenship refers to the benefits and responsibilities that AIDS treatment programs offer and impose on those enrolled in treatment programs, akin to the functions of a modern state. With their ability to track individual identity and confer access to support systems, ranging from food to credit, AIDS treatment programs provide what the collapsed government could not provide: a social safety net, along with the bureaucratic machinery to run the safety net.]
  • Therapeutic citizenship was available only to the few (Nguyen calls it “triage”: prioritizing some individuals for medical treatment over others). When access to antiretroviral therapy was limited, Western aid agencies favored those willing to speak publicly about their diagnosis: “train” African with HIV to “come out” with their stories of being diagnosed, and living, with HIV were the cornerstone of development organizations’ attempts to foster self-help. The lifesaving potential of antiretroviral treatments was dramatized and became as a matter of life and death. As a result, the key to survival is to be able to “tell a good story.”
  • Others who got access to medicines include: those who enrolled in clinical research trials, and a select few actively involved in NGOs who received donations, both of whom were the production of public health campaigns as biological “vanguard.”
  • In short, a therapeutic economy conjugates confessional technologies, self-help strategies, and access to drugs in novel ways; “Treatment influence biology, and through these embodied effects representations of the disease, and in turn the subjectivity of those who are able to access them” (p. 143).

Humanism Industry

  • Humanism industry, which is most sharply expressed as health issues, constructs a logic of invention that displaces local politics and contributes to the fashioning of new identities, a process that has been described as “mobile sovereignty” (p. 125).
  • First generation of efforts to address HIV epidemic in developing countries focused on preventing HIV infection, when condoms served as the key preventive intervention; a second generation of programs stressed the direct involvement of affected communities through the idioms of “self-help” and “empowerment,” a process referred to by some development workers as “resource-capture driven.”
  • NGOs and other “community-based organizations” (CBOs) were considered as representative of preexisting communities, and could be used to target interventions at these communities and mobilize a response to the epidemic.
  • A myth: conducting clinical research in Africa is fraught with “cultural” and economic barriers.  African patients are believed to be notoriously “noncompliant.” In fact, there was a hierarchy that separates patients from physicians, without a culture of explanation at those institutes (it was considered as normal for staff to barely speak to patients); the most important determents of adherence to follow-up were economic.

Question

As Nguyen argues, the idea that public disclosure of HIV status would spontaneously generate solidarity, which is the dominant discourse in many social movements in the West, arose from a radically different context in Africa. In a world of severely limited resources to medical treatment, what does the discourse of public visibility (“coming out”) mean for group solidarity?

 

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