Articles · Vol. 42 No. 1 (2017): Africa Development: Special Issue on Health Governance in Africa: Taking Stock

11 - Producing and Reproducing Inequality: Biopolitical Exclusion, Marginalized Bodies and AIDS Care in Central Mozambique

  • Carla Teófilo Braga
    Carla Teófilo Braga
    Eduardo Mondlane University (EMU), Department of Anthropology, Mozambique. E-mail: cbraga56@yahoo.com
    Their articles →
Vol. 42 · 2017 No. 1 Africa Development: Special Issue on Health Governance in Africa: Taking Stock AD

Abstract

Studies of African countries’ response to HIV/AIDS and more recently to Ebola helped call into question not only individual and behavioural factors related to those conditions, but the centrality of the healthcare delivery systems themselves, particularly in the face of challenges of such magnitude. Weak, insufficient, underfunded and understaffed national health systems, compounded by international financial agencies’ discouragement, if not prevention, of increasing state budgets for social sectors, are usually considered the main challenges in assuring the population’s access to healthcare. In addition, and based on two years ethnographic fieldwork in central Mozambique (where in a neoliberal context, AIDS treatment is being provided through institutional arrangements comprising the state, aid agencies and international NGOs), this article suggests that access to healthcare and AIDS treatment, particularly by the poorest, can also be hindered by three factors. First, the adoption of a ‘one size fits all’ international AIDS treatment delivery model independent of context. Through the research of biomedical AIDS treatment services, this study brings to the fore the interplay of global health policies with the specificities of healthcare delivery at the local level, showing the importance of biomedical services’ organizational culture and history. Second, the production of institutionally stigmatizing categories to label non-adherent patients. As Ian Hacking pointed out categories have consequences for the ways we conceive of others, and those categorizations influenced the ways in which those patients were thought of, talked about and were dealt with within public health units. Third, the valorization of socio-economic markers of differentiation such as the tidiness and educational level of patients. Biomedical care is a complex social process performed within particular cultural matrices and laden with values. This study seeks to make visible the role played by the valorization, if not of a single and hegemonic conception of modernity, then at least of a ‘modern way of life’ (associated with the urban, hygiene and education) in access to AIDS treatment in central Mozambique.

Statistics

Abstract views
238
Downloads
108

Author Biography

  • Carla Teófilo Braga

    Eduardo Mondlane University (EMU), Department of Anthropology, Mozambique. E-mail: cbraga56@yahoo.com

References

  1. Aires, P., 1946, Programa de Acção Sanitária e Profilática, Lourenço Marques: Imprensa Nacional de
  2. Moçambique.
  3. Appadurai, A., 1996, Modernity at Large: Cultural Dimensions of Globalization, Minneapolis MN:
  4. University of Minnesota Press.
  5. Biehl, J., 2005a,Vita: Life in a Zone of Social Abandonment, Berkeley: University of California
  6. Press.
  7. Biehl, J., 2005b, ‘Technologies of Invisibility: Politics of Life and Social Inequality’ in Inda,
  8. J.,ed., Anthropologies of Modernity, Oxford: Blackwell.
  9. Biehl, J., 2007,Will to Live: AIDS Therapies and the Politics of Survival, Princeton PA: Princeton
  10. University Press.
  11. Boyer, S., Clerc I., Bonono, C., Marcellin, F., Bilé, P., Ventelou, B., 2011, ‘Non-adherence to
  12. antiretroviral treatment and unplanned treatment interruption among people living with HIV/AIDS in
  13. Cameroon: individual and healthcare supply-related factors’,Social Science and Medicine72:1383-92.
  14. Braga, C., forthcoming, ‘Popular Ontologies of Power and Biological Citizenship: AIDS Clinics and
  15. Persons Living with HIV/AIDS in Central Mozambique’.
  16. Butchart, A., 1998, The Anatomy of Power: European Constructions of the African Body, London: Zed
  17. Books.
  18. Cliff, J. and Noormahomed, A.,1988a,‘Health as a Target: South Africa’s Destabilization of
  19. Mozambique’, Social Science and Medicine27 (7).
  20. Cliff, J. and Noormahomed, A.,1988b, ‘South African Destabilization and Health in Mozambique’,
  21. Review of African Political Economy42.
  22. CNCS,2010, Mozambique Progress Report for UNGASS (United Nations General Assembly Special Session
  23. on HIV and AIDS 2008-2009, Mozambique National AIDS Council.
  24. Comaroff, J.,1982, ‘Medicine: Symbol and Ideology’, in Wright, P. and Treacher, A, eds,
  25. The Problem of Medical Knowledge, Edinburgh: Edinburgh University Press.
  26. Eisenberg, L.,1977, ‘Disease and Illness: Distinctions between Professional and Popular Ideas of
  27. Sickness’, Culture, Medicine and Psychiatry 1.
  28. Farmer, P.,2001, Infections and Inequalities: The Modern Plagues, Berkeley CA: University of
  29. California Press.
  30. Fassin, D., 2007, When Bodies Remember: Experiences and Politics of AIDS in South Africa, Berkeley
  31. CA: University of California Press.
  32. Foucault, M.,1990, The History of Sexuality: An Introduction, New York NY: Vintage Books.
  33. Foucault, M., 1997, ‘Society Must be Defended’: Lectures at the College de France, 1975- 1976, New
  34. York: Picador.
  35. Fry, P., 2000a, ‘Cultures of Difference: The Aftermath of Portuguese and British Colonial Policies
  36. in Southern Africa’, Social Anthropology 8 (2).
  37. Fry, P.,2000b,‘O Espirito Santo Contra o Feitiço e os Espíritos Revoltados: “Civilização” e
  38. “Tradição” em Moçambique’, Mana 6 (2).
  39. GARPPR (Global AIDS Response Progress Report), 2014, UNAIDS, www.unaids.org,
  40. accessed 19 September 2015.
  41. Africa Development, Volume XLII, No. 1, 2017
  42. Gilks, Ch., Crowley, S., Ekpini, R., Gove, S., Perriens, J., Souteryand, Y., Sutherland,
  43. D.,Vitoria, M. and Guerma, T., 2006,‘The WHO Public-health Approach to Antiretroviral Treatment
  44. against HIV in Resource-limited Settings’, The Lancet 368. Gupta, A., 2006, ‘Blurred Boundaries:
  45. The Discourse of Corruption, the Culture of Politics, and the Imagined State’, in Sharma, A. and
  46. Gupta, A., eds, The Anthropology of the
  47. State: AReader, London: Blackwell.
  48. Hacking, I., 1999, ‘Making Up People’, in: Biagioli, M., ed., The Science Studies Reader, London:
  49. Routledge.
  50. Hardon A., Davey S., Gerrits T. and Hodgkin C., 2006,From Access to Adherence: The Challenges of
  51. Antiretroviral Treatment: Studies from Botswana, Tanzania and Uganda, Geneva: WHO.
  52. INSIDA, 2009, INS Instituto Nacional de Saúde, Mozambique: National Survey on Prevalence,
  53. Behavioral Risks and Information about HIV and AIDS, Maputo: Instituto Nacional de Saúde.
  54. Kalofonos, I.,2010, ‘All I Eat is ARVs’: The Paradox of AIDS Treatment Interventions in Central
  55. Mozambique’, Medical Anthropology Quarterly 24 (3).
  56. Kanji, N., Kanji, N. and Manji, F., 1991, ‘From Development to Sustained Crisis: Structural
  57. Adjustment, Equity and Health’, Social Science and Medicine 33:985-93. Lara, J.,2009,‘Hunger,
  58. Transport Cost and Migration: Barriers to HAART Adherence in Central Mozambique’, Master’s Thesis,
  59. Seattle, University of Washington, Department
  60. of Public Health.
  61. Loubiere, S., Boyer, S., Protopopescu, C. et al., 2009, ‘Decentralization of HIV Care in Cameroon:
  62. Increased Access to Antiretroviral Treatment and Associated Persistent Barriers’, Health
  63. Policy92(2-3):165-73.
  64. Luedke, T. and West, H., eds, 2006, Borders and Healers: Brokering Therapeutic Resources in South
  65. East Africa, Bloomington: Indiana University Press.
  66. Mamdani, M.,1996, Citizen and Subject: Contemporary Africa and the Legacy of Late Colonialism,
  67. Princeton PA: Princeton University Press.
  68. Matsinhe, C., 2005, Tabula Rasa: Dinâmica da Resposta Moçambicana ao HIV/SIDA, Maputo: Texto
  69. Editores.
  70. Micek, M.A., Gimbel-Sherr, K., Baptista, A., Matediana, E., Montoya, P., Pfeiffer, J. Melo, A.,
  71. Gimbel-Sherr, S., Johnson, W. and Gloyd, S., 2009, ‘Loss to Follow-up of Adults in Public HIV Care
  72. Systems in Central Mozambique: Identifying Obstacles to Treatment’, Journal of Acquired Immune
  73. Deficiency Syndrome52 (3): 397-405.
  74. Mills, E. et al., 2006, ‘Adherence to Antiretroviral Therapy in Sub-Saharan Africa and North
  75. America: a Meta-analysis’, JAMA 296 (6).
  76. MISAU/DAM,2004, A aderência como Alvo da Terapia Anti-retroviral: Manual de Apoio à Aderência ao
  77. Tratamento Antiretroviral nos Hospitais de Dia.
  78. Nguyen, V.K., 2009, ‘Government by Exception: Enrolment and Experimentality in Mass HIV Treatment
  79. Programmes in Africa’, Social Theory & Health 7 (3).
  80. O’Laughlin, B., 2010, ‘Questions of Health and Inequality in Mozambique’, Cadernos IESE 4.
  81. O’ Laughlin, B., 2015, ‘Trapped in the Prison of the Proximate: Structural HIV/AIDS Prevention in
  82. Southern Africa’, Review of African Political Economy 42 (145): 342-61.
  83. Braga: Producing and Reproducing Inequality 243
  84. Oksala, J., 2010, ‘Foucault’s Politicization of Ontology’, Continental Philosophy Review 43.
  85. Pereira, C., 2010, ‘Task-Shifting of Major Surgery to Midlevel Providers of Health Care in
  86. Mozambique and Tanzania: A Solution to the Crisis in Human Resources to Enhance Maternal and
  87. Neonatal Survival’, PhD Dissertation, Karolinska Institutet,
  88. Stockholm.
  89. Peters, P., Kambewa, D. and Walker, P., 2007, The Effects of Increasing Rates of HIV/ AIDS Related
  90. Illness and Death on Rural Families in Zomba District, Malawi: A Longitudinal Study. Mimeo. Final
  91. Report presented to the RENEWAL Program.
  92. Pfeiffer, J., 2013, ‘The Struggle for a Public Sector: PEPFAR in Mozambique’, in Biehl,
  93. J. and Petryna, A., eds, When People Come First: Critical Studies in Global Health, Princeton PA:
  94. Princeton University Press.
  95. Pfeiffer, J. and Chapman, R., 2010, ‘Anthropological Perspectives on Structural Adjustment and
  96. Public Health’, Annual Review of Anthropology.
  97. Sherr, K., Micek, M., Gimbel, S., Gloyd, S., Hughes, J., John-Steward, G., Manjate, R., Pfeiffer J.
  98. andWeiss, N., 2010, ‘Quality of HIV Care Provided by Non-physician Clinicians and Physicians in
  99. Mozambique: A Retrospective Cohort Story’, AIDS 24, suppl. 1.
  100. Sousa Santos, B., 2001, ‘Entre Prospero e Caliban: Colonialismo, pós-colonialismo e inter-
  101. identidade’, in Ramalho, M. andRibeiro, A., eds, Entre Ser e Estar: Raízes, Percursos e Discursos
  102. da Identidade, Porto: Edições Afrontamento.
  103. Sullivan, N., 2011, ‘Mediating Abundance and Scarcity: Implementing an HIV/AIDS Targeted Project
  104. within a Government Hospital in Tanzania’, Medical Anthropology 30 (2).
  105. Sumich, J., 2008a, ‘Construir uma Nação: Ideologias de modernidade da elite moçam- bicana’, Análise
  106. Social XII (2).
  107. Sumich, J., 2008b, ‘Politics after the Time of Hunger in Mozambique: A Critique of Neo- Patrimonial
  108. Interpretation of African Elites’, Journal of Southern African Studies 34 (1). Vaughan, M., 1991,
  109. Curing their Ills: Colonial Power and African Illness, Stanford CA:
  110. Stanford University Press.
  111. Walt, G. and Melamed, A., 1984, Mozambique: Towards a People’s Health Service, London:
  112. Zed Books.