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HIV Exceptionalism

HIV Exceptionalism: Development through Disease in Sierra Leone

Adia Benton
Series: A Quadrant Book
Copyright Date: 2015
Pages: 200
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  • Book Info
    HIV Exceptionalism
    Book Description:

    In 2002, Sierra Leone emerged from a decadelong civil war. Seeking international attention and development aid, its government faced a dilemma. Though devastated by conflict, Sierra Leone had a low prevalence of HIV. However, like most African countries, it stood to benefit from a large influx of foreign funds specifically targeted at HIV/AIDS prevention and care.

    What Adia Benton chronicles in this ethnographically rich and often moving book is how one war-ravaged nation reoriented itself as a country suffering from HIV at the expense of other, more pressing health concerns. During her fieldwork in the capital, Freetown, a city of one million people, at least thirty NGOs administered internationally funded programs that included HIV/AIDS prevention and care. Benton probes why HIV exceptionalism-the idea that HIV is an exceptional disease requiring an exceptional response-continues to guide approaches to the epidemic worldwide and especially in Africa, even in low-prevalence settings.

    In the fourth decade since the emergence of HIV/AIDS, many today are questioning whether the effort and money spent on this health crisis has in fact helped or exacerbated the problem.HIV Exceptionalismdoes this and more, asking, what are the unanticipated consequences that HIV/AIDS development programs engender?

    eISBN: 978-1-4529-4384-8
    Subjects: Anthropology, History, Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Preface
    (pp. ix-xii)
  4. Introduction. HIV Exceptionalism in Sierra Leone: Christiana’s Story
    (pp. 1-24)

    I first met Christiana in mid-2006, at a social club in Freetown, Sierra Leone. A mother of two who had married her childhood sweetheart, Christiana had almond-shaped eyes and an infectious smile that immediately endeared her to me. Within days of meeting, she witnessed my unsuccessful attempts to hail a shared taxi and gave me a ride home. Later that day, she invited me to join her vibrant circle of friends. She hosted ladies’ nights at the Lagoonda nightclub, where I joined Christiana’s group to gossip about acquaintances’ (seemingly) clandestine love affairs and dance to the “Electric Slide.”

    On Sundays,...

  5. I. The Exceptional Life of HIV in Sierra Leone

    • 1 The HIV Industry in Postwar Sierra Leone
      (pp. 27-41)

      In late June 2005, I attended a two-day strategic planning meeting to discuss Sierra Leone’s response to HIV/AIDS. Representatives from community-based and international nongovernmental organizations, private industry, and government agencies were all in attendance. This meeting was a crucial step in securing funding from the Global Fund for AIDS, Tuberculosis, and Malaria, the largest financier of state-run programs to combat these three diseases. The Global Fund disburses 20 percent of global HIV funding. By April 2012, the Global Fund had allocated or disbursed more than $60 million in HIV-related aid to Sierra Leone (

      A Nigerian consultant guided us through...

    • 2 Exceptional Life, Exceptional Suffering: Enumerating HIV’s Truths
      (pp. 42-58)

      In October 2007, a press conference held in Freetown launched a week dedicated to ending stigma and discrimination against people living with HIV and AIDS. Although few cases of discrimination against people living with HIV/AIDS had been reported in Sierra Leone, the event was nevertheless presented with great fanfare at a venue near the National Stadium.¹ High-ranking officials from the UN, the National Network for HIV-Positive People (NETHIPS), and the National AIDS Secretariat all attended the event; many were seated at a high table reserved for dignitaries. These officials presented statistics, delivered rousing sermons, and called on the HIV-positive among...

  6. II. Becoming HIV-Positive

    • 3 The Imperative to Talk: Disclosure and Its Preoccupations
      (pp. 61-88)

      When I entered the Miatta Conference Hall for the launch of a new network of HIV support associations, a meticulously produced choral version of “The First Noel” was blaring over a rock concert–grade sound system. Bottles of water were placed at the high table, and the coordinators, wearing HIV/AIDS-themed T-shirts were traveling up and down the aisles, putting small, plastic waste bins at the end of each row for financial contributions to the new organization. After a few minutes of loud music and a rapid ascent of dignitaries to the front of the auditorium, the meeting opened.

      The emcee...

    • 4 Positive Living: Hierarchies of Visibility, Vulnerability, and Self-Reliance
      (pp. 89-114)

      In early 2007, I drove into the center of town from the West End, to attend an AIDS Support Association (ASA) group meeting at their new office. When I arrived, I found a set of red metal doors that had been left ajar, revealing a dark, cool entryway leading to a set of stairs. As I climbed the stairs, a sliver of light from a single window at the top of the stairs revealed the contours of a wooden table and bench. No signs of the meeting. To the right of the window was a door leading to a computer...

  7. III. HIV and Governance

    • 5 For Love of Country: Model Citizens, Good Governance, and the Nationalization of HIV
      (pp. 117-137)

      When I arrived in Sierra Leone to do preliminary fieldwork for this project in 2005, my host Omar, a government worker and son of a former civil servant, offered to introduce me to two high-ranking officials in the National AIDS Secretariat (NAS). Part of the government of Sierra Leone, the NAS is responsible for coordinating the national HIV/AIDS response. It also helps to manage the National AIDS Council, for which the president serves as chairman. At the time of my preliminary fieldwork, the NAS was only three years old and its leaders were “returnees” or “just come” Sierra Leonean elders—...

  8. Conclusion: The Future of HIV Exceptionalism
    (pp. 138-146)

    During a debate at the Fourteenth International AIDS Conference in Washington, D.C., in 2012, Mead Over, a health economist and senior fellow at the Center for Global Development, recounted an anecdote from his work:

    A couple of years ago, I visited a PEPFAR-supported AIDS treatment center in Western Kenya. It was quite an extraordinary experience because the beautiful, modern, clean, efficient AIDS treatment center was constructed at a clinic which had an existing health structure, and I talked to [the] director who was in charge of managing both of those parts of that facility, and I asked him about that...

  9. Acknowledgments
    (pp. 147-150)
  10. Notes
    (pp. 151-158)
  11. Bibliography
    (pp. 159-172)
  12. Index
    (pp. 173-176)
  13. Back Matter
    (pp. 177-177)