You know, I mentioned the paper I wrote in another post on Haiti. I'm going to post it here, in light of these revelations. It's quite instructive. The right-wing has been dabbling (well, much more than dabbling) in Uganda for quite some time. I'm sorry it doesn't also copy my sources, but believe me when I say they are there. I'll also add the bibliography. The professor gave me ten extra points for this, and didn't even mention the run-on sentences and passive voice.
Book Review Essay:
AIDS: The Community of Accusation
Farmer, Paul
AIDS & Accusation: Haiti and the Geography of Blame
University of California Press, 1992
Thornton, Robert J.
Unimagined Community: Sex, Networks, and AIDS in Uganda and South Africa
University of California Press, 2008
Only when the serpent dies can you take his measure.
Haitian Proverb
What causes AIDS? Is it a virus, as the scientific community states? Is it caused by poverty, as Paul Farmer posits? Is it the consequences of unfortunate cultural practices, as Robert Thornton writes? Or is it something much more insidious, much more pervasive, much harder to package into a black-and-white set of statistics, and epidemiological studies, and public health communiqués? What even the most cursory research shows is that the closer a third-world government is to western monetary intervention, especially that of the United States, the much easier seems to be that country’s ability to stem its HIV/AIDS rates, no matter the utter chaos, the massive corruption, or the absolute inability to have any other government program function at even the most basic levels, which weighs heavily on Thornton’s treatise, in particular.
Thornton seeks to establish an anthropological cross-cultural and functionalist frame of reference in understanding why Uganda has managed to curtail the rates of HIV/AIDS infection, while South Africa has not. In doing so he bases his postulate and thesis on whether the Bush Administration’s contention that the A-B-C [primarily the A (abstinence) in the triune] method developed conjunctively between the newly-placed Ugandan government, under the Musavini Administration, and the financial aid given by the United State Government, and right-wing groups within the U.S., most notably from religious institutions, had any efficacy in the reduction of HIV/AIDS rates. Indeed, it was his primary goal, initially, in studying the HIV/AIDS epidemic in Uganda. In his own words,
“President George W. Bush and his administration had been convinced by some researchers that sexual abstinence and churches had played the major role in reversing the AIDS trend in Uganda. Our project was meant to prove conclusively that this was the case. As our interviews, focus groups, and textual research progressed, however, it became clear that this was not the case; at best, it was only part of a very complex story…”
That that story would lead him to form a complex thesis of the success of Uganda, and the utter failure of South Africa, and why it is so, revolves around several questions that Thornton raises and seeks to answer in Unimagined Community. Those questions include the, supposed, intervention of government, and civil organizations, and their efficacy; it also includes geography, and the idea that a rural community has a much higher likelihood of success in stemming HIV/AIDS than does an urban setting such as is found in much of South Africa; and, finally, he seeks to place the HIV/AIDS successes and failures in a cultural context, a context not necessarily outside of government intervention, or geographical setting, though definitely in context of ancient cultural belief systems.
Paul Farmer, on the other hand, cuts to the core of the issue, as he sees it, in AIDS and Accusation: inhumane poverty brought on by a massively unequal distribution of wealth. That the HIV/AIDS pandemic has been shouldered most decisively upon the third world is not an accident in Farmer’s view, and he seeks to explain this massive disparity by a Farmarian-like structural theory that blends some aspects of Marxist theory, and cultural materialism, while also including the naturalistic system of the Haitian people. He believes the people of Haiti are at the mercy of those who control the capital output, including the medicines that could stem not only the tide of the HIV/AIDS pandemic, but also tuberculosis, malaria, and many other epidemic diseases. Farmer, however, doesn’t stop there. He also includes the geographical particulars of his area of focus in Haiti, and the monumental poverty brought on by the construction of the Arbonite Dam in order for the wealthy of Port-au-Prince to have electricity, and how this directly led to the HIV infection of the three people upon whom his treatise focuses.
Farmer also gives a brief history of Haiti in macro, outside of the micro focus of the fictional village of Do Kay. The importance of this cannot be understated. In fact, interference from foreign governments has weighed as a millstone around the figurative neck of Haiti since Columbus came ashore. It is important in the context of this work to keep those “interferences” in the forefront, as they are a preponderant weight upon the success, or failure, of any HIV/AIDS campaign in any country in the world, including Uganda, and South Africa. Finally, Farmer includes the religious and spiritual aspects of the effects of HIV/AIDS in Haiti, and how hardly a people can divorce itself from its culture, even in the face of the seeming defeat of those ritualistic expressions. Above all, Farmer presents an eloquent understanding of the importance of those ritualistic expressions in the face of seemingly unending crises, and how those expressions allow people to face the future.
Several themes play out in connection to class readings and discussions: the thematic of cultural relevance in relation to day-to-day survival; the understanding of that cultural relevance in relation to healers, both allopathic and indigenous, and, the intricate web that healer/patient relations play in the epidemiological setting; the incredibly complex issues surrounding the placebo and nocebo effects; the ecologies of disease transmission; the economics of disease transmission; cultural adaptations to disease; and many, many others. It is impossible to designate one, or even a few, themes as the most important, or being the most germane to this subject; however, it is impossible not to focus on Farmer’s abilities, as both a physician and a medical anthropologist, in understanding the numerous layers that constitute “disease” and “illness” in the broad context of HIV/AIDS transmission, and the desperate attempt by the world’s medical and social communities to find a cure for AIDS, working within the contexts of disease and illness as supported by cultural relevance, and within the seldom-discussed parameters of the subversive political actions of the First World, not to mention the inter-geographical political machinations that affect everything from the public health of Uganda, to gold prices in South Africa.
As has been stated, Thornton’s initial goal was to prove that “abstinence” in the A-B-C conundrum was the primary reason that Uganda was seeing a drop in HIV/AIDS transmission and death during the early 90s, and up to the present. The U.S. Government went so far as to see the premise put into print:
“It is important to work back from the epidemiological and behavioral data. We know that prevalence decline and changes in sexual behavior were most pronounced in youth age 15 to 19. These finding took many of us by surprise since we believed that teenagers are driven by raging hormones, therefore abstinence is an unrealistic or impossible objective.”
Thornton is careful to distance himself from the Bush Administration’s hand in Uganda’s HIV/AIDS pie, saying, again, that abstinence played a minimal role in Uganda’s success against HIV/AIDS. He then proceeds to extol the virtues of a truncated ABC plan, using anthropological jargon and cultural relevance in commending the, supposed, Ugandan success story, piggy-backing the U.S.-supported scheme with, alleged, broad-based Ugandan government implementation, the co-support of all religious and community groups, the unwavering cultural adaptation of the citizens of Uganda, and above all, the incredible openness of the Ugandan government in getting out the message of President Museveni and his administration. It would be an exceptional, even miraculous, story, except that very little, if any of it, is true. Thornton’s anthropological study is based on the premise that the dramatic drop in HIV/AIDS in Uganda is true. Moreover, almost all critiques of HIV/AIDS response in Africa holds Uganda up as the preeminent example.
Without further research, Thornton’s evidence for his thesis is sound: it would seem that the government of Uganda, the NCOs, and the religious institutions worked in harmonious concert to affect change in the HIV/AIDS rate, and then, to add the pièce de résistance, a majority of the populace of Uganda completely upended their cultural habits, both because of the propaganda on HIV/AIDS transmission, and because they feared the consequences. Beyond this, Thornton seeks to find some means of transferring the success story from Uganda to South Africa, some means of defining cultural and sexual networks between the two countries, and some means of cementing a locus of change in South Africa to mirror that of Uganda. Thornton admits, “The Ugandan success story, as it has been called, is both encouraging and puzzling,” and then never addresses the “puzzling” facets of the story. Others, however, have looked into the highly questionable successes of Uganda’s HIV/AIDS programs.
In a United Nations report, by Joseph Tumusabhe, entitled The Politics of HIV/AIDS in Uganda , it is explained that the entire government was supported almost entirely by outside monetary intervention, with much of those monies being funneled into a corrupt system, which saw most of the money disappear into the personal coffers of the governmental elite. Specifically Tumusabhe writes, “…the country’s economic miracle was largely propped up by huge donor resources,” in reference to the media blitz put out by the U.S., and others, about the stunning turn-around of the country after the ascendance of Museveni government, ten years after the ouster of Idi Amin in 1979. At some point, as outside money poured into Uganda, it became important for a show of HIV/AIDS mitigation, entirely propagated on the continuing influx of said money. Until that time, however, “.…Museveni’s government was in no hurry to promote the success of the HIV/AIDS fight….between 1992 and 2000 the government actually maintained a lackluster attitude to the anti-AIDS struggle,” and, “Patients with HIV/AIDS-related illnesses occupied more than 55 percent of the hospital beds, and by 2000 the occupancy rate had increased to 70 percent.” Yet the world is now given the statistics that HIV/AIDS-related infections and deaths were already dropping by 1993. All of this was happening as every sector of government was in complete chaos, unable to affect even the most minimal change, and with a brutal civil war raging in the north part of the country.
Uganda’s continued influx of cash depended upon some visible success, and the HIV/AIDS fight seemed to fit the bill. The Ugandan government also received immediate debt relief under two new programs, and Tumusabhe writes,
“The speed with which Uganda received HIPC [Heavily Indebted Poor Countries Debt Initiative] assistance without having to go through the standard six-year qualifying period was suspicious, but the donor industry and the government were quick to point out that it was due to the country’s exemplary record of macroeconomic reform and a proven commitment to poverty reduction. The question that was left unanswered was why the impressive policy reforms and sustained economic growth, given as reasons for Uganda’s HIPC fast-track qualifications, were not enabling Uganda to pay its debts.”
And in answer to the non-governmental sector’s HIV/AIDS contribution, Tumusabhe writes,
“Thus, by 2000, an AIDS success story in Uganda was crucial to a wide spectrum of “stakeholders” who needed to justify further funding of their programs….For the government, failure to appease donors would lead to economic collapse and seriously roll back the national HIV/AIDS programme. There was little else to show for the huge donor resources poured into Uganda than an ill-planned and poorly executed Universal Primary Education Programme, which was also riddled with fraud at the school and district tendering levels. Thus the government and local staff of donor institutions were under pressure to identify positive outcomes of the massive funds poured into Uganda.”
These are but few of the examples of the graft and corruption at all levels of government in Uganda covered by dozens of investigative reporters, outside of Tumusabhe and the United Nations. When looking into statistics on HIV/AIDS in Africa, almost without exception, those countries showing low HIV/AIDS infection and death rates are countries receiving an influx of outside cash, in exchange, of course, for industrial interests being able to reap the natural resources. The only other countries showing lower HIV/AIDS infection rates in Africa- actually much lower- are Muslim countries. Little reading needs to be done to hear of the solution to the HIV/AIDS “problem” in Muslim countries, and it is not to be suggested here that those solutions were practiced in Uganda, or other countries whose cash influx depended upon a drop in HIV/AIDS infection and death statistics. One could, however, easily draw a conclusion that data was manipulated to garner a specific outcome. Additionally, though this probably matters little to the HIV/AIDS data, Museveni is now being compared to the ousted Ugandan dictator, Idi Amin, with Peter Tatchell of Britain’s Tribune Magazine writing,
“Uganda’s current President, Yoweri Museveni, was once seen as the country’s great democratic saviour. After becoming president in 1986, he transformed Uganda from a one-party state to a multi-party democracy. In the past decade, however, this progress has begun to be reversed. Museveni is becoming increasingly tyrannical, repeatedly violating the democratic and human rights principles of the African Union, United Nations and the Commonwealth. The international community is mute. It colludes with his regime.”
Though one could easily deduce this “collusion” isn’t something new; and with that, it becomes difficult to accept Thornton’s work with anything but great skepticism.
Farmer’s AIDS & Accusation is by far the more sophisticated of the two works, and gives a brief, but honest, telling of a country with a history so rife with hellishness, it seems almost a brutal caricature of itself. Farmer’s decades in Haiti, working intimately with the citizens, both as a physician within their healthcare system, and as a zealous, caring intra-patriot, working tirelessly to correct as many wrongs as is humanly possible, on the macro-and micro-scale of political access outside of Haiti, and in one-on-one communication with the people, gives a completely different weight to his argument that HIV/AIDS is a disease of poverty. Nay, a disease caused by poverty. This long-term affiliation with Haiti as a country, and the people of Haiti, gives far more weight to Farmer’s treatise that AIDS in Haiti is a direct result of the heinous conditions of extreme poverty brought on by the pernicious practices of continually changing dictatorships that are the direct result of outside interference and intervention by foreign governments.
The focus of AIDS and Accusation, of course, is blame. At what doorstep does one lay the responsibility for the AIDS pandemic? The western world, and the United States specifically, was early at the game in blaming “the four Hs:” homosexuals, hemophiliacs, heroin addicts, and Haitians. How media-savvy (or, perhaps, just immensely convenient) was it to have an alliterative whipping post? But above the ideal propaganda limns, the direct effects of HIV/AIDS are leveled upon the people who contract it, and their locus of blame is laid at many different doorsteps: racism, “sent” sida, malevolent intent by outside governments, specifically the United States, and direct interdiction by whatever Haitian government is in power at any given time, to name a few. And, indeed, Farmer does a deft job of laying out the argument that the Haitian people have every reason to blame any one, or all, of these factors.
He gives a broad overview of Haitian history in the context of outside influence and direct intervention by foreigners, he presents an anthropologically sympathetic view of Haitian vudoo and its monumental importance in Haitian culture, and he very capably uncovers the ridiculous economic disparity that exists to the detriment of people in the third world who are at the mercy of forces of which they not only have no power, but do not even particularly know exist except in the most rudimentary fashion. It is in some measure because of this unsophisticated and limited understanding of the workings of outside influence that they have little, perhaps no, recourse in changing the highly monolithic structure in place that affects their world. It is beyond the scope of this critique to innumerate Farmer’s intricate understanding of the problems that exist not only in Haiti, but in almost every Third World country, but a telling example comes from Kidder’s Mountains Beyond Mountains,
“When President Aristide’s government had been restored in 1994, a host of nations and international development banks had pledged their help in rebuilding Haiti. But contributions were already dwindling by the time of Aristide’s reelection in 2000. Now the United States was leading a concerted effort to block aid to Haiti’s government – not just American aid, but also grants and loans from other sources, including loans from an international agency that would have financed an increase in the supplies of potable water and improvements in roads, education, and the public health system. The stated reasons for this policy were various and changeable. [emphasis mine]…Farmer wrote to me about the blocked loans: ‘I think sometimes I’m going nuts, and perhaps there is something good about blocking clean water for those who have none, making sure that illiterate children remain so, and preventing the resuscitation of the public health sector in the country most in need of it.’”
And, so, if there is more than a plethora of evidence that some concerted effort goes into maintaining poverty, at limiting, even eliminating, the ability of people to lift themselves out of circumstances beyond the comprehension of the average First World citizen, then what possible explanation exists to explain such a heinous interdiction? Again, it is beyond the scope of this critique to give a detailed history of the commonalities of countries such as Haiti and South Africa, but Farmer certainly goes a long way in showing that institutional racism exists to the detriment of Haiti, though historical evidence is, again, preponderant in showing that racism has been the factor in Haiti’s inability to throw off the yoke of constant outside interference, “Why would Americans not look on this self-affirming act as the Haitian equivalent of America’s Boston Tea Party? The answer, put simply, is race.” The major, common theme of long-standing existence in Haiti, and of a more recent duration in South Africa, is the fact that there was a revolution of the black populace in both countries. The “revolution” was peaceful in South Africa, but had basically the same effect on the ruling white elite, not only in South Africa, but around the world: it would not do to have a successful black government existing outside the military-industrial complex. And, in a more elemental explanation, it was an embarrassment to the white elite, both in the long-term sense in Haiti, and recently in South Africa.
Oddly, if Thornton wanted to make some sort of a nexus of networks, the network of nefarious First World government intervention would be a good place to start. And the network of poverty would be another one. In Mountains Beyond Mountains Tracy Kidder explains Famer’s initial indoctrination into understanding the network of poverty, and its consequences, “He learned, too, about the central importance of “maternal mortality” – how the death of mothers, common events in those squatter settlements, led to skeins of catastrophes in families, to hunger, and prostitution, to disease and other deaths.” Yet Thornton extolls the bucolic rural nature of Uganda as one of the reasons for the “success” of the HIV/AIDS program there as opposed to South Africa. What, then, explains the deplorable rural system in Haiti? Are their cultural habituations of a lower quality than that of Uganda?
The massive politicization of HIV/AIDS infection and institutional racism have combined to create an immense and seemingly permanent structure of intertwined governmental intervention, corruption, massive influx of money from varying sources, pharmaceutical shenanigans of differing types, inflexible, leaden institutions, unable to change in any degree commensurate with the emergency that is HIV/AIDS, and Third World citizens that have become immune to the promises of all of the above. It is the Third World citizens that are the recipients of both the treatises of the Farmers and of the Thorntons of the world. Graham Green understood this in writing The Comedians, “The suicide has judged by the laws of chance – so many odds against one that to live will be more miserable than to die.” And it is Paul Farmer that understands the picture that applies not only to Haiti, but to South Africa and the entire Third World, as well, when he paraphrases a passage in The Comedians when asked his opinion on the cause of the deaths of several members of one family, “Haiti. They died of Haiti.”
