an explanation is in order

right, so i'm gonna go ahead and blame my lack of writing (as if anyone cares) on having to read and write a good bit for a couple of my classes. basically these two classes boil down to a critical (read: foucauldian) look at hiv/aids and healthcare discourses, respectively. anyways, to rectify this disappointing dearth of reading material (i'm just being an ass: ignore me), i've posted those two research proposals i've been working on the last week or so. i think they're good enough to stand on their own, at least as presenting an argument and working as an introduction to something that will (hopefully) include some actual evidence rather than relying simply on my poorly-documented claims. ah, the demands of the academic discourse. right, so, please read, and let me know of any insights/criticisms you (all two of you reading this) might have.

The representation of women and the spread of HIV

The spread of HIV throughout the world has certainly served as a screen against which preexisting power modes of power been projected, power which has defined and controlled the production of identity of a myriad of “risk groups”, presenting us with the “homosexual”, the “IV drug user”, the “prostitute” and the “long-distance truck driver”, to name but a few. By creating these discrete groups (which are generally understood to be mutually exclusive, not only to each other, but also with the “norm”), subjects have been created, subjects whose possible trajectories have been pre-determined, whose “otherness” as been taken for granted and whose voices have all but been lost in the crowd of the researchers and academics who have written the definitive accounts of “the AIDS epidemic”. While this paper will certainly only be adding to that crowd of academics (though nearly imperceptibly), I hope to elucidate some of those modes of power which have created distinct groups by simply the application of a name, thus cordoning off certain behaviors, nationalities and even genders from the “general population”.

This paper will seek to understand the contradictory representations of “women” in HIV/AIDS discourse. While Treicher notes the lack of research interest in, if not the outright denial of, women’s involvement (or at least the involvement of “normal women”) with HIV in the 1980’s, attitudes have shifted significantly in the 1990’s and the 21^st century, where women have frequently been portrayed as “vectors of disease”—prostitutes transmitting HIV to their clients, mothers transmitting HIV to their children, and, more generally, women holding “the key” to preventing the spread of HIV to the “general population”. Beyond merely placing blame or responsibility for the transmission of the virus, women have also been denied a place among the ranks of “victims”, appearing as carriers or not at all it would seem.

Moreover, HIV is a very strongly sexed pathogen. Due to its beginnings (in the North) as a disease of the gay man, it became and has remained a male disease. Women were reassured that this STI would not be transmissible to them, that this was simply the “fatal price of anal intercourse” (interestingly, also defining heterosexual sex as purely vaginal). Through this characterization of HIV, men were defined from the outset as the primary concerned population.

This “male disease”, it will be shown, is a product of a consistently patriarchal system of symbolic representation, as described by theorist such as Irigaray, Beauvoir and Butler. In the theory of Beauvoir, women are linguistically defined as the sex which is not male (which is defined as the “universal”), they exist as the only marked sex, indeed, they exist as the classic “other” which the “normal” uses to both construct its own identity and obscure its very construction. Irigaray takes a seemingly oppositional approach, seeing women being left as the undefined and undefinable completely outside of an uncompromisingly patriarchal linguistic system; indeed, women are everything that fails to be male, thus defining women as a multiple gender (or the “sex that is not one”). These two theories, however, seem to converge in agreement that the male is the “norm”, the “default”, leaving “female” to constitute something “abnormal” and certainly, leaving it simply as “not-male”.

Under the lens of these theories, it will become clear how this disease, first described in the “all-male” world of the homosexual community in the United States, consistently failed to be given a designation of anything other than this false universality of masculinity. Though very little has actually changed in the representation of HIV infection (as a “gay”, or “male”, disease) in the North, the representation of HIV as a male disease has had to undergo significant modification to “fit” the pattern of transmission in the South, especially in Africa. In Africa, HIV infection, most often transmitted through heterosexual exchange of fluids, has been characterized as a disease of displacement (echoing, perhaps, the 19^th- and 20^th century discourses on tuberculosis as a “disease of civilization”?), affecting primarily those displaced and living along the paths of major population shifts. Here, there is much talk about long-distance truckers and migratory labor (including mining and agriculture), where prostitutes, beyond receiving blame for their infection and transmitting it to others, are consistently relegated to the position of the passive “pool” of infection which spreads then to the more “active” individuals, ie, the mobile males. Further along the represented chain of infection (which is in no way merely linear), women are again left out, receiving no mention as receiving HIV from an infected partner, but again garnering blame in passing HIV on to her innocent unborn offspring.

Throughout this paper I will also refer to the contradictory roles defined for women, both as the dangerously sexual deviant (or temptress) and as the impossibly passive maternal caregiver, and how these defined roles are both a product of and productive of the discourse obscuring the role of women in the global epidemic of HIV infection (whether or not one chooses to “believe” in AIDS as such). Overall, I hope to show that the rigidly binary production of identity (male/female, gay/straight, the norm/the other) seriously obscures both the mechanisms by which these designations are produced and the effects of these designations, especially in the transmission of such a “political” disease.

[check out:

Butler, Judith (1990) Gender trouble: Feminism and the subversion of identity. (New York: Routledge).

Foucault, Michel (1973) Discipline and punish: The birth of the prison. (New York: Penguin).

Treicher, P. A. (1999) How to have theory in an epidemic: cultural chronicles of AIDS. (Durham: Duke University Press).

that should get you started, but if you're still needing more, check out books by Simone de Beauvoir and Luce Irigaray or "Bodies that matter" (so i'm told, i haven't actually read this myself) by Butler (above)]

The Gaze, Advocacy and the God-trick

Chagas’ disease, a parasitic infection of the blood and internal organs endemic to the Americas, plays a largely silent role in the lives of millions of rural people, from Argentina to the southwestern United States. Although present in the blood of up to 80% of the population in affected areas, and although this infection often leads to heart and intestinal failure, little attention is given to containing this plague outside of the rural communities themselves.

Doctors without Borders (or Médecins sans frontiéres, MSF) is a large international non-governmental organization (NGO) which defines its mission as twofold: providing necessary medical relief for underserved populations, especially in poor or war-torn areas; and advocacy on behalf of those populations served, both on the national and international stages.

In the department of Tarija, in southern Bolivia, these two narratives intersect. MSF (along with other NGOs, such as CARE, PLAN and Esperanza/Bolivia) is involved in an attempt to eradicate Chagas’ disease as a major cause of morbidity and mortality in the rural areas. This attempt generally consists of biomedical interventions in identification and treatment of cases (ineffectively—Chagas’ disease is able to “hide” in the blood of adult hosts, and pharmaceutical treatments are considered prohibitively dangerous in patients under 6 years of age and above 15 years) and pseudo-biomedical interventions (public health interventions) designed to improve housing conditions and thus prevent re-infection. In doing so, it involves itself in advocacy, which at least in this case has manifested itself mainly as “consciousness-raising” attempts, especially in the production of photographic expositions which have been shown in the major cities of Bolivia.

This dual role for MSF presents an interesting opportunity for analysis, in which the “gaze” (as defined by Foucault in The Birth of the Clinic) consciously represents itself as the speaking subject, “I”. This involvement/detachment, inherent in the positions of both observer/advocate and interventionist/participant, provides the perfect opportunity for the observation of the “god-trick” as described by Haraway (and though certainly noted, the contradiction inherent in the observation and analysis of the “god-trick” risks unrestrained recusivity and is anyways certainly not within the scope of this paper).

MSF paradoxically presents itself as both the provider of “healthcare” and “development” (as understood within a decidedly Western context) and the voice of those who require its assistance, who are presumed unable to speak for themselves (or even completely voiceless). Within the framework of postmodern (or –development) analysis, this seemingly contradictory stance serves to both preserve and mask the rigid power relations inherent in the positions of developer/developee (or, more specifically in this case, doctor/patient) and advocate/one-who-requires-advocacy. The advocacy both raises awareness of the problem and underlines the need (of representation) of the population, thus justifying its own existence. Meanwhile, this advocacy further justifies continued intervention, which, especially under a Foucauldian lens, serves to create the population to be “developed” as a discrete organism and subject of study. The constant reports, censuses and studies undertaken as the “baseline”, status reports and final achievements of the development project are incredibly self-justifying, constantly promoting the extension and deepening of intervention, all the while selecting, filtering and channeling the flow of subaltern voices and narratives, lending “authenticity” to the dominant narrative presented by the advocates themselves. This uninterrupted flow of information and further involvement preserves the hegemony of the “norm”, the “developed” and the “healthy”, defining its “target population”, inscribing its own boundaries and barriers around this population while pathologizing the living conditions of rural Latin Americans.

This self-evident definition of those in poor countries as “in need” preemptively blocks off any policy options other than those which can be seen as “top-down”. This limitation, in the best case is a self-perpetuation of development discourse which is out of control (because it is out of view) of even the most powerful actors (in the view of Ferguson), or, in the worst case, a systematic perpetuation of current, unequal North-South power relations.

[for more info on this, check out:
www.msf.es --> click on "Especiales: Chagas: una tragedia silenciosa"
www.doctorswithoutborders.com --> click on "Country: Bolivia" or "Programs: Chagas"

or these books:
Escobar, A (1995) The Making and Unmaking of the Third World (Princeton, NJ: Princeton University Press).

Ferguson, J (1990) The Anti-politics Machine: ‘Development’, Depoliticisation and Bureaucratic Power in Lesotho (Cambridge: Cambridge University Press).

Haraway, Donna J. (1991) Simians, cyborgs and women: the reinvention of nature. (London: Free Association Books).]