Public Health, Global Surveillance, and the “Emerging Disease” Worldview: A Postcolonial Appraisal of PEPFAR

Abstract

Drawing upon a postcolonial lens, this project looks at how meanings of HIV/AIDS are discursively constructed within the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), which was launched in 2003 under the presidency of George W. Bush and has been heralded as the largest global public health intervention program in history. Building on existing literature that theorizes the interrelationships of public health and national security, global surveillance, and transnational hegemony, the postcolonial theoretical standpoint interrogates how such meanings are constructed within PEPFAR. A postcolonial deconstruction of the 2009 PEPFAR report to the Congress revealed three meanings of HIV/AIDS that were discursively constructed in such policy documents: (a) the "Third World" as a site of intervention, (b) U.S. altruism as "lifting" the burden of the soul, and (c) AIDS, economics, and security. The themes put forth the linkages among the symbolic representations in neocolonial configurations and the politics of material disparities across the globe, thus issuing a call for the creation of participatory and dialogic spaces for engaging subaltern voices that are typically treated as targets of policy and intervention discourses.

Defining Agency and Vulnerability: PEPFAR and the Role of Women in HIV/AIDS Prevention

“…Sastry and Dutta () discuss the role of the United States as the “savior” and the “other” as those to be “saved.” This relationship emerges in the treatment of women in the language of the PEPFAR program and through its programmatic interventions. This idea manifested itself in various ways, suggesting salvation not only from HIV/AIDS, but also men, institutions, society, and themselves.…”

The somatic-security industrial complex: theorizing the political economy of informationalized biology

“…Whether novel or not, global health security has been successively sedimented into what has been characterized as a 'worldview' that is largely bound up with worries about emerging (and re-emerging) infectious disease alongside concerns with man-made biological threats and bioterrorism (King, 2002;Sastry & Dutta, 2012). Based on a particular form of somatic expertise and technology (Rose, 2007), as well as a materiality and order that is legitimized by an ever-growing list of biological dangers, global health security has concerned itself with a broad set of issues in response.…”

“…As Weir and others note, the main sources of pandemic alerts, epidemics and notifiable outbreaks of infectious disease emerge from sub-Saharan Africa and Southeast Asia, and much of the effort underlying surveillance and containment initiatives in these regions lies with detection of outbreaks incidents in many resource poor countries with poor public health systems (Sastry & Dutta, 2012;Weir, 2014). The Global South is very much the principal source of infectious disease outbreaks in blunt global epidemiological terms (Jones et al, 2008), albeit with the structural drivers of this often simply passed over.…”

Is it Heuristics in Use or ‘Ritualistic and Instrumentalist’ in Purpose? Neoliberal Philosophy and the Use of KAPS (Knowledge, Attitude and Practise Surveys) in a Least Developed Nation

“…The assuming away' [41] is based on various factors, contexts and the philosophical underpinnings of the concerned researcher. Assumptions are inevitable and different levels and types such as the ontological assumptions [41 -46], epistemological assumptions [47 -50] [51], methodological assumptions [52 -54], axiological assumptions [55], fundamentalist assumptions [56] [57],observability assumptions [58,59], consilience assumptions [60], depoliticizing assumptions [61], social world homogeneity [41], in-house assumptions [62], atomistic assumptions [56], rationalist assumptions [63], taken for granted assumptions [64,65], and the 'neoliberal assumptions' [66] within which all of the above and few other types of assumptions which the author might have missed exists. Though assumptions are inevitable many assumptions can be illogical, unwarranted, spurious and misleading.…”