GeoJournal (2012) 77:459–473 DOI 10.1007/s10708-010-9353-y
Imaginative geographies of gender and HIV/AIDS: moving beyond neoliberalism Rachel Bezner Kerr • Paul Mkandawire
Published online: 27 April 2010 Ó Springer Science+Business Media B.V. 2010
Abstract This paper examines how neoliberal development discourse contributes to the production and maintenance of problematic gendered hierarchies and spaces. By interrogating the basic assumptions undergirding this discourse, this paper explores how neoliberalism produces spaces which normalise certain identities—especially those associated with individualism and economic rationality, and makes errant values such as communalism and altruism. Drawing on perspectives from feminist geographies, we argue that by normalising and privileging certain masculine identities, neoliberalism reinscribes and legitimizes gendered power relations that are counterproductive to addressing HIV/AIDS. The ‘ideal’ person fighting HIV/AIDS in the neoliberal framework is rational, competitive and self-interested, but these characteristics are complicit in worsening HIV prevalence and mobilize problematic gender roles and identities. Given the pervasiveness of this ideology in Malawi, we propose ways in which families, communities and institutions can challenge and reshape gender identities and potential solutions to HIV within this context.
R. Bezner Kerr (&) P. Mkandawire Department of Geography, University of Western Ontario, 1151 Richmond Street N., London, ON N6A 5C2, Canada e-mail:
[email protected] URL: http://geography.uwo.ca/faculty/beznerkerrr P. Mkandawire e-mail:
[email protected]
Keywords HIV and AIDS Gender Neoliberalism Feminist geography Malawi
Introduction Neoliberalism, the dominant paradigm guiding international development policy today, emphasizes the market to allocate resources, free trade and capital mobility, with minimal state intervention (Hay 2004; Harvey 2005). These basic principles of neoliberalism promote the idea of an economically motivated, rational individual who exchanges based on profit as the foundation for society (Griffin 2007; Larner 2000). This assumption excludes behaviours based on other types of motivation such as altruism, collectivist strategies, empathy for others, love, reciprocity and care (Ferber and Nelson 2003). More than a set of policies, neoliberalism has been successful in shifting public perceptions about citizen entitlements, government efficiency, and the collective provision of social needs (Hay 2004). In this paper we conceive of neoliberalism as a process, a political economic project and an ideological discourse as opposed to an end-state (Peck and Tickell 2002; Larner 2000). In the contemporary configuration of neoliberalism, governments are encouraged to focus on economic efficiency and international competitiveness, initially through ‘rolling back’ the
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state, and increasingly through market provisioning of services and targeted interventions around social issues such as crime (Peck and Tickell 2002; SaadFilho and Johnston 2005). While some of its effects on human beings are relatively concrete and visible, others tend to be highly abstract, less discernible and more difficult to identify. This paper examines the ways in which neoliberal development discourse inscribes particular gender identities, norms and relations in southern Africa in ways that reinforce gender inequalities, and worsen the situation of HIV/ AIDS. To argue that neoliberalism embodies a tendency to emphasize problematic gender identities is not to posit a wholesale argument against the freemarket imperative, but to understand how neoliberalism as a process becomes variously manifest at different scales. In this paper, we draw attention to some aspects of neoliberalism that seem problematic, particularly in relation to HIV/AIDS. Using Malawi as a case study, we examine the ways in which the ideal economic individual in neoliberal discourse seems to ignore structural factors that hasten the spread of HIV/ AIDS and exacerbate inequalities between men and women. Drawing on feminist geographies, we argue for a new imaginative concept of gender identities beyond neoliberalism, which would reshape identities and foster cooperative social action to address gender inequalities and HIV/AIDS. Concrete conditions that facilitated mobilization and ascendancy of the free-market doctrine were ushered in by the macroeconomic crisis of 1970s, including the oil shock and debt crisis which threatened the stability and viability of the global economy (Saad-Filho and Johnston 2005). The neoliberal school of thought was then harnessed into a political project that placed emphasis on virtues such as free markets, deregulation, flexible labour practices and downsizing government. Despite its ascribed ‘there is no alternative’ status, neoliberalism started encountering its political and institutional limits in the 1990s (Peck and Tickell 2002) which found expression in growing poverty, unemployment, social inequalities, especially in developing countries (SAPRIN 2004). As Peck and Tickell (2002) argue, the ultimate solution for this crisis was not implosion but reconstitution, as neoliberalism gradually transmuted into more social interventionist and ameliorative forms. This move, nonetheless, did not constitute a radical ideological departure as economic
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imperative remained firm on the policy agenda. In addition, the neoliberal project also succeeded in constructing and disseminating new discourses of reform, new norms and modes of delivery, and transformed social subjectivities (Peck and Tickell 2002). These processes together serve to bolster the logic of free-market ideology while simultaneously producing and reproducing a particular mindset that conforms and is subservient to neoliberalism. Although popular conceptions of neoliberalism privilege a monolithic view of the ideology advocating for grand solutions, the free-market ideology is much more differentiated in its manifestations. Examining neoliberalism from this perspective means paying attention to the different variants of neoliberalism, to the hybrid nature of contemporary policies and programmes, and to the multiple and contradictory aspects of neoliberal spaces, techniques, and subjects (Larner and Le Heron 2005). Neoliberalism is therefore understood as produced and reproduced through institutional forms and political action, and is manifest in hybrid, composite forms (Larner 2000). Such an approach represents an attempt to render the analysis of neoliberalism more sensitive to its local variability, revealing the detailed and complex processes involved. In this paper we focus on how neoliberalism is locally constituted and reconstituted through various institutional forms and practices in Malawi, in order to understand how individuals and institutions behave or are seen as neoliberal subjects. The focus of this essay is, therefore, not as much on the implications of the material practices, but rather the effect of the less visible, discursive aspects of neoliberalism, which ultimately have the potential to shape our social relations in profoundly material ways. Neoliberalism is revealed not only in government policies and programs, or in corporate strategies and decisions, but also in ideas, images and representations. These ideas ascribe one set of attributes to economic entities that are assumed to successfully compete and thrive under free market conditions and a different category of characteristics to those that are bound to be outmaneuvered and fail. On the basis of this dichotomy, in this paper we seek to explore how neoliberal development discourse contributes to and reinforces problematic gender norms and roles, with a concomitant impact on HIV/AIDS in sub-Saharan Africa. We are not arguing that neoliberalism is the exclusive or primary determinant of gender inequality
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or HIV/AIDS. It is rather an attempt to understand ways that neoliberal discourse subtly contributes to the reinforcement of certain gender relations and roles, and produces spaces where these identities are legitimized and reproduced, thereby simultaneously eclipsing efforts towards dealing with HIV/AIDS in sub-Saharan Africa. That is, by interrogating the underlying premises of neoliberalism, and how they operate, we seek to examine how the free market imperative simultaneously produces a discourse that stabilizes certain problematic gender stereotypes, and undermines efforts to deal with HIV/AIDS epidemic in the sub-Saharan Africa region, where gender relations constitute a critical factor in the spread of the virus. To fully develop these arguments we interrogate two basic premises of neoliberalism, namely; individualism and economic rationality. First, we argue that neoliberalism exhorts a version of economic rationality that is hostile to feminist goals of gender equality. Here, we suggest that the discourse of neoliberalism valorizes notions of rational economic behaviour that not only privilege certain problematic masculine identities, but simultaneously frame those who get HIV/AIDS as ‘risk groups’ requiring individual-focused interventions. These interventions, in keeping with neoliberal tenets, are increasingly reliant on corporate support rather than the state, with a focus on the technological and biomedical solution of anti-retrovirals (ARVs). Issues of declining health services and health access for the poor majority are largely ignored. The targeted ‘risk groups’ in Malawi are primarily women, youth, prostitutes and orphans—issues of masculinity and the ways in which gender roles and norms perpetuate the transmission of HIV/AIDS are not sufficiently raised in the discourse. The invisibility of men in issues of HIV/AIDS leads to ‘gendered spaces of violence’ (Coleman 2007) within a heteronormative, patriarchal and highly misogynistic discourse that generally blames women for HIV/AIDS rates in Malawi.
Neoliberalism and biomedicine: making neoliberal subjects In addition to being a political ideology and a set of practices, neoliberalism is also a means of governing
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individuals, including disciplining citizens to control themselves (Lemke 2001). Emphasis is placed on the desirability of particular political subjectivities and capacities, thereby mobilizing particular gender identities and social spaces (Griffin 2007). Social and political life is viewed and reconfigured through the lens of certain desirable economic identities. Neoliberalism regulates these identities according to specific desired standards of normalization, including heteronormativity which is almost exclusively embodied in masculine heterosexuals (Griffin 2007). Such manner of social control is remote and largely imperceptible, operating at a discursive level to position selfregulating capacities of individuals in line with government aspirations. The limited number of studies on this aspect of neoliberalism have pointed to a powerful regulatory effect which links individual subjectivities to economic rationality (Ives 2007; Larner and Le Heron 2005; Rankin 2001). However, these political rationalities are constructed in ways that blur racial, gender and economic inequalities that characterize everyday life, thereby shifting responsibility for these inequalities from government to the individual (Ives 2007). Neoliberalism and biomedicine here share a common epistemic and methodological premise, by abstracting people from their social context and ignoring political, economic cultural and geographical inequalities which affect health (Frankford 1994). Individualism is at the heart of a biomedical approach to human health, which focuses on biological factors which cause health problems, using ‘risk populations’ to target groups for individual-focused health interventions (Kreiger 1994). As Kalipeni et al. (2004: p 18) note, in this model the responsibility and agency for improved health lies with an individual, which is intrinsically linked to a capitalist, neoliberal economic model. The focus on individuals as the unit of analysis ignores broader, structural inequalities, as well as inequalities within households and communities, which can foster or initiate health problems. Related to this individual-level of analysis is the notion of rational decision-making in relation to health. Assumptions of individualism and economic rationality are embedded within each other: given adequate knowledge, individuals will make decisions based on what is the most rational economic decision that farther their health and well-being. Thus, women who are ‘choosing’ to have sex with men for food are
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making a rational decision, with knowledge of the choice between death (by contracting HIV/AIDS) or starvation (Bryceson and Fonseca 2006). Here the definition of rationality is narrowly constructed in a way that places those people making ‘irrational’ decisions into the imaginary ‘space’ of other. In the case of HIV/AIDS, that imaginary geographical ‘other’ might be irrational, hypersexual, lacking control, or reservoirs of infection (Craddock 2000).
Feminist geographies of gender in Malawi Feminist geographers analyze the ways in which sex, gender and place are mutually constituted, and how power relations are imbued in social relations and spatial order (Blunt and Wills 2000). Gender, in this paper, is considered to be socially constructed, that is, what it means to be man or woman, and what constitutes masculine or feminine traits varies over space and time. The term ‘male gaze’ describes the ways in which male geographers’ assess landscapes and societies from a masculine perspective, without recognizing the power relations which are imbedded in the places, social relations and in their viewpoints (Rose 1993). The image of the ‘rational, economic individual’ is profoundly masculine (‘the self-made man’) as well as race and class specific in its imaginary (Said 1978). Masculinity in Western culture is strongly associated with rationality, competitiveness and ambition, while values of altruism, love and cooperation are associated with femininity (Belenky et al. 1997; Hekman 1995). Over the past centuries these patriarchal values have infiltrated, clashed and sometimes merged with values in southern Africa. For example, in Malawi colonialism and Christianity came with important changes not only with respect to medicine but also Victorian values that emphasized males as head of households and breadwinners for their families and gave land and legal rights primarily to men rather than women, in contrast to the matrilineal system operating in many parts of Malawi (Lovett 1997; Peters 1997). The post colonial period in Malawi was characterized by policies, especially in agriculture, which assumed that males were more rational and competitive than females. Consequently, land holdings, farming inputs, credit and extension services were directed to males as head of households (Spring
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1995). Neoliberalism discourse mobilizes gendered notions of who can compete and succeed, conjuring masculine identities despite an apparently neutral language (Griffin 2007). In doing so, there is an imagined geographical ‘other’ who does not succeed in this societal vision. One ‘other’ being imagined is the irrational female, who is fettered by social obligations and who is unable to compete effectively. ‘Domestic’ work, the work of caring for children, or the elderly and other activities associated with the feminine are absent in this model. Also invisible is the persistent structural inequality in pay and working conditions experienced by women in the paid workforce, and consequently higher rates of poverty experienced by women compared to men. The ‘male gaze’ in neoliberalism thus values masculine traits and types of work that unequally benefit men compared to women. There is also a racial and classist undertone to the discourse, rooted in spatial dimensions. Emphasis on competition undervalues cooperation, reciprocity and social support still prevalent in many African societies ignores the ways that transportation routes, economic systems and political divisions in Africa have been shaped to the advantage of Western nations. The next section will outline how HIV/AIDS discourse in Malawi is linked to neoliberalism spaces.
Spaces of neoliberalism in HIV/AIDS discourse in Malawi The specific conditions that led to the ascendancy of neoliberalism as the preeminent logic guiding national development in Malawi can be traced back several decades. The global oil shock of 1979, the civil war in the neighboring Mozambique, the influx of refugees into the country and the closure of routes to major sea ports along the coast of Indian Ocean led to an economic crisis in the late 1970s (Englund and Mapanje 2002). In addition, the drought of 1980 exerted severe pressure on the national budget that necessitated external borrowing (WDM 2002). The combined effects of these factors plunged the country into a balance of payment deficit, and for the first time since gaining political independence from Britain in 1964, the economy registered negative growth. To correct these macroeconomic imbalances, the Malawi government turned to the World Bank
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and the International Monetary Fund (IMF). The World Bank and IMF prescribed a set of structural adjustment policies (SAP) primarily aimed at transforming the structure of the economy to enhance its capacity to cope with shocks, to restore macroeconomic stability and put the country back on a sustained economic growth trajectory. The set of policies prescribed included deregulation of agriculture, streamlining social services (including education and health sub-sectors), reforming the civil service, deregulation of credit and financial markets, floating the local currency, and allocation of more autonomy to the Reserve Bank of Malawi (Government of Malawi 2006). Implementation of these policies was accompanied by promulgation of a policy discourse that underscored the virtues of privatization, innovation, enterprise, efficiency, competition, cost sharing (especially in the health sector), and economic rationality consistent the logic of the free market ideology. Although Malawi was generally lauded as one of the strictest adherents and implementers of SAPs, even by the end of 1990 the economy was still unstable and growth was largely elusive (Chilowa 1998). For example, from inception of adjustment polices in 1981–1989, GDP growth was only moderate, averaging 2.3% per annum while in 1992 the economy grew by negative 7.9% (Malawi Government 2000). Meanwhile, perverse social consequences of SAP manifested through declining food security, growing poverty and inequality, increasing unemployment, inflation and deteriorating social services (Harrigan 2003). The health sector also suffered chronic underfunding with the result of deterioration of public health infrastructure, low staff morale and massive braindrain while HIV/AIDS took its toll on the population (Englund and Mapanje 2002). Driven by narrowly conceived ideals of efficiency and economic rationality, the Malawi civil service was also restructured and many of the public services privatized or downloaded to the private sector. In view of this crisis, the Malawi government again at the behest of World Bank and IMF formulated the first Poverty Reduction Strategy Paper in the year 2000, subsequently renamed Malawi Growth and Development Strategy Paper in 2006. The government only guarantees minimal levels of safety nets to the most vulnerable or ‘at-risk’ groups (even the definition of the ‘most vulnerable’ remains problematic in a
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context where over half of the population lives below the poverty line). Evidently norms that govern the conduct of firms and individual citizens which conform to the norms of the market are encoded in these strategies. Malawi ranks amongst the worst HIV/AIDS affected countries in southern Africa. In a country where 12% of the population is already infected with HIV/AIDS, and about 90,000 people die every year from the epidemic (UNAIDS 2008), the disease occupies a central place in people’s everyday lives in Malawi. The presence of HIV/AIDS in the lives of Malawians is manifest in various ways including people living with the virus, orphans, deaths and illnesses. However, the centrality of HIV/AIDS is also revealed in the daily use of language and conversations that take place in different social circles in the country. This section examines the discourse of HIV/AIDS in Malawi. We share in the belief that the manner in which people talk about the HIV/AIDS epidemic reflects not only their perception and definition of the disease, but also how behaviours are negotiated, risks confronted, funerals organised, and consequences mitigated (Kalipeni et al. 2004). But more importantly for this paper, these ideas and narratives about the epidemic provide a lens for understanding the manner in which blame is constructed, manifested and attributed. While in this paper we selectively draw on other studies in Malawi (Craddock 2000; Lwanda 2003), our aim is to provide an account of the extent to which discursive and symbolic constructs relating to HIV/AIDS in Malawi embody the neoliberal premise of individualism, and how these constructs simultaneously create spaces where gendered violence is meted out and legitimized. Through this analysis we seek to reveal the pervasive imprint of neoliberalism in the conception of HIV/AIDS in Malawi, and how the inescapable conceptual hegemony of the market ideology reinscribes problematic gender images and creates spaces of violence. The pervasiveness of HIV/AIDS in Malawi means that popular narratives relating to disease inevitably have multiple sources from which they emanate. For the purposes of this paper we examine these ideas and concepts as they flow from three key locations. These locations can be seen as sites where perceived and emerging narratives about HIV/AIDS are deposited, negotiated and interpreted. Firstly, we critically
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examine the current Malawi National HIV/AIDS Policy Framework (2003) and seek to understand how the discourse of HIV/AIDS in Malawi has been constructed nationally. Secondly, we critically examine how HIV/AIDS policy has manifested in public health promotion efforts. In particular, we closely look at the social marketing of condoms, and seek to deconstruct condom adverts in order to reveal assumptions that are embedded in these texts. Thirdly, the section explores cultural ideas and concepts about HIV/AIDS as illustrated in political speeches by some prominent political party leaders in the country. In this discussion we draw on the work of Lwanda (2003) who argues that messages relating to sexual behaviour and sexuality are present in everyday lives of people in Malawi and are exploited for health promotion. However, we go beyond to examine how these discourses create gendered spaces of violence.
Malawi National HIV/AIDS policy Although the dynamics of HIV/AIDS may have changed over the past years, the current national AIDS policy in Malawi has been in place since 2003. The policy goal is to prevent HIV infections, to reduce vulnerability to HIV, to improve the provision of treatment, care and support for people living with HIV/AIDS and to mitigate the socio-economic impact of HIV/AIDS on individuals, families, communities and the nation (Government of Malawi 2003). The policy framework also acknowledges that vulnerability to HIV/AIDS is largely embedded in broader factors, and suggests that poverty is one of the major drivers of the epidemic in the country. In addition, it is argued that the gendered nature of poverty in the country means that, in general, the unequal position of girls and women makes them more vulnerable to being infected and adversely affected by HIV/AIDS than men. For example, Section 1.4 of the Malawi National HIV/AIDS Policy emphasizes the need to address social, political and economic factors that increase vulnerability to HIV/ AIDS infection and influence the daily lives of those living with HIV/AIDS. This policy aspiration is couched in terms which are consistent with emerging scholarly debates that the epidemic is embedded in socio-economic context (Gillespie 2006; Kalipeni et al. 2004). Recent studies in southern Africa find no
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direct link between wealth and HIV prevalence, but rather, that high levels of income and gender inequality are particularly important drivers of HIV, and the poor experience greater socio-economic impacts from the disease (Gillespie et al. 2007). Understanding the social relations and processes that lead to high rates of HIV transmission are critical for reducing rates. In practice, however, this reflexive observation is quickly confounded by the interventionist approach to addressing the disease. A critical examination of the HIV/AIDS policy in Malawi reveals that there is an ironic conjugation between a broad policy statement that foregrounds structural conditions, and the specific policy strategies that espouse targeting specific groups defined on the basis risk characteristics. The mismatch between broad policy statements that provide context for the disease and narrow interventionist strategies is evident in the following prescriptions: Policy clause 3.2.1.1 states that: To tackle the HIV/AIDS epidemic, people must have the ability to adopt risk-reducing behaviour and also be able to utilize existing opportunities to cope with HIV infection and AIDS. Targeted information delivered within a culturally sensitive context can help to increase awareness and knowledge and to overcome the stigma, discrimination, myths, beliefs and prejudices associated with HIV/AIDS and sexuality. Mass media supported by interpersonal communication are vital channels to reach out to the largest number of people with accurate, targeted and relevant messages. Policy Clause 5.1 states that: Vulnerable populations include women, children, orphans, widows, widowers, young people, the poor, sex workers, prisoners, mobile populations, persons engaged in same sex relations and people with disabilities. These are underprivileged socially, culturally and economically or legally may be less able to fully access education, health care and social services and means of HIV prevention and less able to enforce HIV prevention options and to access needed treatment, care and support. They are thus more vulnerable to the risks of HIV infection and suffer disproportionately from the economic and social consequences of HIV/AIDS.
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The above selected statements typify the inherent tendency of the HIV/AIDS policy in Malawi to gravitate towards targeting HIV/AIDS interventions towards certain groups who are considered to be at risk. While the above strategies are obviously in line with policy objectives, and notwithstanding the role of agency in the spread of HIV/AIDS, the challenge in this particular case is that in a country where more than half of population live below poverty line (Government of Malawi 2006), and where being poor predicates increased vulnerability to the interactive effects of HIV/AIDS, it seems that the majority of the population is already ‘at risk’. In addition, there is recent evidence in southern Africa that there is greater risk of infection for the wealthy, due to their greater mobility, likelihood of living in urban areas, and likelihood to have multiple sexual partners (Gillespie et al. 2007). Therefore, under the existing socio-economic conditions in the country, not only is the act of targeting HIV/AIDS interventions practically difficult, but that the concept of targeting itself is rendered largely irrelevant. Further, by focusing on ‘at risk groups’, the HIV/AIDS policy is framed in a manner that elides relations and processes that make people within these categories vulnerable in the first place. The placement of people in rigid categories serves to separate them from other sources of identity as well as key processes and relations which create vulnerability (Craddock 2000). Inadvertently, this categorization may reinforce stigma and blame towards the ‘risk groups’ while deflecting responsibility for HIV/AIDS away from conditions that create vulnerability. As argued by Kalipeni et al. (2004) the preeminence of the ‘risk group’ approach serves to avoid committing resources to a wider cause, and consequently, in keeping with neoliberalism’s narrowly defined tenets of efficiency and rationality. For example Policy statement 7.3.1 states that: Government shall ensure that people engaged in transactional sex have access to confidential and respectful health care, particularly sexual and reproductive health, life skills, female and male condoms and treatment and care in the case of sex workers who are living with HIV/AIDS. Government shall ensure that people engaged in transactional sex (including commercial sex workers and their clients) are aware of and take
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responsibility for protecting themselves and their sexual partners. Again these policy prescriptions are programmatically consistent with the national goal of reducing the spread of HIV/AIDS and mitigating its impact. However, while the broad policy aspirations acknowledge that the epidemic is largely embedded in social, economic and political conditions, these strategies are, nonetheless, prescribed as interventions based on particular social and economic characteristics of individuals. Although the range of vulnerable groups primarily targeted for HIV/AIDS intervention in Malawi now goes beyond the traditional focus on commercial sex workers (e.g., see policy clause 5.1 above) to include mobile populations and prisoners, it is the practice of consigning individuals into rigid categories based on perceived risky characteristics that renders the whole approach to HIV/AIDS in Malawi problematic (Craddock 2000). There are four major reasons why the risk group approach is problematic in the Malawi context. Firstly, it gives the false impression that individuals who are outside these groups need not to worry about their HIV status or vulnerability (Kalipeni et al. 2004). Secondly, the approach ignores the fluid and contingent nature of social identities such that people can assume different identities or can negotiate them depending on the situation. For example, a woman who is exchanging sex for food might be considered a ‘commercial sex worker’ but might also be a mother and a wife; the rigid categories ignore the power relations at work in the exchanges, which underlie women’s greater vulnerability to HIV infection in Malawi (Bryceson and Fonseca 2006; Craddock 2000). Thirdly, the emphasis on risk groups serves to stigmatize those categorized as vulnerable and this in turn renders then more amenable to blame for poor choices. Lastly, in a country where the majority of the population is poor, and a significant proportion is constantly moving in and out of the poverty category (Government of Malawi 2006), risk and vulnerability framed on the basis of individual attributes can be a complex activity and risk groups are likely to become moving targets. It would, therefore, seem that a broad social mobilization aimed at equalizing social relations, rather than interventionist approach based on individuals with particular risk factors, would be desirable in a country
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with high rates of poverty and social inequality. The notion of individualized risk and vulnerability as manifest in the Malawi HIV/AIDS Policy resonates with the biomedical and capitalist premise about health as emanating from deliberate choices and lifestyles under the control of the individuals (Kalipeni et al. 2004). The desirability of a ‘risk group’ approach to HIV/AIDS rests on a general unwillingness to commit large amounts of funding to a wider preventative approach, or even to developing an HIV/ AIDS vaccine (Craddock 2007). More importantly, antipathy to collectivist strategies is not incidental, but a basic tenet of neoliberalism (Peck and Tickell 2002). Therefore, although the structural dimensions of the HIV/AIDS epidemic are generally acknowledged by policy makers, the epidemiological focus on ‘risk group’ nonetheless serves to encourage individuals to perceive themselves as active subjects who are primarily self-responsible for own health and wellbeing, and engages them on the basis of particular social and political subjectivities or personal risk factors that render them vulnerable to HIV/AIDS. Hence, it is critical to note that while the HIV/AIDS policy in Malawi guides and coordinates national response to HIV/AIDS, the framework seeks to accomplish this by constituting subjects in a manner that is consistent with certain neoliberal political rationalities. The challenge for Malawi is not only that current practical HIV/AIDS control measures do not seem to be firmly interwoven with wider efforts to reduce social inequalities, but that poverty reduction itself is such a daunting task that it renders the risk group approach both technically and politically desirable. Social marketing of condoms One of the major strategies the Malawi government has put in place for HIV prevention is the widespread distribution of condoms (Government of Malawi 2003). Condoms offer a physical barrier that prevents the transmission of the HIV virus and avoids unwanted pregnancies. The Malawi National HIV/ AIDS Policy under section 3.2.2.3.1-2 promotes both male and female condoms as a means to prevent transmission of HIV, and encourages women to have full decision-making power during every sexual encounter. Male and female condoms need to be of good quality, affordable and widely accessible, including prisoners.
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In order to enhance acceptance and distribution of condoms in the country, government, donor partners and the NGO community are engaged in the process of the social marketing of condoms. Population Services International and Banja La Mtsogolo are two of the main actors widely involved in these efforts in the country. While the condoms have a critical role to play in HIV prevention in Malawi, especially given that a vaccine may still be many years away, the manner in which they are ‘sold’ to the general public remains problematic. Embedded in the ‘business’ approach to HIV prevention is the cultivation of a kind of social identity that reveals the neoliberal logics of individualism and rationality. In trying to enhance the use of condoms, public education strategies such television and radio advertisements, billboards, leaflets, sports tournaments and other forms of public performance are widely used. However, the messages and arguments for the use of condoms are constructed in a manner that creates spaces where individual non-compliant behaviour becomes an object of violence. For example, billboards with the following inscriptions are commonplace in Malawi: ‘What smart guys use wearing, Condoms’ ‘Chishango, ndi moyo wako’ - meaning that the condom is your life and your own future and failing to use it is choosing death The logic of neoliberalism is embedded within the assumption of individualism as revealed through emphasis on the notion of personal choice, which also create gendered spaces of violence. Making men responsible for their lives and others through condom use is a laudable goal, but the overemphasis on individual choices ignores the collective implications of non-condom use. Not only do these adverts fall short of recognizing that use of condoms is often highly constrained, but at the same time they frame those who fail to make this personal choice as irresponsible, errant and irrational. Sex often takes place in polarised power relationships such that condoms may not be an inevitable option for certain groups. Recent studies indicate that rural Malawians are actively discussing HIV/AIDS and condom use had increased over time, but that condom use remains low (Bankole et al. 2009; Kalipeni and Ghosh 2006; Smith and Watkins 2005). Extramarital affairs are common, with both qualitative and quantitative data
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indicating that women are less able than men to negotiate use of condoms, or prevent husbands from having affairs, and young women often are coerced or forced to have sex; divorce is increasingly a strategy used by women to avoid HIV infection (Smith and Watkins 2005; Moore et al. 2007). One qualitative study found that women who tested positive for HIV often found their husbands unsupportive and unwilling to use condoms (Chinkonde et al. 2009). There is evidence of high levels of physical and sexual violence against women in Malawi, both within and outside of marital relationships (Bezner Kerr 2005; Kathewera-Banda et al. 2005; Moore et al. 2007). In Thyolo in southern Malawi, the condom was considered by men to be equivalent to bringing an ‘intruder’ into the bedroom (Chimbiri 2007). Another study conducted in the lakeshore district of Nkhota-Kota also found that the fish market in the district was largely gendered, and sexual exchange constituted a key precondition to gainful participation of women in this industry (Kathewera-Banda et al. 2005). Framing the use of condoms in a manner that implies that individuals who do not comply or can use condoms are irrational, therefore, opens up spaces for victim blaming and perpetration of gender-based violence. While framing condom use in this manner may not necessarily amount to neoliberalism at a macro scale, it nonetheless presents a concrete example of an extra-local manifestation of its compelling logic— with notions of individualism and rationality at the centre of the discourse. The long awaited female condoms have recently been introduced in Malawi. According to the Press Release, PSI/Malawi will begin ‘putting the power and reach of the commercial marketplace to work’ to ensure the broad availability of CARE Female Condoms nationwide (Population Services International Malawi 2008). The crusade is targeting beauty saloons, and a total of 2,800 places have been earmarked for placement of the adverts of female condoms. The inscription on the female condom cover reads as follows: ‘For Women Who Choose to CARE’ While the approach of exclusively targeting women (and not men as well) already suggests potential problems with uptake of technology, another shortfall of the above message is evident in the way it is framed. Although this message may be aimed at
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entreating women to using condoms, it is stereotypical, reinforcing the role of women as caregivers, shifting the burden of condom use from women to men. Formulating the advert in this manner therefore serves to place the blame for non-use squarely on women who do not comply. The above inscription seeks to establish a particular pattern of behaving where use of the condom in females is considered the norm, which sidesteps the question of power relations that is central to the spread of the epidemic (Craddock 2000). Therefore, by defining condom nonusers as ‘uncaring’, these individual subjects are amenable to discipline, outmoded and complicit in fuelling the epidemic, despite the gender and economic relations that they find themselves in are inimical to condom use. As evident, although operating remotely from the heartland of state power and aspirations, such adverts contain assumptions about desirable forms of sexuality and conduct at an individual level that are insensitive to social relations within which sex takes place. Thus, the notion of individualism and rationality as revealed in the ‘business’ approach to condom promotion reflects a change in the characterization of women and other vulnerable populations as holders of health rights to ‘clients’ with responsibility for themselves, and onus for wellbeing squarely falling on their shoulders. It should be emphasized however, that for those individuals who do have and are able to make choices in conditions of sexual exchange, or for those who are engaging in transactional sex, it is not wrong for the government to be promoting condoms or providing appropriate health care, respectively. The rhetoric of individual behavior as it relates to condoms is problematic not only because there is no accompanying reference to structural impediments to mitigating risk, but also because these messages are couched in terms that blame the victims. In addition these narratives leave little scope for understanding that HIV prevention is part of a broader process of social transformation not merely aimed at reducing risk, but also identifying and redressing socioeconomic inequalities and injustices that create situations of vulnerability. As such these strategies are not necessarily misguided, but that they are insufficient approaches by themselves for dealing with HIV/ AIDS in a context where the epidemic is propelled by diverse range of factors. In addition, strategies that seem to blame victims can undermine the overall
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fight against the epidemic by promoting stigma and therefore militating against access to care and support. Political speeches and spaces of violence In the early days of the epidemic, issues of sexuality were not publically discussed in Malawi (Lwanda 2003). The culture of secrecy around sexuality in part explains the ambiguity of previous post-colonial governments on the issue of AIDS. In this section we seek to demonstrate that some political speeches, especially those made by the first democratically elected President in Malawi, Bakili Muluzi, drew on a particular image of certain groups of women in order to cast blame on this group of women for the epidemic. Although the Malawi Congress Party (MCP) and the United Democratic Party (UDF) were slow to respond to the epidemic, and, therefore, have contributed to the current state of the HIV in Malawi (Englund and Mapanje 2002), in contexts where politicians make statements about the epidemic, the rhetoric in their political platforms has been couched in terms of sexual prudery, mutual faithfulness and abstinence. Little acknowledgement, if any, about poor social conditions that drive the epidemic in the country has been made. In a country where poverty is highly politicized, any discussions that seem to draw causal links between widespread deprivation and inequality and the spread of HIV/AIDS are generally polarised. As a result framing the spread of HIV/ AIDS in terms of individual behaviour has been the norm. The choice of political speeches as a case study for this paper does not constitute a political stand in relation to their respective authors. Rather the focus on these narratives is informed by the fact that diseases are not exclusively biological entities; they are also social concepts and are defined in ways that reflects the dominant social order. As shown by Schneider (2002), in addition to formulating policies and mobilising resources for addressing HIV/AIDS, the government also has the power to shape public discourse about the epidemic. As Lwanda (2002) suggests, it may have been self interest that forced the UDF-led government to acknowledge the devastation caused by the HIV/ AIDS epidemic after several government ministers and members of parliament apparently died of the disease. In 2004, when launching the first National
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AIDS Policy, the President revealed that his own brother had died of the disease, and urged people to be open about the disease and get tested. In another instance the President, in trying to entreat men to abstain or to be faithful to their sexual partners Muluzi metaphorically said that ‘men should learn to dim their headlights in the face of temptation’ (Lwanda 2002). While Muluzi should be given credit for being the first ruling President to openly discuss AIDS, and singling men as constituting part of the problem of the epidemic in the country, the metaphor casts women in the image of visual pleasure, and as objects of masculine sexual desires. The unquestioned male-centred view of women—male gaze- in this case as objects and recipients of sex is selfevident in this statement (Rose 1993). In addition to framing women as passive recipients of sex, the statement subscribes to the dominant view that men are sexually active while women are passive (Wilton 1996). However, the metaphor used by the president is not incidental. Vision is not a passive biological process, but an enabling account that must take into consideration the technological and political contexts of the viewer (Haraway 1988). As already indicated, the argument that the president’s statements created spaces of violence should be understood not as a political reaction to his rhetoric but as a manifestation of heteropatriarchy- the learned way of doing and thinking that privileges males and certain forms of masculinity over women and femininity, where rules of the game are defined by men. By projecting women as subjects to be avoided if the HIV/AIDS problem is to be contained, the president is simultaneously arguing that it is women who are the reservoirs of the epidemic, and the ‘temptors’ that men need to avoid. Muluzi went further and argued that one of the solutions to the HIV/AIDS problem in the country is that all prostitutes should be prohibited from public places and should be locked up (Englund and Mapanje 2002). Attributing the problem of HIV/ AIDS in the country to prostitution does not only serve to divert attention away from the complicity of structural factors, including poor policies and the ambivalence of his government (Lwanda 2003), but more importantly creates spaces where violence is exercised and justified. This is not to deny that commercial sex workers face the risk of HIV infection or predispose HIV risk to their customers,
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but rather to demonstrate that it is the rhetoric rather than issue of prostitution that is privileged in popular discourses. Such discursive practices have material effects, since prostitution is illegal in Malawi under the Penal Code of Conduct (1968). Women suspected of prostitution are occasionally rounded by police from large towns in Malawi. However, since it is practically difficult to prove an act of prostitution in the court of law beyond circumstantial evidence, many of these women spend only a few nights in custody, and under much lighter charges of vagabond and rouge. In addition to state surveillance and violence, these groups of women are often subjected to symbolic, sexual and physical violence by the general public. While it takes a man as well as a woman to commit prostitution in a heterosexual act, the clear absence of reference to ‘man’ in these references and accounts is testament to the systemic nature of violence. In Malawi, the notion of prostitution is defined in relation to women engaging in what can be called illegitimate sexual liaisons. Statements made by the former president are consistent with what other studies have documented. For example, Craddock (2000) also found that women in Malawi were widely considered as ‘pathologized’ and largely seen as reservoirs of HIV infection. This idea not only renders women’s bodies as sites of violent symbolic inscription, but also had material consequences by undermining women’s access to treatment and social support. In another occasion, Mr Muluzi rightly rebuked the rising incidence of paedophiles. While there were incidences where women committed the crime, it was overwhelmingly a male-perpetrated problem. The president charged that ‘munthu wanzeru sangagwilirire mwana pomwe ma buludoza akungoyendayenda mu tawunimu’, which can be translated as ‘no rational man would dare having sex with a kid whilst there are lots of ‘bulldozers’ roaming around in town.’ It is the reference to women engaging in commercial sex as ‘bulldozers’ that is problematic. The metaphor of ‘bulldozer’ is often used in Malawi to refer to a monstrous, unforgiving and rugged individual, usually a woman seeking sex. Recent studies in Malawi indicate that women often resort to exchanging sex for food and money due to food insecurity, poverty and few alternatives (Bryceson and Fonseca 2006). Derogatory references to such groups, especially when their situation is largely attributable to negative
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structural conditions, constitute a form of violence, and serve to increase worsen their vulnerability to HIV/AIDS. It is critical to note the contradiction in the above speech between going ‘dim’ as a strategy for men for coping with sexual temptation, while at the same time going for ‘bulldozers’ as men’s strategy for avoiding paedophilia. That is, somehow having sex with prostitutes is not seen as a proactive act—the action is placed on prostitutes. But such inconsistencies are bound to occur where elected representatives avoid political and social problems that underlie the HIV/ AIDS problem. In Malawi HIV/AIDS was first manifest amongst the elite (rich and educated) (Lwanda 2003), but as it quickly went down the fault-lines of poverty and gender it has been accompanied by inaction and ambiguity by government, and violence and blame for weak groups. While structural causes of HIV/AIDS are elided in discourse about the epidemic, the individualised and rational terms in which HIV risk is framed in turn serves to create identities that exacerbate vulnerability to the epidemic.
Imagining other ways of being How can these neoliberal discourses that reinforce gender inequalities and worsen HIV/AIDS be challenged? Craddock (2000:160) proposes that looking at the power relations that govern the terms of different practices is one way to begin to understand ways to change these relations. A feminist geographer might ask women how they negotiate sexual encounters, and what constraints they face in ensuring their livelihoods, recognizing that all viewpoints are partial perspectives on the world (McDowell and Sharp 1999; Moss 2002). Multiple questions arise from a feminist geographer’s perspective. How do women’s relations within households, the workplace and the country as a whole govern their sexual encounters and potential ‘risk’ of contracting HIV? How do women negotiate these spaces and relations? What role do rigid, unequal masculine identities play in reinforcing women’s vulnerabilities? What about men’s vulnerability to HIV/AIDS? How do neoliberal policies, regulatory tendencies and discourse influence gender relations and structural conditions that affect HIV/AIDS rates? Other studies have begun to examine the social relations and discourse around
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sexual relations and condoms (e.g., Smith and Watkins 2005). This paper links these relations to neoliberal discourse, but we just begin to scratch the surface; a more in-depth study is required if we are to move ‘beyond the post.’ Beyond neoliberalism, in this case, might include looking for collective, community-based initiatives for addressing HIV/AIDS within a broader context of addressing structural inequalities in health. Here our imagination would need to go beyond the neoliberal state in which we find ourselves. These communitybased initiatives, supported by public funds, could help promote open discussions about gender inequalities that worsen HIV/AIDS rates. Why is condom use-rate low? What power relations govern condom use? What conditions create the need for women to exchange sex for food or other goods? What are some public policies that could encourage healthier intimate relations? Public programs to address gender-based violence and unequal access to education are starting places. Addressing other structural conditions, such as poverty and access to health care, would also fall under the umbrella of collective approaches to addressing HIV/AIDS, and would involve seeking structural solutions that do not rely on commercial gain. Investment in public education, in employment opportunities and sex education are other avenues that would likely make inroads on HIV/AIDS rates. Rather than ‘blaming the victim’ and focusing on individuals, finding ways that families, communities and the country as a whole can collective solve HIV/AIDS means taking a hard look at where AIDS programs are focused, and then making imaginative leaps to bring positive, concrete solutions to break the discursive bounds within we find ourselves. The above probing questions are fundamental, and seek to shift our understanding HIV/AIDS epidemic and appropriate measures beyond the narrow concept of individual risk as imposed by the logic of neoliberalism. The goal is to place economic activity at the service of people and not the other way round (Ferber and Nelson 2003). Such a commitment would facilitate a general view of societal need and human welfare that includes a sense of solidarity with the weakest members of society (Beneria 1999). In the context of this paper, the weakest members include those who are vulnerable to HIV/AIDS. We therefore provide one example of how families in northern Malawi ‘think about people first’ and engage in
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certain livelihood practices, including providing for people and families affected by HIV/AIDS, in ways that undermine market logic of individualism and rationality. The example below is by no means exhaustive and does not provide answers to the whole range of questions that have been raised above, but just provides an empirical case where work is pursued to achieve increased collective wellbeing. Much of the ideas for this paper have grounding in years of research and working with rural families in the Ekwendeni area near Mzuzu in Northern Malawi. To argue that their livelihood strategies contradict the logic of the market is not to assert that these mechanisms have not been spared from onslaught by neoliberalism. Rather, it implies that these social practices have demonstrated resilience and have adapted with varying degrees of failure and success. One brief illustration is given, that of reciprocal labour arrangements, locally known as ulimizgo. Far from any notions of forced labour, the concept of ulimizgo refers to voluntary and reciprocal co-operation amongst family members and kinsmen. This practice has long roots and continues to be practiced, although to a lesser degree than in the past (Bezner Kerr 2006). Ulimizgo has survived onslaughts by early Christian missionaries and the colonial government under the pretext that such work parties provided opportunity for excessive beer consumption considered to be both anti-Christian and anti-progressive (Berry and Petty 1992). Others, however, have argued that it was because the practice of ulimizgo like many other collectivist strategies was generally viewed as direct threat to successful penetration of capitalist mode of production in Malawi. Despite being an economic activity, ulimizgo has always existed outside the formal market. Consequently, it was practically difficult for the colonial government to subject it to exploitative taxation. In addition, ulimizgo usually militated against mobilisation of indentured native labour for settler plantation agriculture that its practice was largely discouraged. Although ulimizgo is usually carried out within the extended family network, and involves one person inviting the rest of their extended family to carry out a particular agricultural practice, such as clearing bushes, creating ridges, weeding or harvesting, community members in general also participate in this labour arrangement. Participation in ulimigzo sometimes extends beyond immediate kinship and
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includes affines and peers. Following the work, everyone shares in a large meal. Ulimizgo is particularly a preferred strategy during periods of peak labour demand and families usually take turns to work on each others’ gardens. Families who are slightly better off tend to be the ones organizing ulimizgo on their land, but in other cases older people, especially women, can invite family members to help them. Therefore, in general labour-strapped households of any wealth and social status, including those with absent male migrants could gain access to additional agricultural labour. Thus, while members of the agriculture work-party expect to be fed during and/or after the work, a decent meal is not necessarily a precondition to accessing such labour. Rather, the right to mobilize such labour is generally is mediated by virtue of being a responsible member of the family, neighbourhood or/and community. The practice of ulimizgo is, therefore, important for families affected by HIV/AIDS, as it has been done for people who are HIV positive, to help them in the fields during times of illness. Not only are HIV positive families vulnerable to agriculture labour shortages, but they also tend to face declining income. In this case community members who are physically and/or financially weak are not necessarily expected to reciprocate in a similar fashion because social norms dictate that the kinship and community have a duty to care and protect those who are sick. Similarly, individuals who have gained social status as being ill and incapable of self-provision hold a claim and can legitimately call upon the services of the kinship or community, including access to agriculture labour. Although the practice of ulimizgo has gone down over the past few decades, largely attributed to a greater reliance on cash, it continues to persist, and is a source of support for AIDS-affected families in Ekwendeni area. Ulimizgo as a peasant practice lies outside the market logic of individualism and economic rationality as espoused by neoliberalism. Ulimizgo work-party members are not optimizing agents in the narrow sense as prescribed by the neoliberal notion of individualistic and rational economic agent because conditions of their labour exchange are altruistic in nature. These actors are neither necessarily self-interested nor primarily motivated by the need to protect, or enhance personal wealth as is usually the case with other forms of labour arrangement. In line with Beneria’s argument
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(see Ferber and Nelson 2003 p 124), ulimizgo as an enduring agrarian institution in northern Malawi presents an alternative development model based on the assumptions of cooperation, empathy, and concern for collective wellbeing.
Conclusion This paper has outlined the ways in which the logic of neoliberalism fosters gendered spaces of violence which may worsen the rates of HIV in southern Africa. Using examples from Malawi, we highlight how national policy, public speeches by politicians and condom advertisements reinforce notions of individualism and economic rationality. In turn, these ideals reinforce gender inequalities, which is one major driver of HIV. We then describe a micro-level strategy (labour sharing) which may provide an alternative approach to the neoliberal discourse and ways of being. While the example above does not describe shifts in gender inequalities, which require more deliberate, new and perhaps ‘radical’ leaps of imagination, it does nonetheless present empirical scenarios where communities and households in southern Africa re-position themselves in spaces that lie beyond the reach of the market logic. More importantly, this example, though at a micro scale, can serve to suggest that alternative imaginations are not impossible, and that inspiration for such alternative visions may not necessarily be drawn from thinktanks in universities, but in learning from the remarkable resilience of some of the world’s poorest against this apparently hard to fight neoliberal project.
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