Exceptional Life: Subjectivity, Moral Statehood, and the Global Politics of HIV Care in Freetown, Sierra Leone

Quadrant: Health and Society

In 2002, Sierra Leone emerged from a decade-long conflict characterized by widespread sexual violence, amputations, and massive displacement. With 1.5 percent HIV prevalence in the war’s aftermath, the disease could have easily received little government funding and international attention. Yet global funding trends, assumptions about how war disrupts social life, and shifts sexual norms—coupled with pervasive ideas about Africa as a site where high HIV prevalence, disorder, and chaos co-mingle—elevated HIV/AIDS to exceptional status in post-conflict Sierra Leone. This project seeks to answer the questions: What happens when antiretroviral therapies (ART) for HIV, long considered too expensive and complex for widespread use in developing countries, are introduced in Sierra Leone? How do disease-specific programs, like those for HIV, affect health systems, labor markets, and individuals’ personal projects? Drawing on seventeen months’ ethnographic fieldwork in Freetown, Sierra Leone, Professor Benton argues that HIV exceptionalism, which requires devoting significant funding to HIV/AIDS to the exclusion of other pressing health concerns, weakened an already ailing health system, undermined efforts to foster and rebuild trust of state forms of caregiving, and produced paradoxical forms of privilege, in which having HIV became a vehicle for social, economic and professional advancement.

University of Minnesota