What only heaven hears: Citizens and the state in the wake of HIV scale-up in Lesotho

Nora J. Kenworthy
This dissertation poses a set of questions about the political impacts of the rapid and large-scale deployment of HIV programs (HIV "scale-up") in Lesotho. As HIV and global health initiatives have expanded over the past decade, they have had sociopolitical, as well as epidemiological, impacts. In particular, HIV scale-up elicited and demanded new political processes that continue to change how policy is crafted, how citizens are represented, and which values drive new health initiatives. More
more » ... undamentally, HIV initiatives have altered the ways that citizens, patients, and communities perceive themselves, the state, and their political worlds. Utilizing multi-sited ethnographic methods, this project observes how citizens in Lesotho are coping with these dramatic changes in their political worlds. The research reveals HIV scale-up's considerable and far-reaching impacts on citizen faith in democracy, perceptions of rights, access to key social protections, and feelings of belonging. In contrast to work on the impacts of social movements, activism, and political will on HIV policies, this dissertation inverts the causal direction of inquiry regarding health and politics. In doing so, it recognizes new global health movements as drivers of political change, mobilizing actors and resources in deploying programs in ways that are altering political worlds and subjectivities. A rich recent literature on biological and therapeutic citizenship in the time of AIDS has begun recognizing these trends and their impacts on patient subjectivity. This research expands the frame of inquiry to examine how public health interventions can also alter citizen subjectivity, expectations of democracy, and the structures of associational life. The dissertation also contributes data towards better understandings of recipient populations' perspectives on accountability, good governance, public-private partnerships, transparency, and participation—approaches currently touted as solutions to poor project outcomes. For citizens in Lesotho, t [...]
doi:10.7916/d8cn738g fatcat:dresvec3czcppbdw7dmssrqwie