Catálogo de publicaciones - libros

In this chapter, I introduce the topic. I show how I became aware of a widespread misconception in the NGO sector and beyond into the world of international donors that so-called ‘harmful cultural practices’ were the main driver of the AIDS epidemic in Malawi. Biomedical evidence shows that ‘harmful cultural practices’ are not the main contributors to the AIDS epidemic. So what is interesting is why so many educated Malawians working in the AIDS sector told me about the practices, not the villagers, and blamed them for the spread of AIDS. I show that the epistemic community in Malawi (epistemic community includes international donors working on HIV and AIDS as well as the Malawian elite) are reframing both sexual cultural practices and women’s rights’ concepts in the context of what is widely considered an emergency, the AIDS epidemic. I argue that a complex interplay of interests has led to the construction of the narrative that the sexual cultural practice of contributes significantly to the spread of AIDS. I argue this complexity can be best understood through three sets of arguments.

In this chapter I present theoretical perspectives that have informed the research. Due to the interdisciplinary nature of this research, I show how a number of theories influenced by argument. First, using the approaches used within the anthropology of development I provide a critique of HIV policymaking. Second, and in order to understand how policy was constructed based on misconceptions, I draw on elite and policymaking theories to demonstrate how the policy process is being mediated by the agendas of elites as opposed to biomedical facts. Third, I use postcolonial theory to highlight how the elites are interpreting for themselves the colonial narrative that is founded on a binary opposition; civilised (the elites) and the uncivilised (the rural uneducated population). This then enables the elites to distance themselves from those living in rural areas, allowing them to maintain a position of power and access to the resources flowing in from the aid community.

In this chapter, I demonstrate the powerful and influential role that international donors (bilateral and multilateral agencies and INGOs) play in constructing AIDS policies and programmes. Additionally, this chapter emphasises that aid conditionality can fail to respond effectively to the AIDS epidemic by demonstrating how funding is often donor led. For example, if donors disagree with policies being implemented in the country to which they are supplying aid, whether it is the way money is being spent or the type of policies the government implements, then they will withdraw funds. I provide an example of the British Government suspending aid because it was unhappy with the President of Malawi’s autocratic management style. The paradox of such policies in practice is that they reduce the ability of nation states to be self-sufficient and instead put them in a dependency relationship with international donors. In this chapter, I also show how the AIDS epidemic was considered to be exceptional, thus requiring exceptional efforts at prevention and mitigation. That HIV requires a response above ‘normal’ health interventions began as a Western response to the virus. I also look at the influence the national elite in Malawi have in shaping international perceptions of sexual cultural practices and AIDS.

In this chapter I show how ‘harmful cultural practices’ have emerged as a development issue in global conventions and policies over the past ten years starting with current policies and mapping backwards to the first step taken by the UN in 2001 at the United Nations General Assembly Special Session on HIV/AIDS. In the second section I look at the shift from the global to the national level and demonstrate how international policies have influenced national policy on AIDS and harmful cultural practices in Malawi. I use data collected from interviews and documents to show how the Malawian elite have constructed narratives around AIDS and cultural practices in Malawi; that rural people’s backwardness is to blame for high HIV prevalence rates.

In this chapter I explore the link between religion and AIDS and analyse the influence of the church in shaping the views of the Malawian elite. I demonstrate through my interviews how the attendance of Malawian elites at church has influenced the way they think about AIDS, cultural practices and rural people. I provide the religious context in Malawi. I explore how religious elites perceive cultural practices as negative and backward, positioned against their Christian beliefs they perceive as enlightened. They perceive cultural practices as harmful because they are practiced primarily, perhaps only, in the rural areas by uneducated backward farmers—those who practice them are not modern. Regardless of how the focus on cultural practices deemed to be harmful, it is interesting how the religious elites volunteer information on sexual cultural practices and enjoy talking about them. By referring to the sexual cultural practices at length they distance themselves from the villagers who supposedly carry out these practices and conveniently apportion blame for HIV/AIDS away from them.

In this chapter I explore the dynamics of the policy development process and I examine theories of policy implementation. By focusing on narratives, I show that the policy process is not characterised by rational policymaking but by people’s views and interpretations. First, I analyse the process of policy construction. Second, I look at the aid game in Malawi. Third, I look at how these narratives have been passed on through education. Fourth, I present data from interviews I conducted with UNAIDS to present stakeholders’ responses to the question I argue there are a wide range of stakeholders involved in policy construction and implementation. These stakeholders include large, and powerful bilateral and multilateral agencies, such as DFID, USAID and the World Bank, as well as international Non-governmental organisations, national NGOs, international and national faith-based organisations, and the organs of the Malawi government, both at the national and the district levels, each with its own vested interests and each with its own policies. Therefore I argue the evidence produced to apply policies is not objective but narratives shaped by various policy agendas and interests of the elites.

In this conclusion I bring together the various threads of my argument. First, I summarise each chapter in relation to the themes identified and the analytical frame employed in this study. Second, I present my three key arguments. Third, I contextualise my study in terms of where we are today with AIDS at the global level and within Malawi. Fourth, I demonstrate how this study contributes to academic debates. Finally, I present recommendations to improve policies and programmes on HIV and AIDS at the international and national level.