HIV Exceptionalism: Development through Disease in Sierra Leone

by Adia Benton

Winner, 2017 Rachel Carson Prize, Society for the Social Studies of Science

In 2002, Sierra Leone emerged from a decade-long civil war. Seeking international attention and development aid, its government faced a dilemma. Though devastated by conflict, Sierra Leone had a low prevalence of HIV. However, like most African countries, it stood to benefit from a large influx of foreign funds specifically targeted at HIV/AIDS prevention and care.

What Adia Benton chronicles in this ethnographically rich and often moving book is how one war-ravaged nation reoriented itself as a country suffering from HIV at the expense of other, more pressing health concerns. During her fieldwork in the capital, Freetown, a city of one million people, at least thirty NGOs administered internationally funded programs that included HIV/AIDS prevention and care. Benton probes why HIV exceptionalism—the idea that HIV is an exceptional disease requiring an exceptional response—continues to guide approaches to the epidemic worldwide and especially in Africa, even in low-prevalence settings.

In the fourth decade since the emergence of HIV/AIDS, many today are questioning whether the effort and money spent on this health crisis has in fact helped or exacerbated the problem. HIV Exceptionalism does this and more, asking, what are the unanticipated consequences that HIV/AIDS development programs engender?

Genres: Africa, Nonfiction

200 pages, Paperback

First published February 15, 2015

Reviews

[Emily · Rating 4 out of 5]

Narrow in its focus, worthwhile in its topic, broad in its implications, HIV Exceptionalism discusses the diverse aspects of HIV policy in Freetown, Sierra Leone. Post-war Sierra Leone should have a significant population of HIV-positive individuals according to predictive models. Fortunately, despite the best math to the contrary, Sierra Leone only has a 1.5% infection rate. Ms. Benton discusses the vertical (HIV-specific) health care stream and its impact on the ground in Freetown, where one's income often determines one's level of engagement with HIV programming. The pressure to participate in HIV-related programming and embody certain roles and attitudes as a person living with HIV, and as a trade-off for receiving resources like medicine and food aid, is considerable. Meanwhile, the welfare state in Sierra Leone is broken and health care for other ailments is notably lacking. Ultimately very interesting.

[Katie · Rating 5 out of 5]

An incredibly interesting book discussing the state of HIV in Sierra Leone while making some statements on western humanitarian efforts in “developing” (a term whose flaws are pointed out in the book) and its concerns. My only critique is in the conclusion the author falls into the trap of exceptionalizing the HIV response in Sierra Leone themself. Many diseases and countries experience similar situations.

[Marina Takagi · Rating 4 out of 5]

Read this for my Global Studies class on Humanitarianism. The book provided really interesting ethnographies of HIV in Sierra Leone. It made me grapple with the concept of humanitarian aid, the concept of the “sick role,” and sexual education in other countries.