While acknowledging the progress that the global health field has made, researchers have called attention to the unexpected inefficiencies and harms that well-intentioned programs have on local communities. My research takes a multi-sited ethnographic approach to look at how governments, providers, and patients respond to and sometimes resist global HIV policies. My project centers around a puzzling case: Malawi, one of the most donor-dependent countries in the world, went against WHO policies and gave pregnant HIV-positive women access to lifelong treatment to prevent HIV transmission to children. Why did Malawi pursue policy innovation? On the ground, how did women respond to this prescription? And why, despite increased access to treatment, did women refuse or stop? My talk moves between macro and micro-level experiences to describe the policymaking process and to show how the design of health policies can produce particular disconnects that become salient for people’s health behaviors. In light of WHO policies that failed to control maternal HIV transmission, Malawi’s policymakers found an opportunity to create a policy tailored to the structure of their healthcare system. However, while the policy fit state needs, treatment was not always beneficial and cost-free for women. Taking treatment as prevention created new uncertainties with the illness experience as well as social and economic opportunity costs. While the benefits were clear to some, for others, taking treatment caused marital problems or led to side effects that made them feel worse and disrupted their ability to work. These findings shed light on processes of resistance to global norms, and it contributes to research on medical decision-making by situating decisions in a broader political economy of changing HIV policies, economic conditions, and everyday uncertainty.
Tuesday, December 12 at 10:00am
Laurel Heights, Suite 340, Gay Becker Conference Room 3333 California Street, San Francisco, California 94118