Structures of Stigma: Diagonal AIDS Care and Treatment Abandonment in Mozambique


Start date: 30 December, 2008 End date: 30 June, 2013 Project type: Smaller projects: PhD Project code: 65-08-RUC Countries: Mozambique Thematic areas: Health, Lead institution: Roskilde University (RUC), Denmark Policy Brief: Policy Brief Project coordinator: Bent Steenberg Olsen Total grant: 2,147,963 DKK

Project summary

From a predominantly political standpoint, informed by a multi-sited ethnographical case study in Mozambique, this project aims to provide a clear articulation of the relationship between curative AIDS interventions and malnutrition in Mozambique. Supported by international donors, Mozambique and other Sub-Saharan countries are in the process of rolling out extensive anti-retroviral (ARV) drug interventions. In light of the paramount importance of adequate nutrition to the efficacy of AIDS treatment, this project points to a political paradox of the priorities in funding for nutrition and AIDS treatment that urgently requires reorientation: that AIDS receives absolute highest priority from international donors while nutrition receives absolute lowest priority. These issues are analysed on two levels: 1) the international political economy of AIDS treatment and nutrition; and 2) the actual on-site implementation of these policies and different modalities of ARV drug provision in Mozambique; some which include components that also address nutrition (nutritional support schemes, home-based care, etc). Documental sources and empirical data are examined within an innovative analytical framework that combines international political economy of health, methodological individualism, and ethnography. A full year of fieldwork is planned in Mozambique. National ARV provision services and a successful international ARV delivery programme (DREAM – Drug Resource Enhancement against AIDS and Malnutrition) are analysed comparatively in order to bring about a broad contextualisation of societal processes and factors relevant to ARV drug interventions and priorities in donor policy crucial to the effectiveness international development aid.


Project Completion Report:

This ethnography is based on 13 months of fieldwork in Mozambican AIDS treatment facilities, which are made up of a patchwork of global health discourse, national priorities, donor agendas, and regional and local political manoeuvring. Exploring a socioeconomic landscape characterised by poverty and endemic malnutrition, the monograph argues that this complexity of institutional interaction unintentionally aggravates stigma in ways that ironically and paradoxically exacerbate rates of non-adherence to antiretroviral drugs and AIDS treatment abandonment in spite of best intentions. It is demonstrated how an AIDS care apparatus, fully intent on alleviating suffering and treating disease, has become an engine of stigma. Theoretically, thoughts of classical sociologists and medical anthropologists are brought together to form a more comprehensive blueprint of the causal functions and basic social mechanisms of AIDS stigma —   a conceptual systematisation referred to as 'stigmatics'.

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