Overview

The Republic of Therapy tells the story of the global response to the HIV epidemic from the perspective of community organizers, activists, and people living with HIV in West Africa. Drawing on his experiences as a physician and anthropologist in Burkina Faso and Cote d'Ivoire, Vinh-Kim Nguyen focuses on the period between 1994, when effective antiretroviral treatments for HIV were discovered, and 2000, when the global health community acknowledged a right to treatment, making the drugs more available. During the intervening years, when antiretrovirals were scarce in Africa, triage decisions were made determining who would receive lifesaving treatment. Nguyen explains how those decisions altered social relations in West Africa. In 1994, anxious to ""break the silence"" and ""put a face to the epidemic,"" international agencies unwittingly created a market in which stories about being HIV positive could be bartered for access to limited medical resources. Being able to talk about oneself became a matter of life or death. Tracing the cultural and political logic of triage back to colonial classification systems, Nguyen shows how it persists in contemporary attempts to design, fund, and implement mass treatment programs in the developing world. He argues that as an enactment of decisions about who may live, triage constitutes a partial, mobile form of sovereignty: what might be called therapeutic sovereignty.

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9780822348627

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Reviews

In Republic of Therapy, the experts range from the international AIDS industry to Ivorian healers, activists, and friends of the author. Nguyen, a medical doctor and anthropologist, writes from his work as a community organizer among HIV-positive groups in West Africa, as an AIDS physician in an Abidjan clinic, and as an ethnographer in the city's subcultures... The book is important for understanding how 'technologies of the self' used by people in local organizations resemble both colonial patterns of interaction and international AIDS organizations' confessional theatre. AIDS treatment technologies make for a particular kind of politics. - Lisa Ann Richey, African Affairs A tour de force. A Republic of Therapy is a shrewdly theorized ethnography of AIDS practices, technologies, drugs, confessions, and individuals in West Africa. Tracing how triage, confession, and activism emerged from 1995 in Abidjan, site of one of the very first HIV treatment programs in Africa, Vinh-Kim Nguyen analyses the workings and unintended consequences of a new politics of biomedical survival. Scrupulously un-romanticized, the book reveals francophone West Africans competing to stay alive in the time of AIDS, while actively linking their selves and bodies to practices of triage and confession. This sharp, urgent, and intellectually daring book brings uncommon critical insight to the violence of humanistic global health interventions and the searing paradoxes of triage. --Nancy Rose Hunt, author of A Colonial Lexicon: Of Birth Ritual, Medicalization, and Mobility in the Congo The activist, physician, and anthropologist Vinh-Kim Nguyen has written an engaged, rigorous, and compelling account of the years when, in West Africa, AIDS treatment started to become available and persons living with HIV began to organize. With insight and sympathy, he explores how new political forms were thus invented in Cote d'Ivoire and Burkina Faso, combining therapeutic sovereignty and health democracy, triage of patients and empowerment of communities, confessions and accusations. --Didier Fassin, author of When Bodies Remember: Experiences and Politics of AIDS in South Africa

A tour de force. A Republic of Therapy is a shrewdly theorized ethnography of AIDS practices, technologies, drugs, confessions, and individuals in West Africa. Tracing how triage, confession, and activism emerged from 1995 in Abidjan, site of one of the very first HIV treatment programs in Africa, Vinh-Kim Nguyen analyses the workings and unintended consequences of a new politics of biomedical survival. Scrupulously un-romanticized, the book reveals francophone West Africans competing to stay alive in the time of AIDS, while actively linking their selves and bodies to practices of triage and confession. This sharp, urgent, and intellectually daring book brings uncommon critical insight to the violence of humanistic global health interventions and the searing paradoxes of triage. oNancy Rose Hunt, author of A Colonial Lexicon: Of Birth Ritual, Medicalization, and Mobility in the Congo The activist, physician, and anthropologist Vinh-Kim Nguyen has written an engaged, rigorous, and compelling account of the years when, in West Africa, AIDS treatment started to become available and persons living with HIV began to organize. With insight and sympathy, he explores how new political forms were thus invented in Cote d'Ivoire and Burkina Faso, combining therapeutic sovereignty and health democracy, triage of patients and empowerment of communities, confessions and accusations. oDidier Fassin, author of When Bodies Remember: Experiences and Politics of AIDS in South Africa

Neither activist, nor politician, nor patient, nor pharmaceutical provider, Nguyen brings a more objective perspective to the AIDS crisis, even as he gives a first- hand account and conveys his close relationships with HIV-positive patients. A telling and provocative study of AIDS treatment in Africa, The Republic of Therapy offers no prospective solutions, but highlights the complexities and power dynamics inherent in the process of intervention. - Sarah Fletcher, Montreal Review of Books [A] book that can and will be read by audiences far beyond the domain of medical anthropology. The resultant volume captures the evanescent history of a slowly developing crisis within the rapidly changing landscape of postcolonial health in sub-Saharan Africa. In this unsparing and clear-eyed account, Nguyen admirably sets forth the difficult but necessary task for contemporary social scientists in the critique of global health practices. - Jeremy A. Greene, Journal of the History of Medicine and Allied Sciences [P]ath-breaking... Nguyen's strengths as an ethnographer are his capacity to move among different organizations and institutions, his sensitivity to the roles he plays in these contexts, and his long-term engagement with local activists and other informants, and he parries these strengths into a nuanced account of the urban politics of triage and HIV in West Africa. - Betsey Brada, Somatosphere This work is notable not only for the quality of its craft but also the degree to which it lends a personal face to political and economic crisis... Written in lucid, largely understated prose and drawing on the author's long experience as both physician and anthropologist, the result is sure to provoke discussion and reaction well beyond the discipline. - Peter Redfield, American Anthropologist The activist, physician, and anthropologist Vinh-Kim Nguyen has written an engaged, rigorous, and compelling account of the years when, in West Africa, AIDS treatment started to become available and persons living with HIV began to organize. With insight and sympathy, he explores how new political forms were thus invented in Cote d'Ivoire and Burkina Faso, combining therapeutic sovereignty and health democracy, triage of patients and empowerment of communities, confessions and accusations. -Didier Fassin, author of When Bodies Remember: Experiences and Politics of AIDS in South Africa [A] book that can and will be read by audiences far beyond the domain of medical anthropology. The resultant volume captures the evanescent history of a slowly developing crisis within the rapidly changing landscape of postcolonial health in sub-Saharan Africa. In this unsparing and clear-eyed account, Nguyen admirably sets forth the difficult but necessary task for contemporary social scientists in the critique of global health practices. -- Jeremy A. Greene Journal of the History of Medicine and Allied Sciences [P]ath-breaking... Nguyen's strengths as an ethnographer are his capacity to move among different organizations and institutions, his sensitivity to the roles he plays in these contexts, and his long-term engagement with local activists and other informants, and he parries these strengths into a nuanced account of the urban politics of triage and HIV in West Africa. -- Betsey Brada Somatosphere Neither activist, nor politician, nor patient, nor pharmaceutical provider, Nguyen brings a more objective perspective to the AIDS crisis, even as he gives a first- hand account and conveys his close relationships with HIV-positive patients. A telling and provocative study of AIDS treatment in Africa, The Republic of Therapy offers no prospective solutions, but highlights the complexities and power dynamics inherent in the process of intervention. -- Sarah Fletcher Montreal Review of Books This work is notable not only for the quality of its craft but also the degree to which it lends a personal face to political and economic crisis... Written in lucid, largely understated prose and drawing on the author's long experience as both physician and anthropologist, the result is sure to provoke discussion and reaction well beyond the discipline. -- Peter Redfield American Anthropologist

Author Information

Vinh-Kim Nguyen is Associate Professor of Social and Preventive Medicine in the School of Public Health at the University of Montreal.

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