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neoliberal frames in HIV/AIDS Communication

Tomorrow, I present my concept paper "Interrogating neoliberal ideologies of HIV/AIDS Communication: Power, Control, and Agency" at the IAMCR conference in Dublin.

The paper is a key component of my upcoming book on "Neoliberalism and Health Communication" to be published by Left Coast Press.

Here is the summary of the key arguments in the piece:

HIV/AIDS has witnessed a global response over the last decade.

Global NGOs, Foundations, private corporations, and state governments have joined hands in tackling HIV/AIDS. Prevention services and health care services in the domain of HIV/AIDS are framed within the interconnected linkages of Foundations, private corporations and nation states.

The ideology guiding the global work on HIV/AIDS is shaped within the organizing framework of neoliberalism, privileging market rationality in addressing HIV/AIDS.

(a) the response to HIV/AIDS has been taken over by large Foundations such as the Gates Foundation, UNAIDS, and the Global Fund. The positioning of HIV/AIDS prevention and service delivery within the decision-making capacity of private foundations has opened up the gateway for large scale privatization of public health as well as for the influential role of Foundations in shaping global health policy mandates. As demonstrated by my earlier analysis of the Gates Foundation, the framing of HIV/AIDS response in the business model has led to a fundamental paradigm shift in how health is approached, shifting responsibility from the state to the hands of private entities. Furthermore, the addressing of HIV/AIDS within the market logic has led to the commoditization of health, with the reduction of resources for addressing health problems.  The sole focus on HIV/AIDS for instance, has diverted resources from other key public health resources, and the simultaneous privatization of health infrastructures has led to the weakening of public health systems in multiple nation states in the global South. Private Foundations therefore utilize the facade of HIV/AIDS intervention as an entry point to push neoliberal reforms in global health.





(b) the global landscape of health has been shaped in the language of geo-security, with health being articulated as a threat to the security of the global order. This framing of health as security positions it within the purview of the military-industrial complex, with health interventions and health promotion strategies being carried out by the military apparatus, health budgets being allocated to the military. Intrinsic to the global management of HIV/AIDS is the framing of the disease within the dictates of neocolonial project. The global South emerges within the ambit of HIV/AIDS communication as a threat to the security apparatus in the North/West. This articulation of health in military terms justifies the deployment of military responses carried out by the North/West in the global South. What then are the implications for global health policy and practice when meanings of health are understood within the framework of military response?



(c) One area where we witness the influential role of Foundations is in the formation of public-private partnerships in addressing HIV/AIDS. The problematization of HIV/AIDS as well as the solutions to the disease are  framed in the market rationality of the private sector. HIV/AIDS emerges as a business opportunity for investment by private corporations. Investing in HIV/AIDS gets connected to the opportunities for profitability for private corporations. Tenders are issued for businesses to participate in the delivery of solutions for HIV/AIDS. Private-public partnerships also become the facade for removing regulations on businesses in crafting windows of opportunity for profiteering. For instance, the partnership with pharmaceutical companies also emerges as a strategy for creating new markets and strategic entry point for pharmaceuticals.

(d)  The emphasis of HIV/AIDS communication in the global ideology is on the individual. Although the language of structures and structural determinants of HIV/AIDS are fashionably inserted into the global frames of HIV/AIDS, the solutions that are proposed inevitably emphasize behaviour change, locating individual behaviour as the root of the problem. Absent from the policy and program implementations are the structural features of neoliberalism that result in high risks of HIV/AIDS. The individualisation of HIV/AIDS removes the focus from state institutions and state resources and instead places the onus on the individuals, his/her attitudes, behaviors and actions. The paradox of neoliberal response to HIV/AIDS lies in the omission of the structural features of neoliberal reforms that place communities at the margins at risk of HIV/AIDS. The very neoliberal solutions that in the form of structural adjustment programs have impoverished the margins in the global South are paradoxically proposed as solutions.

(e) In spite of the logic of rational decision-making and business-driven models that guide neoliberal responses to HIV/AIDS, the business of HIV/AIDS is run with little attention to evaluation, evidence, and systematic data gathering. For instance, with the "Avahan" campaign run by the Gates Foundation in India, evidence on effectiveness is limited, and where it does exist, points toward minimal effects in spite of the large sums of money spent on the campaign. Paradoxically, the rationality of global HIV/AIDS communication pays little attention to such data in spite of its rhetorical emphasis on science and science-driven decision-making processes. Similarly, the language of business scale-up is substantiated by little empirical evidence regarding effectiveness.

and

(f) Participation has emerged as a key element of the neoliberal management of HIV/AIDS. The language of participation and community percolate through the various HIV/AIDS prevention programs and services. Placing the onus of decision-making in the hands of the community is a key element of the participatory rhetoric. However, as I have shown elsewhere, the paradox of participation lies in the predominantly expert-driven decision-making processes and structures that configure HIV/AIDS communication. Key decisions are made by experts located at the center and participation is co-opted into the agendas of pre-formulated HIV/AIDS interventions designed at the center. This is another paradox of the neoliberal ideology.

In sum, the global framing of HIV/AIDS as a site for pushing the market rationality undermines the global public health infrastructure, pathologizes the global South, serves the profiteering agendas of transnational capital, militarizes HIV/AIDS, and operates on the basis of fundamental conceptual paradoxes.

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