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  • Acknowledgments ix

    Introduction: Côte-d'Ivoire and Triage in the Time of AIDS 1

    1. Testimonials That Bind: Organizing Communities with HIV 15

    2. Confessional Technologies: Conjuring the Self 35

    3. Soldiers of God: Together and Apart 61

    4. Life Itself: Triage and Therapeutic Citizenship 89

    5. Biopower: Fevers, Tribes, and Bulldozers 111

    6. The Crisis: Economies, Warriors, and the Erosion of Sovereignty 137

    7. Uses and Pleasures: The Republic Inside Out 157

    Conclusion: Who Lives? Who Dies? 175

    Notes 189

    References 205

    Index 229
  • Winner, 2012 Joel Gregory Prize, presented by the Canadian Association of African Studies

  • Republic of Therapy is at its best as an ethnographic demonstration of the meaning of new forms of graduated citizenship that draw on older forms of social order.”

    “[A]n insightful and important book. . . . The strength of The Republic of Therapy lies in its detailed ethnographic attention to local efforts to respond to the HIV/AIDS epidemic of West Africa and placing that response—as well as the eventual humanitarian intervention—within the region’s colonial history.”

    “The book will interest scholars of the medical social sciences and Africa for the broad analysis of biomedicine as a force of social change. It will also engage practitioners and policy-makers in global health for its combination of on-the-ground insights with broader, systemic, and historical analysis. Nguyen’s well-crafted prose and lucid explanations of novel concepts make it appropriate for undergraduate as well as graduate courses.”

    “With his exploration of urban youth culture in Abidjan immediately before the outbreak of civil war, Nguyen’s book is of value beyond the field of medical anthropology: it is a nuanced study of a collapsed state, seen through the eyes of the young and vulnerable, where AIDS treatment programs offered one of the only tangible signs of a functioning state.”

    This excellent ethnography—written in clear prose and with innovative analysis—provides a compelling, troubling, and persuasive account. Anyone who wants to understand the meaning and consequences of AIDS in Africa, or the iatrogenic effects of medical humanitarian aid, should read The Republic of Therapy.”

    “[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.”

    “[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.”

    “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.”

    “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.”

    Awards

  • Winner, 2012 Joel Gregory Prize, presented by the Canadian Association of African Studies

  • Reviews

  • Republic of Therapy is at its best as an ethnographic demonstration of the meaning of new forms of graduated citizenship that draw on older forms of social order.”

    “[A]n insightful and important book. . . . The strength of The Republic of Therapy lies in its detailed ethnographic attention to local efforts to respond to the HIV/AIDS epidemic of West Africa and placing that response—as well as the eventual humanitarian intervention—within the region’s colonial history.”

    “The book will interest scholars of the medical social sciences and Africa for the broad analysis of biomedicine as a force of social change. It will also engage practitioners and policy-makers in global health for its combination of on-the-ground insights with broader, systemic, and historical analysis. Nguyen’s well-crafted prose and lucid explanations of novel concepts make it appropriate for undergraduate as well as graduate courses.”

    “With his exploration of urban youth culture in Abidjan immediately before the outbreak of civil war, Nguyen’s book is of value beyond the field of medical anthropology: it is a nuanced study of a collapsed state, seen through the eyes of the young and vulnerable, where AIDS treatment programs offered one of the only tangible signs of a functioning state.”

    This excellent ethnography—written in clear prose and with innovative analysis—provides a compelling, troubling, and persuasive account. Anyone who wants to understand the meaning and consequences of AIDS in Africa, or the iatrogenic effects of medical humanitarian aid, should read The Republic of Therapy.”

    “[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.”

    “[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.”

    “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.”

    “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.”

  • “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 Côte 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

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  • Description

    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 Côte 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.

    About The Author(s)

    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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