Community Health Workers: Lives, Labor, and Hopes for an AIDS-Free Generation in Maputo, Mozambique

Inguane, Celso. Community Health Workers: Lives, Labor, and Hopes for an AIDS-Free Generation in Maputo, Mozambique. Diss. U of Washington. 2018.

In this dissertation, I describe how current efforts to meet the globally-defined ambitious HIV treatment goals to end AIDS by 2030 marginalize community health workers (activists andcounselors) who have dedicated their lives, skills and experience to helping address HIV and AIDS. My focus fits within a broader research agenda that has been documenting the “social aspects of antiretroviral therapy scale-up” for the last decade and a half in the global south. It contributes to efforts to relativize the dominance of grand theory, and to value ordinary people’s empirical and analytical contributions to social theory that Foucault (2003) articulated as political historicism, which resonates with calls for ethnography as a fruitful avenue for theory grounded on fieldwork experience and data (Biehl 2013, Nader 2011). The dissertation is based on nearly 18 months of ethnographic research, between February 2016 and July 2017, mostly at a health facility in Maputo, Mozambique, using participant observation, ethnographic interviews and archival research. It was supplemented by nearly amonth of exploratory research between August and September 2015, and a short weekly visit during dissertation writing in July 2018. For ethical reasons, I concealed the names of people who participated in the research and of the health facility and province where I conducted research. Community health workers have for several years contributed with labor, experience and dedication that build and maintain enduring social ties that help ensure compliance to antiretroviral therapy and reproduce sociality. They also help bridge the gaps between the public-driven and the international non-governmental organization-driven patient tracking systems. This contribution is being marginalized by current efforts to meet the ambitious HIV treatment goals, under which experienced community health workers are being demoted, moved to other roles, reduce work hours, and train new staff that replaces them from their previous positions. Experienced community health workers perceive these changes as instantiating their marginalization, economic exploitation and disposability, inways that have precedents in the scale up of universal antiretroviral therapy, about a decade ago (documented in Mozambique and in sub-Saharan Africa). This marginalization reveals aneglect for knowledge and skills represented as hierarchically inferior within the health sector (epistemic violence) and signal a growing risk of global HIV interventions contributing to neoliberal politics of social abandonment that produce undervalued and disposable labor, while undermining the institutional arrangements that have historically enabled the implementation of equity-oriented strategies through public health systems (political expression of structural violence).

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