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Theses Doctoral

‘Out of the Shadows’: Moroccan HIV Prevention and the Politics of Sexual Risk

Montgomery, Anne M.

This dissertation is among the first ethnographic investigations of HIV/AIDS programs in the Middle East and North Africa (MENA) region. Contemporary representations of the region’s HIV/AIDS epidemic often recycle simplistic orientalist tropes, lumping together diverse countries, communities, and histories under the rubric of a shared socio-cultural and religious context. This cultural heritage is presumed to explain both the region’s seemingly unique epidemiological dynamics and its reportedly extreme forms of stigma and taboo. Public health efforts in the region aim to ‘lift the veil’ on HIV risk, and efforts are currently underway across the MENA to bring groups like sex workers and men who have sex with men – considered to be ‘at risk’ by virtue of their sexual behaviors – “out of the shadows” (UNAIDS 2010).
Drawing on 26 months (2009 – 2013) of ethnographic research in Morocco, I approach internationally circulating best practices in HIV prevention as technologies of visibility that seek to expose particular bodies to forms of surveillance and management. In the process, I argue, they also serve to highlight certain narratives about risk and vulnerability, and spotlight particular fault-lines in the Moroccan social terrain. What is unique and notable about HIV transmission and prevention in the MENA region, I argue, is not a singular ‘Muslim culture’ steeped in stigma and taboo. Rather, what is remarkable about HIV/AIDS in the region is the way that epidemiological markers of sexual risk, as well as efforts to make that risk visible, become entangled in historically important debates about cultural authenticity, distinctions between public and private, and processes and pressures for social and political change.
This research explores tensions between a focus on individual-level HIV risk, on the one hand, and the potential for political action to address the structural factors of collective HIV- related vulnerability, on the other. I ask, how do the new visibilities of HIV/AIDS prevention open up or foreclose possibilities for politicizing risk and vulnerability? Here, my research foregrounds the narratives of women recruited by AIDS organizations, who are largely from precarious socio-economic backgrounds and are often single heads of households. My interlocutors used a variety of discursive strategies to frame their vulnerability in ways that challenged the limited lens of individual sexual risk that HIV/AIDS organizations tended to promote; for example, these women drew on religious discourses to highlight a failed social contract, in which a corrupt class of rich Muslims neglected their duties to the Muslim poor. In this context, my interlocutors attempted to de-exceptionalize sex work by highlighting commonalities with the arduous and exploitative aspects of other forms of low-wage labor, at the intersection of gendered and class-based inequalities. And they spoke about the inadequacies of a healthcare system and a social service sector – which included AIDS organizations – that was not equipped to care for the poorest and most vulnerable.
Importantly, this research itself might be understood as a technology of visibility with the power to uncover a particular, socially situated story about HIV/AIDS work in Morocco. Here, I seek to provide, not a sensational tale about Arab-Muslim culture, nor a melodramatic representation of sexual exploitation, but a story of how public health best practices render (in)visible and (de)politicize particular social fault lines in the process of reading and responding to the spread of HIV/AIDS. Through a comparison of the everyday labor of two AIDS organizations, I show how incorporating an ‘ethnographic’ view of the lives of ‘at-risk’ groups can help elucidate socio-structural aspects of risk and vulnerability. Thus, under the right conditions, I suggest that particular institutional forms may, in fact, produce visibilities that harbor the seeds of meaningful participation, activism, and political change.

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More About This Work

Academic Units
Sociomedical Sciences
Thesis Advisors
Vance, Carole
Degree
Ph.D., Columbia University
Published Here
August 20, 2017
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