The primary period of fieldwork for this project was supported by a Fulbright Institute of International Education grant; I thank Dorothy Ngalombi and the late Paul Stevenson, both at the U.S. embassy in Kampala, for their help administering that grant. Other periods of fieldwork were supported by a Summer Fieldwork grant and a MacCracken Fellowship, both from New York University (NYU); and a Junior Faculty Development Grant from the University of North Carolina (UNC). A University Research Council Small Grant from UNC provided funding for the map included in chapter 2 and for the completion of the book’s index. A fellowship at the Institute for the History of the Production of Knowledge (NYU) provided me with a year of support during the completion of an early draft of this book. I thank Troy Duster, Emily Martin, and Mary Poovey for that opportunity.
I am deeply indebted to the professors who guided this project in its earliest stages, most especially Tom Beidelman, Fred Myers, Bambi Schieffelin, Rayna Rapp, and Aisha Khan; their contributions to this book and to my growth as a scholar are too numerous to count. Friends and colleagues at New York University and beyond provided me with invaluable support, insight, and camaraderie: Elise Andaya, Ilka Datig, Nica Davidov, Kristin Dowell, Omri Elisha, Sholly Gunter, Jelena Karanovic, Jack Murphy, Karin Rachbauer, Pilar Rau, Ruti Talmor, and Will Thompson.
I am fortunate to have completed this book at the University of North Carolina–Chapel Hill in the company of a dynamic community of scholars. I have especially benefited from the support of my colleagues in the Department of African, African American, and Diaspora Studies—particularly my department chair Eunice Sahle. The Moral Economies of Medicine working group, hosted by members of the departments of Anthropology and Social Medicine, has been a rich forum of intellectual exchange and engagement. Special thanks to members of that group, and in particular Peter Redfield and Michele Rivkin-Fish. Two undergraduate research assistants at UNC, Mia Celnarova and Courtney Reed, helped with the transcription and coding of interviews. Friends at UNC have provided me with a supportive community in which to grapple with new ideas; very special thanks go to Mara Buchbinder, Emily Burrill, Jocelyn Chua, Jean Dennison, Jesse Summers, and Ariana Vigil. I could not imagine the process of writing this book, from beginning to end, without the support and close friendship of Ayako Takamori.
For reading and providing valuable feedback on parts of the manuscript, often at critical junctures in the writing process, I thank Emily Burrill, Nica Davidov, Michele Rivkin-Fish, Ayako Takamori, Clare Talwalker, and especially Dave Pier. For her supportive words and keen eye in the final stages of writing, I thank Holly Hanson. Two anonymous reviewers at Ohio University Press provided me with careful readings of the entire text and gave me very thoughtful insights on how to expand and improve my arguments. I am grateful to Gillian Berchowitz at Ohio University Press and Jim Webb, the editor of the Perspectives on Global Health series, for seeing potential in my manuscript.
A version of chapter 6 has been published previously in Anthropological Quarterly 86, no. 3 (2013) as “The Problem with Freedom: Homosexuality and Human Rights in Uganda” and is included here courtesy of the Institute for Ethnographic Research. Special thanks to Phil Schwartzberg at Meridian Mapping for the map that appears in chapter 2.
Writing a book can be an isolating process, and it is those closest to you who provide the emotional support that sees you through to the project’s completion. My parents, Jean Boyd and the late Joe Boyd, were unfailing in their encouragement of me, as have been my sisters Meredith and Sarah. I am most grateful for the extraordinary love of my husband, Dave Pier, and my daughter Ivy. Ivy was born just before I finished this book, and she has brought Dave and me the unadulterated joy that comes from seeing the world through a child’s curious eyes. Dave and I fell in love in Uganda, doing fieldwork alongside each other. The work that follows was made much richer because of our many discussions about Ugandan society and the experiences we shared there together. I dedicate this book to him.
INTRODUCTION
The Politics and Antipolitics of Miracles
The story of the early years of the AIDS pandemic in Uganda is now well known, but the lived experience beneath the streams of data is still hard to grasp. By the early 1990s, in some of the hardest-hit trading centers of southwestern Uganda every third household had an adult member dying of AIDS.1 HIV prevalence rates were some of the highest in the world, nearing 15 percent of the national population.2 Communities were faced with rates of death and disability that can only be described as devastating. Uganda, a country in eastern Africa, would soon become all but synonymous with the virus. And yet, against seemingly unimaginable odds and during a decade of intense economic and political upheaval, Ugandans were somehow able to roll back the tide of HIV/AIDS. Years before the World Health Organization was able to mobilize a global response to the epidemic, and during a decade when U.S. federal policies addressing AIDS were all but absent, Ugandans living in out-of the-way places,3 far from the reaches of academic biomedicine, were winning the fight against this deadly disease. Beginning in the late 1980s the seemingly inexorable spread of the virus began to slow. By the early 1990s HIV prevalence in Uganda began to drop precipitously. This reversal was so dramatic, and so unexpected, that it has been dubbed a “miracle” of HIV prevention success. By the early years of the twenty-first century, Uganda’s national prevalence rate was well below 10 percent of the population, and the epicenter of the global AIDS crisis had shifted to other parts of the continent.
Uganda’s “miracle” catapulted the country to the forefront of debates over HIV/AIDS prevention—debates whose stakes grew higher as global funds for treatment and prevention grew dramatically in the decades that followed. This book is about the wakes produced as this miraculous story was reclaimed, retold, used to justify certain responses to the epidemic, and adopted by politicians on both sides of the Atlantic to buttress new forms of political capital and international influence. It is a study of an American AIDS policy’s reception in Uganda, and the ways in which a policy supposedly drawn from Uganda’s early success returned there to shift the landscape of HIV activism and advocacy, engaging and reshaping long-standing arguments about sexual morality, marriage, and gender relations.
In 2003, President George W. Bush reversed a long period of intermittent action and partial measures by announcing a global AIDS policy of unprecedented proportions. Using soaring, optimistic language, Bush proclaimed that the President’s Emergency Plan for AIDS Relief (PEPFAR) represented a “great mission of rescue” that would prevent new HIV infections and save the lives of millions living with AIDS around the world. To promote HIV treatment and prevention was to enable “the advance of freedom” itself, reasserting America as a beacon of “hope” in parts of