Government-by-exception: enrolment and experimentality in mass HIV treatment programs in Africa

V-K Nguyen. Government-by-exception: enrolment and experimentality in mass HIV treatment programs in Africa. Social Theory and Health 2009 7(3): 196-222.

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This paper explores the implications of mass HIV treatment programmes in Africa, particularly when non-governmental organizations, American universities or European hospitals, directly govern the lives of populations (such as those living with HIV) and in fact have power of life or death over them. It explores a novel form of legitimate, therapeutic domination that results from framing the epidemic as a humanitarian emergency. That lives be saved requires enrolment: that a standardized population be called into being so that it may then be targeted, relying on the deployment of biological and political technologies for constituting populations and transforming bodies and subjectivities. These transformations that seek to direct consciousness and change bodily practice are governmentalities exceptionally directed at the biological existence of those living with or potentially at risk for HIV. And, in an inversion of the classical model whereby evidence of efficacy permits intervention, in this case intervention drives the need for self-validating evidence (that is, the intervention was effective). The conjugation of these standardized humanitarian problems and populations with the production of post-facto, self-validating knowledge (most often described as ‘lessons learned’ or ‘best practices’) is an ‘experimentality’ that leverages the deployment of these interventions across the globe.
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