Neoliberal Plague: The Political Economy of HIV Transmission in Swaziland
Neoliberal Plague: The Political Economy of HIV Transmission in Swaziland
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DOI：
10.1080/03057070.2012.699700
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发表时间：
2012-01-01
影响因子：
0.5
通讯作者：
Hickel, Jason
中科院分区：
文献类型：
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作者：
Hickel, Jason
斯威士兰的艾滋病毒流行率是世界上最高的，尽管动员了数十亿美元的预防努力来遏制这种流行病。在这篇文章中，我要指出，斯威士兰的艾滋病毒预防运动从根本上误解了这一流行病的原因，把重点放在个人行为的改变上，而忽略了疾病传播的更广泛的社会经济背景。这一模式源于西方的生物医学范式，该范式将个人视为责任中心，并掩盖了限制人们行为的结构性暴力。在过去几十年中，斯威士兰一直受制于新自由主义经济政策，造成了前所未有的艾滋病毒风险环境。结构调整方案和以出口为导向的投资战略导致经济增长率、正规就业和农业生产率下降，加剧了贫困家庭的劳动力移徙和性行为压力。与此同时，自由贸易协定阻碍了公共卫生系统，阻碍了抗逆转录病毒疗法的推出。这篇文章的结论是，斯威士兰艾滋病毒的高流行率与其说是一种生物医学状况，不如说是新自由主义市场政策的症状，行为改变的负担不应该落在艾滋病毒患者身上，而应该落在当前经济秩序的缔造者和受益者身上。
Swaziland has the highest HIV prevalence rate in the world, despite the billions of dollars' worth of prevention efforts mobilised to curtail the epidemic. In this article I will argue that Swaziland's HIV prevention campaign fundamentally misperceives the causes of the epidemic by focusing on individual behaviour change to the exclusion of the wider socio-economic context of disease transmission. This model derives from a western biomedical paradigm that fetishizes the individual as the locus of responsibility and obscures the structural violence that constrains people's agency. Over the past few decades, Swaziland has been subject to a regimen of neoliberal economic policies that have created an environment of unprecedented HIV risk. Structural adjustment programmes and export-oriented investment strategies have led to declining rates of economic growth, formal employment and agricultural productivity, exacerbating pressures for labour migration and transactional sex among poor households. At the same time, free trade agreements have hobbled the public health system and prevented the rollout of antiretroviral therapy. This article concludes that high HIV prevalence in Swaziland is less a biomedical condition than a symptom of neoliberal market policy and that the burden of behaviour change should lie not with HIV patients but with the architects and beneficiaries of the prevailing economic order.