Allowable Death and the Valuation of Human life: A study of People Living with HIV and AIDS in Zimbabwe

UoM administered thesis: Phd

  • Authors:
  • Fortunate Machingura

Abstract

With more than 75% of its population experiencing poverty, Zimbabwe was in 2012 considered one of the world's poorest countries. The country sits at the centre of the global HIV/AIDS epidemic and remains one of the hardest hit countries accounting for 5% of all new infections in sub-Saharan Africa. Zimbabwe's 15% HIV prevalence rate was 19 times the global average by 2012, and the total years of life lost due to premature mortality increased by over 150% between 1990 and 2010 because of HIV/AIDS. This study draws on notions of 'governmentality' to ask how the 'framing' of the value of PLWHA has influenced their treatment by the Zimbabwean government and society. Four questions are posed: first the study asks, in what ways do health policy decision-makers in Zimbabwe frame the value of people living with HIV/AIDS (PLWHA)? Secondly, the study questions the ways in which people not infected by HIV (Non-PLWHA) frame the value of PLWHA. Thirdly, the study turns to PLWHA and asks how they frame their own value. Finally, the study investigates the implications of valuing PLWHA, for their lives, or conversely, their deaths. The study draws upon primary research undertaken through interviews, focus group discussions, observations and document review. While there are some contradictions within and between groups of study participants in the ways they frame the value of PLWHA; the study finds consensus within and between these groups in the manner in which they tend to value PLWHA. Analysing these findings, there are five ways people in Zimbabwe frame the value of PLWHA. Firstly, from a 'citizen' perspective, PLWHA are both legal and political citizens who can identify as equal members of society like other citizens. They have social rights; participate, belong and can access HIV treatment that can reduce risks of death. Secondly, from a 'client' standpoint; PLWHA are customers, gaining access to health services through individual monetary payments or social payments such as Government budget allocations. This introduces a degree of 'rationing', forcing the clients (PLWHA) to behave in ways that increase their chances of receiving services. Those with lower purchasing power struggle to access expensive life-saving anti-retrovirals, thus individual wealth confers value on the lives of the wealthy. Thirdly, framing from a Statistical Representation perspective - through statistics, PLWHA can be used as a means of bargaining for government to gain access to international funding, to increase the chances of survival for PLWHA by bringing services such as antiretroviral therapy (ART). Fourthly, the 'Expendable populations' perspective views subgroups of PLWHA who fail to adhere to norms of behaviour prescribed by the government, including those unable to purchase services, such as the poor and homosexuals, sex workers and prisoners, as populations that may be allowed to die. Finally, the study shows that PLWHA lament the discursive space of technocrats with a counter-narrative of their value in which they emerge not as expendable victims but as victors reframed as an indefatigable population - 'Resiliencers'. PLWHA create a narrative of disobedient materiality, challenging totalising notions of governmentality. This study concludes by considering the relevance in the Zimbabwean context of the concept of 'Allowable Death' as a premature, avoidable death despite consciously crafted narratives that the death happened because nothing could have been done under the prevailing conditions to prevent it.

Details

Original languageEnglish
Awarding Institution
Supervisors/Advisors
Award date31 Dec 2016