HIV, Stigma, and Globalization in Kenya

A review of Viral Stories: HIV/AIDS, Stigma, and Globalization in Kenya, by Elizabeth J. Pfeiffer.

In her dissertation Viral Stories: HIV/AIDS, Stigma and Globalization in Kenya, Elizabeth Pfeiffer, through thoughtful and reflexive ethnographic writing, explores the linguistic and social dimensions of stigma for HIV in Mahali, Kenya (a pseudonym). Based on nine months of intensive fieldwork, she focuses on the friction between local narratives and global discourses of HIV/AIDS as told through “viral stories.” These stories bring rich detail to lived experience and show the power of language in creating the milieu in which HIV is experienced. Indeed, as Pfeiffer notes, words in her field site “were powerful, sometimes even more so than the virus itself” (p.xi). Pfeiffer shows how viral stories, via daily discourses and the language of HIV, reflect larger concerns and uncertainties. Drawing from anthropological theories of globalization, particularly those by Anna Tsing, this work conceptualizes HIV/AIDS as a lens for exploring the metaculture of language and its accelerative force for changing culture. HIV in this community is set in multi-scalar perspective, from micro-level quotidian gossip to the mezzo-level post-election violence that has marred the region—and affected the structures of NGO and clinical interventions–to macro-level national policies and international guidelines.

Pfeiffer is engagingly present as an ethnographer throughout her dissertation. Her interactions and personal lens frame her analysis and she shares with the reader the true messiness of conducting ethnographic fieldwork. From concerns about safety and finding a space to live, to the trials of balancing research and motherhood, to witnessing and processing deeply unsettling acts of violence, Pfeiffer writes with honesty and audacity.

This dissertation is divided into seven chapters. The preface and Chapter 1 introduce the context of the research and draw the reader to the town of Mahali. In this space, Pfeiffer theorizes the concept of “viral stories.” These illness-specific narratives are frames for broader social processes and how HIV becomes “seen” in local social interactions. In fact, they are a mechanism for telling a story, rather than the story of HIV/AIDS in a particular setting. Traditional illness narratives are extended to include all talk about HIV- gossip, rumor, news- rather than simply individual experiences. Stories and social and biological experience are mutually constitutive. As the subsequent stories show, viral stories are agentive forms of the negotiation of social and individual uncertainty. Similarly, globalization is both a cause of and reaction to the HIV epidemic, through the spread of the virus and the technologies of its response. The emphasis on language underpins Pfeiffer’s argument that stigma operates primarily through the spoken word and social interactions (p.28). Indeed, she connects the “viral” spread of information with the spread of the virus itself.

Chapter 2 links theory and method, outlining the research process. Pfeiffer uses a combination of participant observation, semi-structured interviews, life history interviews, illness narratives, and conversational journals. The rules for “proper talk” in Mahali are also detailed here, giving context to the rest of the narratives presented. Residents speak in locally-particular coded language, through the use of encouraging words, metaphor, and selective concealment. Even clinicians in the area subscribe to these linguistic rules and speak in indirect language with some patients. As an extension of this particularism, Pfeiffer demonstrates gendered differences in HIV testing in Mahali, presumably a result of local interventions targeting women. To give broader context to the experiences of Mahali, Chapter 3 outlines the broader context of insecurity, corruption, and political and ethnic conflict in Kenya. It is in this section that Pfeiffer begins interweaving her  personal narratives and reflections of the research process with her findings.

Chapters 4, 5, and 6 are the ethnographic heart of the dissertation. Each contains extended viral narratives, followed by further details and analysis. Chapter 4 begins to explore what stigma means in a local context, arguing that it is shifting and deeply “locally-contingent” (p.143). Deploying Goffman, Yang, and other anthropological theories of stigma, Pfeiffer demonstrates how frictions created through the stigmatizing language of HIV reflect both individual and social insecurity. For instance, interestingly, Pfeiffer’s interlocutors frequently reject national statistics estimating HIV prevalence in their region. Instead, they believe the rates to be significantly higher, giving rise to the refrain that everyone in the area is either “infected or affected” by HIV. This is interpreted as possibly an extension of local insecurity and the moral danger of HIV; both the place and disease are stigmatized, and, in the local understanding, cursed.

Chapter 5 further explores gossip and stigma, but in relationship to the “imported” words used in HIV intervention programs. In this section, drawing from Langwick’s work on health in the region, HIV is considered broadly as a “malady,” with emphasis on the social, moral, and physical dimensions of disease. In one example, Pfeiffer tracks a nefarious local rumor about the circulation of a list of women intentionally infected with HIV by a bodaboda driver. Although the physical existence of the list was not substantiated through research, Pfeiffer illustrates the very real effects of rumor in the actual experiences of residents. In another case, Pfeiffer  describes how one woman who identified herself as a commercial sex worker to access resources, despite having never engaged in transactional sex. She overlooked the moral ambiguity  of commercial sex work–targeted as moral deviance and a site for international intervention– for the sake of material exigencies.

Drawing upon anthropological theories of personhood in sub-Saharan Africa, Chapter 6 explores the ways in which the meanings of HIV intertwine with meanings of self. The social challenges faced by those with the disease demonstrate the diminished sense of personhood that they feel and experience. The realms of sex, work, and marriage are especially impacted.Pfeiffer argues that felt and enacted stigma are both at play in Mahali, changing the social and individual sense of self for persons living with HIV/AIDS; one metaphor Pfeiffer that documents in a Mahali clinc is of being “eaten” by HIV or “being HIV.” Chapter 7 is a poignant conclusion to the dissertation. In it, Pfeiffer shares a disturbing eyewitness account corporal punishment. She uses this story to reflect on her own attempts to acquire “hardness” as a researcher and the ongoing challenges to the social personhood of those living with HIV.

Overall, Pfeiffer’s dissertation provides a “thick” ethnographic description of life in Mahali and makes several important contributions to cultural and medical anthropology and HIV/AIDS interventions. Within anthropology, her work engages with and expands the elicitation of illness narratives and the significance of language and rumor in understanding with HIV. She uses HIV/AIDS as a lens for understanding broader social processes and the complex “stickiness” of globalization. Her rich ethnographic detail gives depth to regional understandings of illness and the interactions of the local with the global. As she notes, responses to HIV/AIDS never occur in a “cultural void” (p.15), and her dissertation shows the significance of local perceptions and responses in creating effective health interventions.

Margaret Winchester
Department of Geography
Pennsylvania State University
msw23@psu.edu  

Primary Sources
Participant observation
Ethnographic, semi-structured, and life history interviews
Conversational journals
Media
Statistical data

Dissertation Information
Indiana University. 2014. 380 pp. Primary Advisor: Sarah D. Phillips.

Image: photo taken by author.

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