DEVELOPMENT DISCOURSES OF HIV/AIDS IN YEMEN A Thesis submitted to the Faculty of the Graduate School of Arts and Sciences of Georgetown University in partial fulfillment of the requirements for the degree of Master of Arts In Arab Studies By Cassandra Filer, B.A. Washington, DC May 3, 2010 Copyright 2010 by Cassandra Filer All Rights Reserved ii DEVELOPMENT DISCOURSES OF HIV/AIDS IN YEMEN Cassandra B. Filer, B.A. Thesis Advisors: Fida Adely, Ph.D. and Irene A. Jillson, Ph.D. ABSTRACT This paper is a study of discourses related to HIV/AIDS development programming in Yemen. It is situated within Hakan Seckinelgin’s problematization of the global governance of HIV. It analyzes how development workers addressing HIV/AIDS in Yemen conceptualize their approaches and objectives to HIV/AIDS initiatives and situates these amongst alternative discourses, identifications, and interpretations of cultural and religious contexts. The author argues that 1) global HIV/AIDS discourses influence national and local HIV initiatives in ways that transform systems of knowledge, attempt to shape and delimit individuals’ behaviors and self-identifications, and mute possibilities for development programs to meet local needs of people living with and affected by HIV; 2) efforts of development workers to situate HIV in Yemen in cultural or religious contexts have potentials to hinder as well as help formulate effective HIV/AIDS programming; and 3) Sheikh Abdul Majid al-Zindani’s alternative HIV/AIDS discourse in Yemen is functioning as a bridge between Yemenis’ needs and the restricted possibilities of global development efforts. iii Table of Contents List of Acronyms ………………………..………………………………………………..……………….………….. iv Introduction …………………………………………………………………………………..……………………..…. 1 Chapter I: Alternative Discourses: Voices from the Yemeni Print Media ……….………… 25 Chapter II: Transnational Governmentality and the Shaping of PLWH …………………..… 44 Chapter III: Culture and Islam: Framing HIV/AIDS in Yemen ……………………….……………..82 Conclusion …………………………………………………………………………………………………………….. 107 Appendix I ………………………………………………………………………………………………………..………110 Appendix II ……………………………………………………………………………………………….……………. 112 Appendix III ………………………………………………………………………………………….………………… 113 Bibliography …………………………………………………………………………………………………………… 114 iv List of Acronyms MENA Middle East & North Africa DW Development worker NGO Non-Governmental Organization FBO Faith-Based Organization HIV Human immunodeficiency virus AIDS Acquired immune deficiency syndrome PCT Prevention, Counseling and Testing ART Anti-retroviral Therapy PMTCT Preventing Mother-to-Child Transmission NGO Non-Governmental Organization TB Tuberculosis NAP National AIDS Program NPC National Population Council NBTRC National Blood Transfusion and Research Center (NBTRC) MoPHP Ministry of Public Health and Population MARP Most at-risk population MSM Men who have sex with men IDU Injecting drug user FSW Female sex worker MSW Male sex worker CSW Commercial sex worker STI Sexually transmitted infection CCM Country Coordinating Mechanism HARPAS HIV/AIDS Regional Program in the Arab States UNAIDS Joint UN Program on AIDS UNDP United Nations Development Program UNFPA United Nations Population Fund UNHCR United Nations High Commission for Refugees UNICEF United Nations Children’s Fund WHO World Health Organization YAR Yemen Arab Republic PDRY People’s Democratic Republic of Yemen v Introduction The building was a bit old and worn-down. I sat, comfortable in my black abaya and my favorite orange hijab, conversing with a local public health worker. He reminded me of many Yemeni men I knew – humble, polite, and kind. He patiently answered my questions, making sure that I understood his English and that I had written every number he read to me of the many statistics his office kept on HIV/AIDS. His tone was courteous and subdued until I asked him why he was interested in working to address HIV/AIDS in Yemen. With this question his eyes lit up and he looked at me: It’s exciting! The issues, the tasks, they keep me busy! The years passed quickly and I didn’t feel them. But there are still many things to be done! Many of the people I interviewed for this project voiced similar passion and dedication to their work, proud of what they had accomplished, and determined to do much more. ******* This paper is a study of discourses related to HIV/AIDS development programming in Yemen. Situating my study within Seckinelgin’s problematization of the global governance of HIV, I analyze how development workers addressing HIV/AIDS in Yemen conceptualize their approaches and objectives to HIV/AIDS initiatives and situate these amongst alternative discourses, identifications, and interpretations of cultural and religious contexts. I argue that • global HIV/AIDS discourses influence national and local HIV initiatives in ways that transform systems of knowledge, attempt to shape and delimit individuals’ behaviors and self-identifications, and mute possibilities for development programs to meet local needs of people living with and affected by HIV; 1 • efforts of development workers to situate HIV in Yemen in cultural or religious contexts have potentials to hinder as well as help formulate effective HIV/AIDS programming; • a prevalent alternative discourse in Yemen is functioning as a bridge between Yemenis’ needs and the restricted possibilities of global development efforts. Background of HIV/AIDS Programming in the MENA Region Yemen is considered a low HIV-prevalence country. HIV/AIDS programming has become a greater focus in the last decade for many Arab countries, including Yemen. Yemen unified in 1990 to form the Republic of Yemen. Before that time, HIV/AIDS national programs were established in both countries in 1987. The first case of HIV was reported in the northern Yemen Arab Republic (YAR) in 1987,1 which led to the creation of the National AIDS Program (NAP) in Sana’a. A program also began in 1987 in the southern People’s Democratic Republic of Yemen (PDRY), which also discovered its first case of HIV that year. Many other countries also established AIDS programs the same year. 2 One of my informants explained the founding of the NAP in the PDRY as a response to the World Health Organization’s (WHO) announcement that all members establish such a program. 1 Amel al-Ariqi, “Draft Law to Protect Rights of HIV/AIDS Patients,” Yemen Times, 12 Aug 2009, available from http://www.yementimes.com/defaultdet.aspx?SUB_ID=30152 ; accessed 29 March 2010. 2 Other countries that started a national AIDS program in 1987 include Ethiopia, South Africa, Guyana, India, Maldives, Pakistan, Liberia, the Philippines, and the Democratic Republic of the Congo. Many civil society organizations, like ACT-UP in the US, also began the same year. 1987 is understood to be the beginning of the WHO “institutionalization” of the fight against HIV/AIDS: Sandra Jones, “WHO International Response to HIV,” Pan American Health Organization, 11 August 2007, PowerPoint: available from http://www.laccaso.org/pdfs/ptap%20-%20Who%20International%20Response%20to%20HIV%20and%20Aids.pdf Accessed 29 Apr 2010. WHO launched the Global Program on AIDS (GPA) in 1986, which was led by Jonathan Mann, to evaluate the scope of the AIDS pandemic. Mann reported in March 1987 that “AIDS is spreading like an epidemic and will strike virtually every country in the world within the next few years”: “AIDS to Strike All Nations, UN Warns,” Reuters, 24 March 1987, available from http://articles.latimes.com/1987-03-24/news/mn-169_1_aids- warns-nations ; Accessed 29 Apr 2010. In March 1987 the US FDA approved AZT, the first drug approved for treatment of HIV. 2 For most countries in the Arab world, Development Co-operation Directorate (DAC) and multilateral funding disbursements towards controlling the spread of HIV/AIDS began to approach their present amounts between 2003 and 2005 (See Figure 1).3 Jumps in disbursements parallel the publications of two reports by the World Bank, both of which recommended that MENA countries take action against HIV/AIDS.4 Figure 1: HIV Funding 2002 - 2007 6 5 Algeria 4 Egypt 3 Jordan 2 Syria Tunisia 1 Yemen 0 2002 2003 2004 2005 2006 2007 -1 Literature documenting and reporting on HIV/AIDS in the Arab world has produced a steady discourse for the past decade intimating that HIV prevalence rates in the Arab world are much higher than evidence suggests. The deficiency of reliable surveillance date and mechanisms in most Arab countries allow a considerable degree of flexibility in how HIV prevalence is presented. This lack of information is often used to point to an invisible threat to the Arab world. 3 OECD “CRS Aid activities in support of HIVAIDS control,” available from http://stats.oecd.org/index.aspx?r=546395 ; Accessed 2 Oct 2009. 4 Jenkins, Carol Lynn and David A. Robalino. HIV/AIDS in the Middle East and North Africa : The Costs of Inaction (Washington, D.C. : World Bank, 2003).; World Bank, Preventing HIV/AIDS in the Middle East and North Africa: a Window of Opportunity to Act (Washington, D.C.: World Bank, 2005). 3 The World Bank published reports on the situation of HIV/AIDS in the Arab world in 2003, 2004, and 2005. The central theme throughout all three was that governments in the Arab world need to address HIV/AIDS before it became a general epidemic. Most MENA countries are still at an early stage of the HIV infection with a 0.3 percent regional prevalence. What makes the HIV/AIDS epidemic particularly lethal is that it remains invisible for a long period of time and has an incubation period of five to eight years, separating HIV infection from the AIDS stage. As has happened in other countries, if action to prevent this is not taken early, MENA countries face the risk that the HIV infection will spread through the general population. The option of waiting to act until the HIV prevalence rate rises further in the general population would be a costly one. By that time, a general epidemic would be well on its way and, as shown by the international evidence, it would then be too late to prevent the inevitable increase in human sufferings as well as associated losses in economic growth.