PREVENTING HIV BY CREATING SISTA STRENGTH: AN ANALYSIS OF ONE U.S.-SPONSORED INTERVENTION INTO BLACK WOMEN’S HEALTH Allison Schlobohm A dissertation submitted to the faculty at the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Communication in the College of Arts and Sciences. Chapel Hill 2016 Approved by: Eric King Watts Carole Blair Wahneema Lubiano Patricia Parker Barry Saunders © 2016 Allison Schlobohm ALL RIGHTS RESERVED ii ABSTRACT Allison Schlobohm: Preventing HIV by Creating SISTA Strength: An Analysis of One U.S.-Sponsored Intervention into Black Women’s Health (Under the direction of Eric King Watts) The United States’ modes of intervening into HIV/AIDS are inextricably sutured to contemporary understandings of blackness. In this dissertation, I explore these articulations by rhetorically examining one state-sponsored intervention into black women’s health—the SISTA HIV prevention program. I use a rhetorical lens to examine this program’s texts and its conditions of emergence, variously focusing on SISTA’s unique materials and the larger cultural, political, and economic forces that give it meaning. Specifically, I trace SISTA’s redeployment of some already-existing tropes of blackness and neo-liberal subjectivity, and I find that the intervention’s attempts to help black women avoid contracting HIV/AIDS are unfortunately complicit in regimes of anti-black oppression that foster the differential impacts of HIV/AIDS it is responding to. I begin my analysis by tracing the historical relationship between public health intervention in the United States and the strategic exclusion of black Americans from state support. I follow this relationship over a period of more than 100 years, highlighting key moments when U.S. public health policy underwent significant change as well as the sordid history of racist legitimation of black suffering. I then use this history to situate SISTA’s particular deployment of tropes of blackness, including the tropes of pathological and Afrocentric blackness and the trope of the strong black woman. Ultimately, I argue that SISTA attempts to help black women become strong, empowered subjects of neo-liberalism, but in doing so it reinvigorates centuries-old logics in the United States whereby the racist expulsion of iii black Americans from structures of state support is authorized by narratives of black irresponsibility and inadequate self-management. iv To the men and women who fight for their lives and the lives of others in the constant struggle against racist oppression. Thank you. v ACKNOWLEDGMENTS This project, like all academic projects, may have one name on the title page but is the result of years of collaboration. Many of SISTA’s creators and disseminators were incredibly generous with their time and were willing to speak with me for hours about this program. Conversations with Arlene Edwards, Joan Ferguson, Patricia Frye, Marilyn Moering-Watkins, Amna Osman, Miriam Phields, Tobey Sapiano, Lucy Slater, and Dana Williams all fundamentally shaped this dissertation. My adviser, Eric King Watts, taught me the value of insightful incisions and the work that we, as rhetorical scholars, can do to begin undoing the nefarious entanglements that maintain racism’s tenaciousness. My committee members, Carole Blair, Wahneema Lubiano, Patricia Parker, and Barry Saunders, were incredibly generous throughout both this dissertation process and my graduate career, and most of the ideas in these pages can be traced to classes I took with them, books I read with them, or conversations I had with them. My undergraduate mentor and adviser, Leslie Hahner, first taught me how to use rhetoric’s tools to expose racism and sexism in the United States. Countless other professors and fellow graduate students have guided me and helped me think over the past 10 years, and I owe them all a debt of gratitude. My family and friends have pushed me to be a better scholar at the same time they have helped keep me sane. My friends, especially Erin Arizzi, Jennifer Fink, Marjorie Hazeltine, Amanda Hakanson-Stacy, Lena Kyman, and Amanda Stevens, all provided sustenance when I needed it most. Mary Paul challenged me to think deeply about the men and women who use the tools of public health to make the world a better place, and she made me some really great martinis. My family never stopped believing in me, even when I wasn’t sure I believed in vi myself. I am who I am because of their guidance, and I was only able to accomplish this monumental task because of the infinite support they provided. I’ll never be able to thank them enough. And Joshua Smicker, my partner, best friend, and favorite sparring partner, has loved me unconditionally, even in some quite difficult conditions. I am a better person because of him, and I am truly lucky to have such a brilliant husbando. vii TABLE OF CONTENTS LIST OF ABBREVIATIONS ..........................................................................................................x CHAPTER 1: INTRODUCTION ....................................................................................................1 Statement of Problem ...........................................................................................................2 Literature Review.................................................................................................................7 Theoretical Orientation ......................................................................................................17 Case Study .........................................................................................................................26 Chapter Descriptions ..........................................................................................................36 CHAPTER 2: HISTORICAL TRENDS IN PUBLIC HEALTH AND BLACKNESS ................43 Nineteenth Century Public Health Interventions into Morality .........................................44 Germ Theory, the Social Hygiene Movement, and Public Health’s Focus on the Individual ...........................................................................................................................50 Syphilis Control, Black Americans, and the United States Public Health Service............60 The Great Depression and Public Health ...........................................................................62 WWII and the Discovery of Penicillin...............................................................................64 The Rise of Epidemiology .................................................................................................65 Black Inclusion in the 1960s ..............................................................................................67 Making Healthy People......................................................................................................69 Black Exclusion in the “New Public health” .....................................................................72 The Move Towards Cultural Relevance ............................................................................74 Conclusion .........................................................................................................................76 CHAPTER 3: PATHOLOGICAL AND AFROCENTRIC BLACKNESS ..................................79 viii The Trope of Pathological Blackness ................................................................................81 Pathological Blackness in SISTA ......................................................................................90 The Trope of Afrocentric Blackness ..................................................................................97 Afrocentric Blackness in SISTA ......................................................................................101 Afrocentricity and the Heteronormative Black Family ...................................................108 Conclusion .......................................................................................................................110 CHAPTER 4: THE STRONG BLACK SISTA ...........................................................................112 The Strong Black Woman ................................................................................................112 The Strong Black SISTA .................................................................................................116 Public Health Discourse and Neo-Liberal Logics of Subjectivity ...................................132 CHAPTER 5: CONCLUSIONS ..................................................................................................146 APPENDIX A: “EGO TRIPPING (THERE MAY BE A REASON WHY” ..............................154 APPENDIX B: COVER OF 2008 SISTA U.S. IMPLEMENTATION MANUAL ....................155 APPENDIX C: “STILL I RISE”..................................................................................................156 APPENDIX D: “ALWAYS THERE ARE THE CHILDREN” ..................................................157 WORKS CITED ..........................................................................................................................158 ix LIST OF ABBREVIATIONS AIDS Acquired immune deficiency syndrome ASHA American social hygiene association CBO Community-based organization CDC Centers for disease control and prevention DHAP Division of HIV/AIDS prevention at the CDC DEBI Diffusion of effective behavioral interventions EBI Evidence-based