MEN MANAGING UNCERTAINTY: THE POLITICAL ECONOMY OF HIV IN URBAN UGANDA by MEGAN M. SCHMIDT-SANE Submitted in partial fulfillment of the requirements For the degree of Doctor of Philosophy Department of Anthropology CASE WESTERN RESERVE UNIVERSITY May 2020 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the dissertation of Megan M. SchmiDt-Sane Candidate for the degree of Doctor of Philosophy. Committee Chair Janet W. McGrath, Ph.D. Committee Member Lee Hoffer, Ph.D. Committee Member Jill Korbin, Ph.D. Committee Member Aloen TownsenD, Ph.D. Date of Defense February 19, 2020 *We also certify that written approval has been obtained for any proprietary material contained therein. Table of Contents LIST OF TABLES ......................................................................................................................................... 6 LIST OF FIGURES........................................................................................................................................ 7 ACKNOWLEDGEMENTS................................................................................................................................ 8 LIST OF ABBREVIATIONS ............................................................................................................................ 10 GLOSSARY ............................................................................................................................................. 11 ABSTRACT ............................................................................................................................................. 14 CHAPTER 1 INTRODUCTION.................................................................................................................... 16 1.1. RESEARCH OVERVIEW ........................................................................................................................ 16 1.2. RESEARCH OBJECTIVES ....................................................................................................................... 17 1.3. SIGNIFICANCE .................................................................................................................................. 18 1.4. ORGANIZATION OF THE DISSERTATION ................................................................................................... 19 CHAPTER 2 BACKGROUND ..................................................................................................................... 21 2.1. OVERVIEW ...................................................................................................................................... 21 2.2. POLITICAL ECONOMY OF HEALTH .......................................................................................................... 22 2.2.1. Neoliberalism ........................................................................................................................ 28 2.2.2. Power and Prestige ............................................................................................................... 29 2.2.3. Inequality.............................................................................................................................. 30 2.3. THE RISK ENVIRONMENT .................................................................................................................... 33 2.4. STRUCTURAL AND SYNERGISTIC VULNERABILITIES ...................................................................................... 35 2.5. SOCIAL RESILIENCE ............................................................................................................................ 38 CHAPTER 3 UGANDA CONTEXT .............................................................................................................. 40 3.1. OVERVIEW ...................................................................................................................................... 40 3.2. URBANIZATION, INEQUALITY, AND JOB LOSS: A BY-PRODUCT OF NEOLIBERALISM AND COLONIALISM .................... 41 3.2.1. Colonial Rooted Processes of Urbanization and Stratification ................................................. 41 3.2.2. Winters of Discontent: Precursors to Independence ............................................................... 44 3.2.3. Post-Independence, Neoliberal Policies, and the Makings of Inequality .................................. 45 3.2.4. Rural to Urban Migration ...................................................................................................... 49 3.2.5. The Impact of Urbanization on Social Relations ..................................................................... 51 3.2.6. The Informal Settlement ........................................................................................................ 53 3.2.7. The Informal Economy .......................................................................................................... 54 3.2.8. The Policing of Urban Social Space ........................................................................................ 56 3.3. NEW OPPOSITION AND RISING TENSIONS: MP ROBERT KYAGULANYI (BOBI WINE) ........................................... 59 3.4. UGANDA’S HISTORY WITH THE HIV EPIDEMIC .......................................................................................... 61 3.4.1. Overview of HIV in Uganda ................................................................................................... 61 3.4.2. Navigating Uncertainty ......................................................................................................... 63 3.4.3. Literature on HIV among Ugandan Men ................................................................................ 65 3.5. STUDY SETTING ................................................................................................................................ 67 CHAPTER 4 PILOT FINDINGS ................................................................................................................... 76 Overview ................................................................................................................................................... 76 Sampling ................................................................................................................................................... 76 Semi-structured interviews ........................................................................................................................ 76 Analysis ..................................................................................................................................................... 77 Findings .................................................................................................................................................... 77 CHAPTER 5 METHODS ............................................................................................................................ 79 5.1. OVERVIEW ...................................................................................................................................... 79 3 5.2. SURVEY DESIGN ............................................................................................................................... 81 5.3. COMMUNITY CENSUS ........................................................................................................................ 81 5.4. SURVEY .......................................................................................................................................... 83 Sampling ................................................................................................................................................... 83 Sampling Frame......................................................................................................................................... 84 Randomization .......................................................................................................................................... 84 Data management ..................................................................................................................................... 88 5.5. QUANTITATIVE DATA ANALYSIS ............................................................................................................ 89 Preliminary Data Screening ........................................................................................................................ 91 Hierarchical OLS Multiple Regression ......................................................................................................... 92 Cluster Data Analysis ................................................................................................................................. 93 Least Square Dummy Variable (LSDV) Fixed Effects Model .......................................................................... 94 5.6. SERVICE PROVIDER INTERVIEWS............................................................................................................ 95 5.7. IN-DEPTH INTERVIEWS ....................................................................................................................... 95 5.8. PARTICIPANT OBSERVATION ................................................................................................................ 97 5.9. QUALITATIVE DATA ANALYSIS .............................................................................................................. 99 5.10. INTEGRATION OF QUANTITATIVE AND QUALITATIVE