The Democratic Biopolitics of PrEP

PrEP (Pre-Exposure Prophylaxis) is a relatively new drug-based HIV prevention technique and an important means to lower the HIV risk of gay men who are especially vulnerable to HIV. From the perspective of biopolitics, PrEP inscribes itself in a larger trend of medicalization and the rise of pharmapower. This article reconstructs and evaluates contemporary literature on biopolitical theory as it applies to PrEP, by bringing it in a dialogue with a mapping of the political debate on PrEP. As PrEP changes sexual norms and subjectification, for example condom use and its meaning for gay subjectivity, it is highly contested. The article shows that the debate on PrEP can be best described with the concepts ‘sexual-somatic ethics’ and ‘democratic biopolitics’, which I develop based on the biopolitical approach of Nikolas Rose and Paul Rabinow. In contrast, interpretations of PrEP which are following governmentality studies or Italian Theory amount to either farfetched or trivial positions on PrEP, when seen in light of the political debate. Furthermore, the article is a contribution to the scholarship on gay subjectivity, highlighting how homophobia and homonormativity haunts gay sex even in liberal environments, and how PrEP can serve as an entry point for the destigmatization of gay sexuality and transformation of gay subjectivity. ‘Biopolitical democratization’ entails making explicit how medical technology and health care relates to sexual subjectification and ethics, to strengthen the voice of (potential) PrEP users in health politics, and to renegotiate the profit and power of Big Pharma

The Politics of Global Governance of HIV/AIDS in Sub-Saharan Africa: The Case of Gender

There has emerged a consensus around the world that HIV/AIDS should be highlighted as a serious global problem. It is seen as a humanitarian, development and global security issue. Regardless of perceiving HIV/AIDS as a humanitarian, development or global security issue, our common consciousness of HIV/AIDS is related to two different aspects: to its occurrence in multiple countries and to the international policy context. Thus what is global about HIV/AIDS is not only the magnitude of the problem but also the approved response to the problem. The approved global response to HIV/AIDS is organized through a global governance regime. This regime consists of many multilateral and bilateral organizations, programs and funds which constitute a complex system. As a result of setting the HIV/AIDS on the global policy agenda, especially African states have had to adopt a multisectoral approach to their epidemics. Within the multisectoral approach there are different actors working against HIV/AIDS in cooperation. Consequence of the multisectoral approach is that the national level is bypassed and the global level is in direct contact with the local level. Despite the direct contact of global and local levels, Africans can very seldom get their voices heard within the global level. Due to this the practices of global governance and the experiences of Africans do not always correspond. This has made many projects that address HIV/AIDS in sub-Saharan Africa ineffective in tackling HIV/AIDS, but not ineffective in establishing authority. The research will address this disjunction and shed light on the effects of the global governance of sub-Saharan HIV/AIDS. Theoretically and methodologically the research is based on the analytics of government approach, which emanates from the work of Michel Foucault, although the research also contains methodological decisions that are based on the criticism of this approach. More specifically, the research addresses the global governance of sub-Saharan HIV/AIDS through the case of gender. This is because, even though homogenous and universal gender inequality is frequently rendered at the heart of Sub-Saharan HIV/AIDS, there has been vast work done by a bunch of researchers who emphasize the heterogeneity and dynamism of sexual and gender relations in Africa. Hence, it is only by through simplification that sub-Saharan HIV/AIDS can be made governable through gender. Furthermore, this governance is only practiced within specific limits. If these limits are violated promotion of gender equality is forgotten and authoritarian practices are put into action. This is especially salient when the global governance of sub-Saharan HIV/AIDS is examined through its collision with the management of migration. From these perspectives it is possible to view the gender-based governance of HIV/AIDS as a political struggle. According to the research, the contemporary global governance of sub-Saharan HIV/AIDS is unlikely to solve the health crisis, but it helps to keep sub-Saharan Africa governable. In addition, the governance can be harmful to traditional ways, customs and habits. Thus the governance is suitable for managing risks of contemporary world order, but at the cost of discrimination. However, this scenario is not inevitable as there are some possibilities for resistance

Biopolitiikan teoria ja HIV/AIDS-pandemian globaali hallinta : Kritiikistä affirmaatioon

Lukuisilla mittareilla tarkasteltuna etenkin viimeisen viidentoista vuoden aikana tapahtunut HIV/AIDS-pandemian hallinnan globaali intensifioituminen ja liberalisoituminen on parantanut tilannetta käytännössä kaikkialla. Kuten lukuisat globaalin hallinnan käytännön vaikutuksia luotaavat kriittiset tutkimukset ovat kuitenkin samaan aikaan osoittaneet, globaalisti marginalisoitujen alueiden kohdalla kehitys on sivutuotteenaan myös pakottanut joitain ihmisiä perusteettomasti huonompaan asemaan kuin toisia. Marginaalisissa konteksteissa puutteellisesta terveydenhuollon infrastruktuurista ja köyhyydestä johtuen ihmisten sattumanvaraiset fysikaaliset erot ovat toistuvasti johtaneet siihen, että HIV/AIDS-pandemian hallinta ei ole käytännössä onnistunut toimimaan täysin omien periaatteidensa mukaisesti kaikkien oikeuksia ja tasavertaisuutta kunnioittaen. Tämä ei ole yllättävää monitieteellisen biopoliittisen teoriaperinteen näkökulmasta. Biopoliittisen teorian yksi keskeisimmistä väitteistä on jo pitkään ollut, että poliittisen universalismin ja väestöjen elämän hallinnoinnin välinen suhde on ristiriitainen. Kun väestöjen elämää pyritään turvaamaan, vaalimaan tai muuttamaan, huomio keskittyy lopulta välttämättömästi partikulaareihin biologisiin ja fysiologisiin eroavaisuuksiin, mikä tekee poliittisesta universaalisuudesta käytännössä merkityksetöntä tai ainoastaan muodollisia. Edellisistä yhtäläisyyksistä huolimatta HIV/AIDS-pandemian globaalia hallintaa ei ole tähän mennessä laajamittaisesti ja systemaattisesti tarkasteltu biopoliittisen teorian näkökulmasta. Käsillä oleva tutkimukseni pyrkii osaltaan täyttämään tätä aukkoa. Tutkimuksessani HIV/AIDS-pandemian globaalin hallinnan politiikkaa käsitellään käyttämällä hyväksi biopolitiikan teorian piirissä esitettyjä viimeaikaisia avauksia. Lähestymistapa on lähtökohtaisesti lupaava, sillä vaikka täyttä konsensusta ei ole syntynyt ja osittain viimeaikaiset avaukset ovat olleet vaikeaselkoisia, on erityisesti ’affirmatiivisen’ biopolitiikan teorian piirissä jo pystytty esittämään alustavia ideoita, joiden perusteella poliittisen universalismin ja elämän hallinnoinnin välinen ristiriita mahdollisesti voitaisiin ratkaista. Johtuen edellä mainittujen avausten luonnosmaisuudessa tutkimuksessa ei sovelleta valmista teoriaa HIV/AIDS-pandemian globaalin hallinnan tapaukseen. Päinvastoin, tutkimuksessa biopolitiikan teoriaa edelleen kehitetään esimerkiksi Giorgio Agambenin, Michel Foucault’n ja Roberto Espositon ajatuksia jalostaen. Teoreettisten kehittelyjen perusteella tutkimuksessa päädytään lopulta empiirisesti tarkastelemaan HIV/AIDS-pandemian globaalin hallinnan politiikkaa kirjallisuuden avulla. Empiirisesti tutkimus hyödyntää neljää teosta, jotka kaikki käsittelevät globaalisti marginalisoitujen ihmisten vaikea tilannetta HIV/AIDS-pandemian yhteydessä. Kyseiset teokset ovat Carolyne Adallan Confessions of an AIDS Victim, Jamaica Kincaidin My Brother, Meja Mwangin The Last Plague ja Yan Lianken Dream of Ding Village, joita kaikkia tutkimuksessa luetaan peilaamalla teoksien sisältöä HIV/AIDS-pandemian globaalin hallinnan nykypäivän ongelmiin. Metodologisesti teoksien luentatapa pohjautuu Elaine Scarryn kehittämään kirjallisuuden ’materialistiseen kritiikkiin’. Empiirisen analyysin perusteella tutkimuksessa esitetään, että jopa globaalisti kaikkein marginalisoiduimmat ihmiset voidaan biopoliittisesta perspektiivistä käsittää vapaimmiksi ja tasavertaisimmiksi kuin liberaalin HIV/AIDS-pandemian hallinnan näkökulmasta katsottuna on mahdollista. Näin tutkimuksessa ei ainoastaan kyseenalaisteta nykymuotoisen HIV/AIDS-pandemian globaalin hallinnan legitimiteettiä, vaan biopoliittisen vapauden ja tasavertaisuuden ideoiden avulla tutkimuksessa myös osoitetaan poliittiset suuntaviivat, joiden perustalta pandemian globaalin hallinnoinnin uudelleenjärjestely on mahdollista. Lopuksi tutkimuksessa pohditaan, mitä kyseisten suuntaviivojen seuraaminen konkreettisesti tarkoittaa.The vast evidence shows that the scale up and liberalization of the global HIV/AIDS relief especially in the past fifteen years has overall improved the life changes of people virtually everywhere. However, as numerous critical studies have simultaneously emphasized, in the globally marginalized locations this overall improvement has been accompanied by cementing already existing hierarchies and the establishment of new inequalities. In these locations the well-intentioned global response to HIV/AIDS has run into an obstacle that has been undefeatable; namely, the body. Due to the fact that people are physiologically and pharmaceutically different, the global response to HIV/AIDS has not been able in reality to affirm the freedom and equality of all globally marginalized sufferers, despite this being the intention. This is not at all surprising from the perspective of the biopolitical theorizing of the past four decades. One of the most established and well-known claims in this interdisciplinary field is that political universalism recedes when life steps to the foreground. When the general aim is to save, improve, secure, modify or foster life, the attention is eventually focused on particular biological differences, regardless of universal ideas that might inspire this governance. And yet, in spite of this resonance that runs between the field of biopolitical thought and the concrete problems of the contemporary global HIV/AIDS governance, extensive and systematic attempts to introduce biopolitical theories into the context of the global HIV/AIDS governance have so far been lacking. This research responds to this lack. The focus of the study lies in bringing the field of biopolitical thought into an intimate connection with the currently unsolvable political problematics of the contemporary HIV/AIDS governance in order to move beyond a simple critical elaboration of the current situation. After all, in spite of the difficulty of thinking political universalism and the management of our lives together, not all scholars of biopolitics have seen political universalism and the domain of life as absolutely incompatible. On the contrary, recently a number of theorists of biopolitics have brought forward different ideas on how political universalism might still be made operative in relation to the domain of life. In spite of the insightfulness of these ideas, however, these so-called theories of ‘affirmative biopolitics’ have remained somewhat cryptic and no general consensus have emerged over how life and politics could be brought together in a way that would make it possible, for instance, to speak about politics of life that also in practice affirms everyone’s freedom and equality. As a result of this ambiguousness, we will not only reflect the current debates within the field of biopolitical theory but also develop and push further the ideas of seminal theorists of biopolitics, such as Giorgio Agamben, Roberto Esposito and Michel Foucault. Empirically this engagement will lead us to analyze the political limits of the contemporary global response to HIV/AIDS through literary works that concentrate on the difficult situation of the globally marginalized HIV/AIDS sufferers. The literary works we will focus on are Carolyne Adalla’s Confessions of an AIDS Victim, Jamaica Kincaid’s My Brother, Meja Mwangi’s The Last Plague and Yan Lianke’s Dream of Ding Village. All these works have been selected on the basis of their resonance to the actual problems of the global governance of HIV/AIDS, and all these works are read by contrasting them to the political limitations of our current perceptions of these problems, along the lines set by a methodological orientation called the ‘materialist criticism’ of literature, which originates from the work of Elaine Scarry. Through our empirical analysis we will show how even the most marginalized HIV/AIDS sufferers can be seen on the basis of their lives to be actually free and equal in a more extensive sense than on the basis of the liberal public health ethos. In this manner, we will eventually introduce ‘affirmative-biopolitical’ ideas of freedom and equality into the context of global HIV/AIDS governance. Through these two ideas we will sketch a political relation that consists from the prevalent liberal policies and from the viable possibility of concrete affirmative biopolitics, which on the basis of the affirmation of these ideas of freedom and equality, possesses genuine potential to go beyond the limitations of the current global response to HIV/AIDS. Finally, we will reflect our actual possibilities to transform the contemporary global response to HIV/AIDS and elaborate what kind of political acts as such are in this context faithful expressions of affirmative biopolitics

Biopolitiikan teoria ja HIV/AIDS-pandemian globaali hallinta : Kritiikistä affirmaatioon

Lukuisilla mittareilla tarkasteltuna etenkin viimeisen viidentoista vuoden aikana tapahtunut HIV/AIDS-pandemian hallinnan globaali intensifioituminen ja liberalisoituminen on parantanut tilannetta käytännössä kaikkialla. Kuten lukuisat globaalin hallinnan käytännön vaikutuksia luotaavat kriittiset tutkimukset ovat kuitenkin samaan aikaan osoittaneet, globaalisti marginalisoitujen alueiden kohdalla kehitys on sivutuotteenaan myös pakottanut joitain ihmisiä perusteettomasti huonompaan asemaan kuin toisia. Marginaalisissa konteksteissa puutteellisesta terveydenhuollon infrastruktuurista ja köyhyydestä johtuen ihmisten sattumanvaraiset fysikaaliset erot ovat toistuvasti johtaneet siihen, että HIV/AIDS-pandemian hallinta ei ole käytännössä onnistunut toimimaan täysin omien periaatteidensa mukaisesti kaikkien oikeuksia ja tasavertaisuutta kunnioittaen. Tämä ei ole yllättävää monitieteellisen biopoliittisen teoriaperinteen näkökulmasta. Biopoliittisen teorian yksi keskeisimmistä väitteistä on jo pitkään ollut, että poliittisen universalismin ja väestöjen elämän hallinnoinnin välinen suhde on ristiriitainen. Kun väestöjen elämää pyritään turvaamaan, vaalimaan tai muuttamaan, huomio keskittyy lopulta välttämättömästi partikulaareihin biologisiin ja fysiologisiin eroavaisuuksiin, mikä tekee poliittisesta universaalisuudesta käytännössä merkityksetöntä tai ainoastaan muodollisia. Edellisistä yhtäläisyyksistä huolimatta HIV/AIDS-pandemian globaalia hallintaa ei ole tähän mennessä laajamittaisesti ja systemaattisesti tarkasteltu biopoliittisen teorian näkökulmasta. Käsillä oleva tutkimukseni pyrkii osaltaan täyttämään tätä aukkoa. Tutkimuksessani HIV/AIDS-pandemian globaalin hallinnan politiikkaa käsitellään käyttämällä hyväksi biopolitiikan teorian piirissä esitettyjä viimeaikaisia avauksia. Lähestymistapa on lähtökohtaisesti lupaava, sillä vaikka täyttä konsensusta ei ole syntynyt ja osittain viimeaikaiset avaukset ovat olleet vaikeaselkoisia, on erityisesti ’affirmatiivisen’ biopolitiikan teorian piirissä jo pystytty esittämään alustavia ideoita, joiden perusteella poliittisen universalismin ja elämän hallinnoinnin välinen ristiriita mahdollisesti voitaisiin ratkaista. Johtuen edellä mainittujen avausten luonnosmaisuudessa tutkimuksessa ei sovelleta valmista teoriaa HIV/AIDS-pandemian globaalin hallinnan tapaukseen. Päinvastoin, tutkimuksessa biopolitiikan teoriaa edelleen kehitetään esimerkiksi Giorgio Agambenin, Michel Foucault’n ja Roberto Espositon ajatuksia jalostaen. Teoreettisten kehittelyjen perusteella tutkimuksessa päädytään lopulta empiirisesti tarkastelemaan HIV/AIDS-pandemian globaalin hallinnan politiikkaa kirjallisuuden avulla. Empiirisesti tutkimus hyödyntää neljää teosta, jotka kaikki käsittelevät globaalisti marginalisoitujen ihmisten vaikea tilannetta HIV/AIDS-pandemian yhteydessä. Kyseiset teokset ovat Carolyne Adallan Confessions of an AIDS Victim, Jamaica Kincaidin My Brother, Meja Mwangin The Last Plague ja Yan Lianken Dream of Ding Village, joita kaikkia tutkimuksessa luetaan peilaamalla teoksien sisältöä HIV/AIDS-pandemian globaalin hallinnan nykypäivän ongelmiin. Metodologisesti teoksien luentatapa pohjautuu Elaine Scarryn kehittämään kirjallisuuden ’materialistiseen kritiikkiin’. Empiirisen analyysin perusteella tutkimuksessa esitetään, että jopa globaalisti kaikkein marginalisoiduimmat ihmiset voidaan biopoliittisesta perspektiivistä käsittää vapaimmiksi ja tasavertaisimmiksi kuin liberaalin HIV/AIDS-pandemian hallinnan näkökulmasta katsottuna on mahdollista. Näin tutkimuksessa ei ainoastaan kyseenalaisteta nykymuotoisen HIV/AIDS-pandemian globaalin hallinnan legitimiteettiä, vaan biopoliittisen vapauden ja tasavertaisuuden ideoiden avulla tutkimuksessa myös osoitetaan poliittiset suuntaviivat, joiden perustalta pandemian globaalin hallinnoinnin uudelleenjärjestely on mahdollista. Lopuksi tutkimuksessa pohditaan, mitä kyseisten suuntaviivojen seuraaminen konkreettisesti tarkoittaa.The vast evidence shows that the scale up and liberalization of the global HIV/AIDS relief especially in the past fifteen years has overall improved the life changes of people virtually everywhere. However, as numerous critical studies have simultaneously emphasized, in the globally marginalized locations this overall improvement has been accompanied by cementing already existing hierarchies and the establishment of new inequalities. In these locations the well-intentioned global response to HIV/AIDS has run into an obstacle that has been undefeatable; namely, the body. Due to the fact that people are physiologically and pharmaceutically different, the global response to HIV/AIDS has not been able in reality to affirm the freedom and equality of all globally marginalized sufferers, despite this being the intention. This is not at all surprising from the perspective of the biopolitical theorizing of the past four decades. One of the most established and well-known claims in this interdisciplinary field is that political universalism recedes when life steps to the foreground. When the general aim is to save, improve, secure, modify or foster life, the attention is eventually focused on particular biological differences, regardless of universal ideas that might inspire this governance. And yet, in spite of this resonance that runs between the field of biopolitical thought and the concrete problems of the contemporary global HIV/AIDS governance, extensive and systematic attempts to introduce biopolitical theories into the context of the global HIV/AIDS governance have so far been lacking. This research responds to this lack. The focus of the study lies in bringing the field of biopolitical thought into an intimate connection with the currently unsolvable political problematics of the contemporary HIV/AIDS governance in order to move beyond a simple critical elaboration of the current situation. After all, in spite of the difficulty of thinking political universalism and the management of our lives together, not all scholars of biopolitics have seen political universalism and the domain of life as absolutely incompatible. On the contrary, recently a number of theorists of biopolitics have brought forward different ideas on how political universalism might still be made operative in relation to the domain of life. In spite of the insightfulness of these ideas, however, these so-called theories of ‘affirmative biopolitics’ have remained somewhat cryptic and no general consensus have emerged over how life and politics could be brought together in a way that would make it possible, for instance, to speak about politics of life that also in practice affirms everyone’s freedom and equality. As a result of this ambiguousness, we will not only reflect the current debates within the field of biopolitical theory but also develop and push further the ideas of seminal theorists of biopolitics, such as Giorgio Agamben, Roberto Esposito and Michel Foucault. Empirically this engagement will lead us to analyze the political limits of the contemporary global response to HIV/AIDS through literary works that concentrate on the difficult situation of the globally marginalized HIV/AIDS sufferers. The literary works we will focus on are Carolyne Adalla’s Confessions of an AIDS Victim, Jamaica Kincaid’s My Brother, Meja Mwangi’s The Last Plague and Yan Lianke’s Dream of Ding Village. All these works have been selected on the basis of their resonance to the actual problems of the global governance of HIV/AIDS, and all these works are read by contrasting them to the political limitations of our current perceptions of these problems, along the lines set by a methodological orientation called the ‘materialist criticism’ of literature, which originates from the work of Elaine Scarry. Through our empirical analysis we will show how even the most marginalized HIV/AIDS sufferers can be seen on the basis of their lives to be actually free and equal in a more extensive sense than on the basis of the liberal public health ethos. In this manner, we will eventually introduce ‘affirmative-biopolitical’ ideas of freedom and equality into the context of global HIV/AIDS governance. Through these two ideas we will sketch a political relation that consists from the prevalent liberal policies and from the viable possibility of concrete affirmative biopolitics, which on the basis of the affirmation of these ideas of freedom and equality, possesses genuine potential to go beyond the limitations of the current global response to HIV/AIDS. Finally, we will reflect our actual possibilities to transform the contemporary global response to HIV/AIDS and elaborate what kind of political acts as such are in this context faithful expressions of affirmative biopolitics

The Politics of Global Governance of HIV/AIDS in Sub-Saharan Africa: The Case of Gender

There has emerged a consensus around the world that HIV/AIDS should be highlighted as a serious global problem. It is seen as a humanitarian, development and global security issue. Regardless of perceiving HIV/AIDS as a humanitarian, development or global security issue, our common consciousness of HIV/AIDS is related to two different aspects: to its occurrence in multiple countries and to the international policy context. Thus what is global about HIV/AIDS is not only the magnitude of the problem but also the approved response to the problem. The approved global response to HIV/AIDS is organized through a global governance regime. This regime consists of many multilateral and bilateral organizations, programs and funds which constitute a complex system. As a result of setting the HIV/AIDS on the global policy agenda, especially African states have had to adopt a multisectoral approach to their epidemics. Within the multisectoral approach there are different actors working against HIV/AIDS in cooperation. Consequence of the multisectoral approach is that the national level is bypassed and the global level is in direct contact with the local level. Despite the direct contact of global and local levels, Africans can very seldom get their voices heard within the global level. Due to this the practices of global governance and the experiences of Africans do not always correspond. This has made many projects that address HIV/AIDS in sub-Saharan Africa ineffective in tackling HIV/AIDS, but not ineffective in establishing authority. The research will address this disjunction and shed light on the effects of the global governance of sub-Saharan HIV/AIDS. Theoretically and methodologically the research is based on the analytics of government approach, which emanates from the work of Michel Foucault, although the research also contains methodological decisions that are based on the criticism of this approach. More specifically, the research addresses the global governance of sub-Saharan HIV/AIDS through the case of gender. This is because, even though homogenous and universal gender inequality is frequently rendered at the heart of Sub-Saharan HIV/AIDS, there has been vast work done by a bunch of researchers who emphasize the heterogeneity and dynamism of sexual and gender relations in Africa. Hence, it is only by through simplification that sub-Saharan HIV/AIDS can be made governable through gender. Furthermore, this governance is only practiced within specific limits. If these limits are violated promotion of gender equality is forgotten and authoritarian practices are put into action. This is especially salient when the global governance of sub-Saharan HIV/AIDS is examined through its collision with the management of migration. From these perspectives it is possible to view the gender-based governance of HIV/AIDS as a political struggle. According to the research, the contemporary global governance of sub-Saharan HIV/AIDS is unlikely to solve the health crisis, but it helps to keep sub-Saharan Africa governable. In addition, the governance can be harmful to traditional ways, customs and habits. Thus the governance is suitable for managing risks of contemporary world order, but at the cost of discrimination. However, this scenario is not inevitable as there are some possibilities for resistance

Sosiaalihuollon asiakastietomäärittelyjen ja palvelutuotannon toiminnallisten määrittelyjen hallinta : 4.0, Maaliskuu 2022

Julkaisun sähköinen versio:https://yhteistyotilat.fi/wiki08/display/SAPTJULKTässä julkaisussa kuvataan sosiaalihuollon asiakastietomäärittelyjen ja palvelutuotannon toiminnallisten määriteltyjen laadukas ja toimiva hallinnointitapa. Hallintamallin avulla tavoitellaan määrittelyjen yhtenäisyyttä, ajantasaisuutta ja tarkoituksenmukaisuutta. Tavoitteena on myös muutosehdotusten hallinta, mahdollisimman nopea käsittely sekä tehtyjen muutosten läpinäkyvyys ja jäljitettävyys.4.