Pathologies of Patriarchy : Death, Suffering, Care, and Coping in the Gendered Gaps of HIV/AIDS Interventions in Nigeria

In the delta region of Nigeria, women seeking HIV care face a plethora of deeply gendered inequalities. As a result, HIV-positive women are often unable to use the treatment schemes that are seemingly available to them. Pathologies of Patriarchy brings together a geographic analysis of gendered inequalities with practical implementation questions concerning the limits of current global health programming. This book is an experiential analysis of HIV treatment programs that includes first-hand accounts of how female patients explain and cope with the poor access to and the inconsistencies in the delivery of HIV service care that complicates their adherence to treatment, as well as the complex power relations they navigate daily. Eloho Ese Basikoro also addresses the failures of policymakers who talk about gender mainstreaming but fail to deliver sustainable health services for disenfranchised women suffering from the social stigma and alienation associated with seropositivity. This inter-regional study is of great interdisciplinary interest to a wide variety of scholars and policymakers, whether they are researching gendered inequality from a geographical, anthropological, or global health perspective or are interested in broader concerns about development and inequality in sub-Saharan Africa. -- book cover Pathologies of Patriarchy 1 Contents 6 Acknowledgments 8 PART 1: HISTORY, POLITICS, AND HIV/AIDS GOVERNANCE 10 1 Gender, HIV/AIDS, and Treatment Sustainability 12 Key Theories and Concepts 16 Access and Adherence 17 Gender Frames and Positionality 19 Nongovernmental Organizations 22 Needs- and Rights-Based Discourses 24 About the Book 25 Organization of the Book 27 2 HIV/AIDS in Nigeria: Denialism and Response 34 A Landscape of Interventions 38 Paradigms of Interventions 43 Treatment, Care, and Support 45 Gender 45 3 The Political Economy and Socioecological Contingencies of the Niger Delta 52 Erhoike 57 HIV Care in Erhoike 61 PART 2: EMBODIED ACCOUNTS 70 4 Constructed Gendered Identities: Rethinking and Reconstructing the Notions of Care 72 Care and Responsibility 73 A Gendered Morality of Care? 76 Unpacking the Moral Dilemmas of Care 79 Rethinking Care 85 5 It Is the Fear: Contextualizing the Politics of HIV/AIDS (Non)Disclosure 92 Nondisclosure 93 HIV/AIDS and the Changing Family Structure: Quasi-Widowhood 101 6 Feminism and the Conflicting Discourses of Empowerment 110 Clarifying and Contextualizing Empowerment through Local Voices 114 Feminism in Nigeria 119 7 Biomedicalization of Treatment Interventions and HIV/AIDS Support Networks 130 HIV/AIDS Support Groups as Emerging Therapeutic Enclaves 133 Perceptions of HIV/AIDS Policies and Programs 139 8 Structuring and Stricturing Individual Coping Strategies 144 Individualized Coping Strategies 145 The Culture of Blame 150 Constructing HIV/AIDS Exceptionalism from the Other Side 154 PART 3: MODELS OF INTERVENTIONS 160 9 Beyond the Rhetoric of Gender Mainstreaming 162 Gender Mainstreaming 164 The Gender Knowledge Gap 166 Politics of Identity and the Conflicting Models of Gender Mainstreaming 170 Global Health Regulatory Frameworks and the Funding Politics of International Organizations 173 10 Conclusion about an Unending Work 184 Claiming Gender in Health through a Needs-Rights Approach 185 Final Note 192 Appendix: HIV/AIDS Policy Texts Analyzed 194 Bibliography 196 Index 212 About the Author 218 In the delta region of Nigeria, women seeking HIV care face a plethora of deeply gendered inequalities. As a result, HIV-positive women are often unable to use the treatment schemes that are seemingly available to them. Pathologies of Patriarchy brings together a geographic analysis of gendered inequalities with practical implementation questions concerning the limits of current global health programming. This book is an experiential analysis of HIV treatment programs that includes first-hand accounts of how female patients explain and cope with the poor access to and the inconsistencies in the delivery of HIV service care that complicates their adherence to treatment, and the complex power relations they navigate daily. Eloho Ese Basikoro also addresses the failures of policy-makers who talk about gender mainstreaming but fail to deliver sustainable health services for disenfranchised women suffering from the social stigma and alienation associated with seropositivity. This inter-regional study is of disciplinary and interdisciplinary interest to a wide variety of scholars and policy-makers, whether they are researching gendered inequality from a geographical, anthropological or global health perspective, or interested in broader concerns about development and inequality in sub-Saharan Africa Pathologies of Patriarchy explores the gendered inequalities that bar HIV-positive women in the Nigerian delta region from the HIV treatment seemingly available to them. Eloho Ese Basikoro brings together an ethnographic study and geographic analysis with practical implementation questions concerning current policy and global health programming.