Ellen E. Foley

HIV/AIDS and African immigrant women in Philadelphia: structural and cultural barriers to care.

Abstract Although African immigration to American cities is increasing, there is little published demographic or epidemiological data on this population. As growing numbers of HIV-positive Africans seek care at public health centres in the city of Philadelphia, medical personnel are confronted with the challenges of serving this population. This qualitative study explores the perspectives of HIV service providers who are treating this new patient group, and it examines the cultural and structural barriers African women face in the area of HIV prevention, testing, and treatment in the city of Philadelphia. These barriers include legal status, linguistic problems, fear of the American health system, misunderstandings about modes of transmission of HIV, and lack of awareness about antiretroviral treatment. Culturally appropriate education about HIV prevention and treatment needs to be developed for African immigrants, and medical personnel need to understand the experiences, fears, and concerns of this population.

Overlaps and Disconnects in Reproductive Health Care: Global Policies, National Programs, and the Micropolitics of Reproduction in Northern Senegal

The International Conference on Population and Development (ICPD) held in Cairo in 1994 called for a global commitment to increasing womens agency and reproductive options by promoting a reproductive health agenda. Voluntary contraceptive use and the quality of reproductive health care have become the predominant emphases in family planning initiatives. Yet, many programs worldwide demonstrate a continued commitment to fertility reduction and slowing population growth. This article explores three arenas of contemporary discourse about reproductive health and family planning. Using Senegal as a case study, it highlights the significant overlaps and disconnects among global reproductive health policy, national priorities and programs, and the biopolitics of gender, marriage, and fertility that shape Senegalese womens reproductive behavior. The article points to the slow decline in national fertility rates to explore how family planning initiatives fail to address reproduction in the context of womens socio-economic challenges and cultural and religious fertility ideals.

Mbaraan and the shifting political economy of sex in urban Senegal

This paper examines transactional sex in Dakar as a window into broader processes of social and economic change in urban Senegal. Patterns of heterosexual behaviour in Senegals capital (late and increasing age at first marriage for women, a relatively high divorce rate and a rise in transactional sex) reflect a confluence of socioeconomic forces that curtail some forms of heterosexual union and facilitate others. Our analysis focuses on the rise of mbaraan, a practice in which single, married and divorced women have multiple male partners. We argue that while mbaraan is in part an expression of womens agency and a transgression of dominant gender norms, it also reflects womens social and economic subordination and their inability to achieve self-sufficiency independent of mens financial support. We suggest that this urban phenomenon is the outcome of contradictory opportunities and constraints that women face as they grapple with material insecurity and marital disappointments.

Negotiating Love and Marriage in Contemporary Senegal: A Good Man Is Hard to Find

Abstract: In Senegal, love, respect, and compatibility have historically figured into marital calculations, yet prospective husbands must also provide material support. After decades of stagnant economic growth, good providers are hard to find. In this article we examine two strategies that women employ in an attempt to achieve economic security: nonmarital sex and transnational marriage. Though recent anthropological literature proposes a global transition toward companionate marriage, evidence from Dakar suggests that Senegalese women are prioritizing short-term material gain over longer-term projects of social reproduction. Transnational marriage and nonmarital sexual relationships illuminate women’s new strategies to stabilize their social positions in increasingly precarious times. Résumé: Au Sénégal, les maris potentiels doivent certes fournir un soutien matériel à leur épouse cependant amour, respect et compatibilité ont historiquement également figuré dans les calculs matrimoniaux. Après des décennies de stagnation de la croissance économique, les bons chefs de famille sont difficiles à trouver. Dans cet article, nous examinons deux stratégies que les femmes emploient pour tenter de parvenir à la sécurité économique : sexe hors mariage et mariage transnational. Bien que la récente littérature anthropologique propose une transition mondiale vers le mariage de compagnie, des témoignages provenant de Dakar indique que les femmes sénégalaises privilégient les gains matériels à court terme par rapport aux projets de reproduction sociale à plus long terme. Le mariage transnational et les relations sexuelles hors mariage éclairent les nouvelles stratégies des femmes pour stabiliser leur position sociale à une époque de plus en plus précaire.

Courting success in HIV/AIDS prevention: the challenges of addressing aconcentrated epidemic in Senegal

This article presents findings from a study of HIV/AIDS programmes for urban sex workers in Dakar, Senegal. The objective of the research was to assess HIV prevention and treatment efforts to date, and to identify challenges that must be overcome in the long term to reduce the spread of HIV in Senegal. The research team organised four day-long community dialogues, in June 2008, with registered and unregistered sex workers in the Senegalese capital. In addition to these sessions, we conducted interviews with physicians employed by the Senegalese Ministry of Health, leaders of sex-worker organisations, and directors and staff at non-governmental organisations whose programmes target sex workers and other vulnerable groups. Our findings indicate that Senegals public health strategies have been largely effective at containing the countrys HIV epidemic, but not at addressing the social drivers of HIV transmission or protecting the rights of sexual minorities, such as sex workers and men who have sex with men. For Senegals HIV/AIDS response to continue on a successful path, it must expand to include structural interventions and incorporate a human-rights approach.

Regulating sex work: subjectivity and stigma in Senegal

Abstract Senegal provides a unique example of a sub-Saharan African country with a legal framework for the regulation of commercial sex work. While registering as a legal sex worker affords women access to valuable social and medical resources, sex work is condemned by Senegalese society. Women who engage in sex work occupy a socially marginal status and confront a variety of stigmatising discourses and practices that legitimate their marginality. This paper examines two institutions that provide social and medical services to registered sex workers in Dakar: a medical clinic and a non-governmental organisation. It highlights the discourses about sex work that women encounter within these institutions and in their everyday lives. Women’s accounts reveal a variety of strategies for managing stigma, from discretion and deception to asserting self-worth. As registered sex workers negotiate their precarious social position, their strategies both reproduce and challenge stigmatising representations of sex work. Their experiences demonstrate the contradictory outcomes of the Senegalese approach to regulating sex work.

From population control to AIDS: conceptualising and critiquing the global crisis model.

This essay takes as its point of departure comparative analyses of the population control movement and the global AIDS response. We argue that the responses to both rapid population growth and AIDS reflect a particular model for approaching development issues: the global crisis model. This model provides a framework in which development issues become classified as (1) global in scope, (2) highly urgent and unique, (3) a threat to international stability and (4) addressable through a concerted global response. By reviewing the population control movement and the past, present and possible future of the AIDS response, we examine the evolution of the global crisis model and its consequences in shaping development priorities, problems and solutions. We argue that the model mobilises significant financial resources, but it skews the allocation of development assistance, creates narrow, technical interventions, and fails to examine or remedy the social inequalities that produce health and development disparities.

The anti-politics of health reform: household power relations and child health in rural Senegal

This article employs ethnographic evidence from rural Senegal to explore two dimensions of health sector reform. First, it makes the case that health reforms intersect with and exacerbate existing social, political, and economic inequalities. Current equity analysis draws attention to the ways that liberal and utilitarian frameworks for health reform fail to achieve distributive justice. The authors data suggest that horizontal power relations within households and small communities are equally important for understanding health disparities and the effects of health reform. Second, the article explores how liberal discourses of health reform, particularly calls for ‘state–citizen partnerships’ and ‘responsiblization’, promote depoliticised understandings of health. Discourses associated with health reform paradoxically highlight individual responsibility for health while masking the ways that individual health practice is constrained by structural inequalities.