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Theoretical Perspectives

  • Samantha PageEmail author
Open Access
Chapter

Abstract

In this chapter I present theoretical perspectives that have informed the research. Due to the interdisciplinary nature of this research, I show how a number of theories influenced by argument. First, using the approaches used within the anthropology of development I provide a critique of HIV policymaking. Second, and in order to understand how policy was constructed based on misconceptions, I draw on elite and policymaking theories to demonstrate how the policy process is being mediated by the agendas of elites as opposed to biomedical facts. Third, I use postcolonial theory to highlight how the elites are interpreting for themselves the colonial narrative that is founded on a binary opposition; civilised (the elites) and the uncivilised (the rural uneducated population). This then enables the elites to distance themselves from those living in rural areas, allowing them to maintain a position of power and access to the resources flowing in from the aid community.

This chapter provides an overview of the literature relevant to my three sets of arguments. My theoretical framework has been influenced by scholars within anthropology of development as I provide a critique of a specific policy field in development. It exposes current misconceptions among development practitioners and policymakers in Malawi concerning AIDS: that sexual cultural practices are fuelling the HIV pandemic. I argue that this is an example of a development policy and programme that has failed. Thus, literature within the field of anthropology of development, especially the work of Mosse (2011) and Crewe and Harrison (1998) is relevant because their research demonstrates how many different actors are involved in influencing policies and programmes. They critically analyse the complex relationships of power between global multilateral organisations, donors, governments of resource-poor countries, and local communities, and their impact on development projects. I also criticise the impact multilateral agencies have on development. I criticise the neoliberal economic ideology that has been used by agencies such as the World Bank and the International Monetary Fund (IMF) to offer financial assistance to low income countries. I critique this model of development and agree with Sadasivam (1997) and Macleans, Geo-Jaja and Mangum (2001) who argue that neoliberalism required low income countries to reduce spending on social issues including health, education and development, while debt repayment and other economic policies were prioritised. I also agree with Stiglitz (2000) who argues that institutions such as the IMF undermine democratic processes by imposing policies on national governments.

Mosse and Crewe also demonstrate how to critically engage with development practice by combining academic development work with academic writing and reflection, which is the praxis through which my research was produced. I have done this by working as a development practitioner while conducting my doctorate research. I worked as a consultant for UNAIDS in Malawi while doing my field work. Their approaches have been instrumental in helping me develop my own theoretical framework, as my research looks at how different people working within the field of AIDS are able to construct policies based on their own agendas while at the same time I questioned my own position as a researcher.

One area that is also particularly significant is that public policy making, particularly in terms of HIV prevention, is being set by the agendas of a group of elites (see section on elites in Chapter  6). Elite theory has its roots in the work of Pareto (1935) and Mosca (1896, 1939). They argued that society is governed and controlled by the interests of a group of powerful elites as opposed to the electorate. Such theorists reject an idealised notion of democracy as a reflection of the will of the people, instead arguing that a group of powerful elites own the decision-making power in government, corporations, and institutions that shape policy, and in doing so they act in accordance to their own self-interest. Pareto argued that there is a group of elites who control wealth and power until they are removed by a new aristocratic class (1935).

C. Wright Mills used elite theory to understand the nature of power in 1950s America. Mills (1956) argues that the structure of American society was such that a small hierarchy of groups monopolised power (Mills 1956) and that power is concentrated in several fields of life, including family, religion, education, professional life, military and politics (Mills 1956, p. 3). Mills uses the idea of the power elites in an attempt to overcome the over determinism of Marxism. For Mills, there is a range of elites who may have competing and conflicting interests, as opposed to power being centralised by a single group. This was the case with Marxist ideology where power was controlled by a single group ‘the Bourgeoisie’ and based on the ownership of the means of production (Marx and Engels 1962 first published 1848). Whereas Mills argues power is not held simply by one group, he also rejects pluralistic theory stating that the majority of these elites are interlocking and self-perpetuating (Mills 1956). Many individuals in such elite circles are democratically elected. Mills adds that they are not always conscious they are part of the elite. Lasswell and Kaplan (1950) in Power and Society remark that elites can hold more than one powerful position.

Persons who occupy a top position with respect to one value are likely to hold correspondingly favourable positions with respect to other values; in fact, this possibility is the agglutination hypothesis. (Laswell and Kaplan 1950, p. 97).

This theory has since been used in sociopolitical theory to describe any small group of people that controls a disproportionate amount of wealth, privileges, and access to decision-making (Bottomore 1993). Higley and Burton (2006) identify two elite types; united and disunited political elites and their associated political regimes. They define political elites as:

persons who are able, by virtue of their authoritative positions in powerful organizations and movements of whatever kind, to affect national political outcomes regularly and substantially. (Higley and Burton 1989, p. 9).

Despite differences between elite theorists all conclude that power in society is monopolised by a small group of individuals or groups who shape or influence decisions that affect policy. The next section looks at how elites influence policy.

Elite Theory and Policymaking

Elite theory applied to policy making argues that policymaking is not simply based on using empirical research to construct the most effective means of dealing with a given social issue. Instead in reality any such policymaking process is mediated by a range of powerful elites, vying for their own interests, many of which may hold agendas that are quite contradictory to the objective aims of such policies. Anderson (1984) argues that the ruling elites create the narratives on which polices are constructed. Scholars such as Herrera (1996) concur with Anderson and argue that elites play a key role in defining problems and setting agendas for public policy making. In many contexts policies are shaped by elites who warp democratic processes. Lasswell (1936) argues political elites are able to do this through occupying key leadership positions, giving them proximity to power and resources, which they use to determine who gets what, when and how. He argues that as a result there is a clash between interests of the elite and those of the general public.

Easton (1965) in his major theoretical work A Framework for Political Analysis argued that most policy decisions concerning the allocation of scarce resources are made by the political elite in line with their interests. De Waal (1997) argues that the power of the elites working on humanitarian issues has been an obstacle to development. He refers to the ‘internal political decay’ in Africa, which along with increasing authoritarianism, has impeded the construction of anti-famine political contracts (1997, p. 3). He argues that NGOs tend to conflate their interests with those of ‘the poor’ and present their interests as identical. He reveals there are many organisational imperatives that drive NGO decisions and these are unrelated to the needs of the people whose lives they are trying to improve. In other words, their interests are not the same.

Mosse’s (2011, p. 10) and Chin’s (2007) work is also relevant. Mosse (2011) highlights the importance of actor relationships in the shaping and salience of policy ideas and the importance of policy ideas in maintaining professionals’ jobs. In the context in which I worked policy ideas are both the policies and legislation drafted to eradicate sexual cultural practices in Malawi. However Mosse does not reduce policymaking processes to this alone. Chin (2007) concludes that AIDS policies and programmes are being implemented for social and moral reasons to keep the disease on the political agenda and, by implication, ensure funding and jobs for those working on HIV (Chin 2007 as cited by Whiteside and Smith 2009). Here it is important to note that the elites in Malawi have not manufactured a crisis, but instead they are shaping how this crisis is being interpreted to pursue their own agendas. In the context of Malawi, although policies on AIDS are not produced in national vacuums, they are informed by international frameworks and agendas: elites within Malawi have the power to warp such agendas for their own interests.

Elites in Sub-Saharan Africa

There is a wealth of literature on SSA that recognises that groups of elites play an important role in controlling power within national contexts (Svanikier 2007 and see Ornett and Hewitt 2006 for a comprehensive literature review on elites and institutions in SSA). SSA is diverse and it is perhaps unjust to make generalisations about the elites. However, Hossain and Moore provide a definition of the elites in a low income country context as:

the people who make or shape the main political and economic decisions: ministers and legislators; owners and controllers of TV and radio stations and major business enterprises and activities; large property owners; upper-level public servants; senior members of the armed forces, police and intelligence services; editors of major newspapers; publicly prominent intellectuals, lawyers and doctors; and—more variably—influential socialites and heads of large trades unions, religious establishments and movements, universities and development NGOs … In most developing countries, governing elites tend to be especially powerful. They often command a particularly large slice of the national income, and the influence that goes with it. (Hossain and Moore 2002, p. 1)

The many different national contexts in SSA imply that elites are not a homogenous group and indeed many scholars differentiate between the elites. Ornett and Hewitt (2006) remark that the elites are divided by ethnicity, functionality, politics and economics. They do not, however, divide the elites in terms of gender. They contend that since decolonisation, the elites in Africa have developed within or in close proximity to the state, as both politics and economics have been almost entirely linked to the state in countries in SSA.

In SSA it is important to highlight that the middle class is often absent as Sklar (1999) refers to the lack of an ‘autonomous bourgeoisie’ in most post-colonial African countries. However, In Architects of Poverty, Mbeki (2009) discusses the flawed capitalism in Africa and particularly censures the political elite, who he argues have no capital of their own and who manage to keep their fellow citizens poor while enriching themselves.

However Chandra (2006) argues that there is a middle class in Africa. She identifies elites as those who have the capital to launch a political career, who are upwardly mobile middle-class individuals, better educated and better off than the voters whom they seek to mobilise. She uses the term ‘elite’ interchangeably with the terms ‘politician’, ‘candidate’, ‘incumbent’ and ‘entrepreneur’ (Chandra 2006). Scholars such as Bassey (1999), Kitching (1982), Wa Thiong’o (1992), and Lloyd (1967) describe the elite in SSA as the postcolonial elite. They identify two types of postcolonial elites: elites with a Western style of education that enabled them to access employment opportunities with adequate wages to meet their living expenses; and elites associated with chiefs and administrative positions during the colonial period who had already acquired some wealth. They argue that in general both types of elites often shared some common Western behaviour patterns and had often converted to Christianity. The identification of Christianity as a factor in the identity of elites in SAA is particularly relevant in the findings of my study. Christianity not only plays a symbolic role in identifying commonality between high status individuals in Malawi but also was a driving force behind the policy construction of sexual cultural practices.

Galtung (1971) in his structural imperialism theory also focuses on the elite in terms of postcolonialism. He described the African elites as having more in common with Western elites than with ‘their own people’ thus sustaining neocolonialism in their quest for survival. In other words, the African elites are legitimising their existence within western contexts by converting to Christianity and by distancing themselves from the rest of their nation. Although some of these groups are not inherently political, divides between spheres of power, for example the business, the political, the religious in the Global South are far more porous.

Diop (2012) also refers to the self-interest of the new African modernising classes during the post-colonial period:

The immediate post-colonial period was one of optimism in which the new African modernising classes had the opportunity to pick and choose the optimal modalities for development. But they failed to deliver, mesmerised as they were by the material dazzle of the products of modern market capitalism. But modern market capitalism needs and wants those products which in their raw forms serve as the basis for the production of those goods coveted by the post-colonial African bourgeoisie. The result of this class egotism is the open face of an Africa plagued by cultural collapse in key areas such as its vaunted communitarianism, only to be replaced by the false consciousness of corrosive self-interest, consumer greed, eruptive xenophobia – as in the cases of South Africa and Ivory Coast – and political corruption. (Diop 2012, p. 234).

Further he talks about elites in relation to their traditional cultures:

The reader must have noticed that the word ‘elites’ is in the plural. In so doing I want to express the idea that all elites are concerned here: intellectual, political, cultural, and those of the business world. The reason is that each particular elite group is necessarily imbued with the cultural tokens of tradition. But what creates the cultural antinomies is the fact that – for the most part – they willingly allow themselves to succumb to the temptations and blandishments of neoliberal capitalism. And in spite of the communitarian principles of their traditional cultures, the dictates of neoliberalism force them to satisfy their own individual wants and needs and not extend such privileges beyond their neo-class boundaries. (Diop 2012, p. 223)

Chabal and Daloz (1999) concur that that power is often exercised in SSA between Big men, or patrons, and their constituent communities (1999, p. 37). As a result, they hold the view that most state institutions in a number of countries have been subordinated to the interests of these elites. Several scholars also use the ‘big man’ model, a term made popular by Sahlins (1963), which in a SSA context describes the leader of a country who uses his networks to maintain power. The big man concept can be seen in Malawi and elsewhere in SSA as Cammack et al. (2006) points out there is a continuity in leadership style among Malawi’s ‘big men’ and that the former President Mutharika was one of the big men (the President at the time the fieldwork for this study was conducted). Malawi has been considered a neopatrimonial state since its independence in 1964 and the ‘big man syndrome’ has been a perpetual feature of its politics. Cammack et al. (2007) conducted a study on the former President Mutharika and explains:

In ‘hybrid’ states where neopatrimonial politics are the norm there is by definition a weak legal regime. In such states the constitution, rules, laws, and behavioural norms may be well-articulated, even written down, but they are weakly applied. The institutions normally responsible for their application are themselves weak – judiciaries, watch-dog institutions, parliaments, police, media, civic organisations, etc. They are sometimes ‘captured’ by the leader through his control of the appointment (and dismissal) process, or through patronage and clientelist practices. States such as these are invariably poor and unproductive – because the weak regulatory environment makes them risky environments for investment and corrupt. Also, because they are unproductive, individuals are unlikely to have outside sources of income, or alternative economic prospects, and are therefore reliant on the leader (or one of his subordinates) for employment and income. When he uses the same techniques to get his way, there are few who can rein him in and no institutions to call upon to limit his excesses. (Cammack et al. 2007, p. 1)

Cammack et al. (2007) also makes an important point and remarks that the dynamics of neo-patrimonial politics tend to legitimise and strengthen elite groups that are not necessarily interested in focusing on development and subsequently accelerate the disparities even in states with sufficient capacity to fight poverty. Lange et al. (2000) focus on government elites in Tanzania setting up ‘independent’ civil society organisations (CSOs). They argue that these CSOs were staffed by civil servants to access funding from donors who, during the 1980s, turned to CSOs to take on the service delivery role that the state often failed to carry out as well as becoming more engaged in the policy process.

Although there is a vast literature on the elites in sub-Saharan Africa there are gaps in the body of knowledge concerning AIDS and the elites. One of the few scholars that addresses the subject is Van de Walle (2003). He argues that:

The development of the pandemic defects the stability of the governing elite. All countries are run by a relatively small group of people who dominate government, party, army, business and civil society… One of the challenges facing many African countries is how to ensure a smooth transition from a relatively closed elite… to a more institutionalized and pluralistic system with wider access. The HIV/AIDS pandemic has several consequences. It erodes the institutionalization of the government and accelerates the need to replenish this elite. As noted, this affects patrimonial structures as well as rational-legal ones. Men and women who have decades of political experience, strong networks and respected judgment, are being lost, and younger cadres are being promoted to fill the posts, but cannot fill the structural gap… the most probable scenario is that those in power rely more heavily on a smaller circle of loyal comrades, and use more ruthless or corrupt methods to co-opt or buy support. (Van de Walle 2003, p. 300)

I also argue that there are a small group of elites in Malawi who dominate government and civil society in the context of policy making on AIDS.

Orrnert and Hewitt (2006) state that in small countries in Sub-Saharan Africa like in Malawi or Benin the number of elites can be very small (between 800 and 1000). And in larger countries like South Africa and Nigeria they will have more but in all cases the number of elites comprises a small portion of the population. Swidler and Watkins (2009) conducted research on the elites in Malawi and identified three types; local elites, interstitial elites and national elites. Matiki (2001) remarks that the English language is used in Malawi to provide a code, which symbolises modernisation and elitism. Miller (1974) also makes the link between education and elitism and describes education as being the pathway to elite status (1974, p. 527). Further, he makes the link between education and modernity.

Education itself tends to set an individual apart, especially in a predominately illiterate society. To acquire an education is also to be re-socialised into a modern western orientation in which achievement, universal, rational, criteria tend to displace ascriptive, particular and traditional norms. (Miller 1974, p. 527)

Policymaking Process

In terms of the policymaking process I present theories on public policymaking in Chapter  6. Policymaking is not a rational process with a beginning, a middle and an end. It should be understood as a ‘chaos of purposes and accidents’ (Sutton 1999, p. 5; see also Clay and Shaffer 1994; see Chapter  6). Sutton (1999) points out that concepts and tools from different disciplines can be deployed to put some order into the chaos, including policy narratives, policy communities, discourse analysis, regime theory, change management, and the role of street-level bureaucrats in implementation.

Situating the Elite Theory and Policymaking in Malawi

This book focuses on the elites that implement AIDS policies. I argue AIDS policies are being produced to further the interests and agenda of national elites (Anderson 1984). However I recognise that they too are concerned about getting AIDS. Thus, that the fisi practice contributes significantly to the spread of HIV in Malawi is a narrative produced in line with the interests of elite groups. (The elites to which I am referring are presented in Chapter  4.) I argue that the policy making process is messy and complex and that the process of AIDS policy production in Malawi has in fact been manipulated and warped to fit in with the agendas of a small group of elites.

Studies conducted in SSA have shown a high correlation between higher education and political elite status. What the elites in my study have in common is that they all are English speaking and literate with at least secondary education and all work in some form or other on HIV and AIDS prevention. As observed by Matiki (2001) the English language is used in Malawi to provide a code, which symbolises modernisation and elitism. Elites then are likely to have a common educational background. This is an important point as in order to qualify for jobs related to HIV and development one must have to speak English and be literate. This suggests that once people use English at work and are literate they are perceived as elites as those who speak English and are literate are a minority in Malawi. However, my research demonstrates that elites in Malawi are stratified with those who have external PhDs at the top to those with degrees below them.

The elites in this study are educated thus enabling them to access employment opportunities they would not have had if they had not been educated. Further, they have adopted Christianity as their religious faith. My study demonstrates that the ideology of Christian elites within Malawi is in fact a key catalyst driving the harmful cultural practice agenda of AIDS policies.

Many scholars do separate elites into distinct groups. However, it is difficult to split the Malawian elites into groups as boundaries are fluid and often different individuals fit into multiple elite groups. For example, there is a degree of fragmentation within and between the various elites. Individuals may occupy positions within more than one elite group: a journalist may also be a religious leader or an MP may also own a private company (Lasswell and Kaplan 1950). Or a programme officer working for an AIDS NGO may also be pushing a religious agenda. Furthermore, although elites who work as AIDS officers in districts cannot be perceived as elites in the same way as urban policy makers, they are all elites.

Whereas the majority of the narratives are produced by the national elites, they are often being communicated to the general population by local elites. For example, the Church preaches through services of worship and the media that AIDS can only be controlled through abstinence and faithfulness in marriage.

The narrative of blame for AIDS is maintained that focuses on harmful cultural practices so that the elite can ensure the stability of the policy and programmes directed to reduced transmission and therefore maintain their professional status. These elites push cultural reasons over others because it makes them seem modern and also distances themselves from the crisis at a national level. As a result, they make their positions safer as they are seen as the group with which multinational agencies should engage with at a national level to solve these problems. Elites produce these narratives so they are seen as part of the solution and not part of the problem.

My argument confirms the work of Chin (2007) who stated that UNAIDS and AIDS activists accept certain myths about HIV epidemiology to keep the disease on the political agenda and, by implication, ensure funding and jobs. As Chin said ‘AIDS programmes developed by international agencies and faith-based organisations have been and continue to be more socially, politically, and moralistically correct than epidemiologically accurate’ (2007, p. vi). He further argues that the myth that HIV is spread easily is done either unintentionally out of genuine ignorance or misunderstanding or intentionally by deliberate exaggeration (2007, p. vi).

Epidemiology

The science of epidemiology, which includes biology, clinical medicine, social sciences and ecology, seeks to describe, understand and utilise disease patterns to improve health. Epidemiology is concerned with the spread of disease in a population. Therefore, knowing about the epidemiology of HIV is a crucial element of my theory. I draw on two decades of literature on the epidemiology of the HIV virus to determine whether the sexual practice of fisi contributes significantly to the spread of the disease.

Epidemiology of HIV

Key to understanding the spread of HIV (and other communicable diseases) is estimating the probability of transmission from an infected person to an uninfected one. Here, my focus is on the studies that have estimated the probability of transmission per unprotected coital act with an HIV+ partner for more than two decades, using empirical studies of serodiscordant couples (one partner is infected, the other is not) and modelling. Although such estimates cannot give the exact risk of HIV transmission for an individual, they do provide empirically based data on the average risk of transmission. Such estimates, according to Gray and Wawer (2012), mainly derive from empirical studies and modelling based on HIV discordant couples meaning where one partner is HIV infected and the other is not. Pilcher et al. (2004) also notes that probabilities of transmission are only derived from HIV-1 discordant couples and argues that estimates generally reflect transmission by individuals with long-term infection. Thus the data available on this topic are based on HIV discordant couples.

Transmission is much lower than is generally perceived by those living through the AIDS epidemic. In a survey conducted in Malawi, when respondents were asked what the likelihood of infection from a single act of unprotected intercourse with an infected is, over 90% said that it was ‘certain’ or ‘highly likely’ (Anglewicz 2009). The scientific literature, however, shows that it is much lower. Powers et al. (2008) conducted a review and systematic analysis of studies that produced estimates of heterosexual transmission. The analysis found that that HIV-1 transmission was commonly found to be 0.001, or 1 transmission per thousand contacts (p. 553). Findings from a study by Gray et al. (2001), also show that the overall probability of HIV transmission was 0.0011 per coital act (p. 1149). In this study, data were collected between 1994 and 1998 in a community-randomised trial of STI control of AIDS prevention in Rakai, a rural district in Uganda. 15,127 individuals aged 15–59 years were originally involved in the study and were followed up in their homes every 10 months. A subsequent study by the same researchers (Wawer et al. 2005) confirmed these results. In this study, they estimated rates of HIV-1 transmission per coital act in HIV discordant couples by stage of HIV-1 infection in the index partner and found that the overall rate of HIV transmission among discordant couples, 0.0012/coital act. Wilson et al. (2008) used the results of the Rakai 2001 study to derive a mathematical relation between viral load and the risk of HIV transmission per unprotected intercourse with an infected partner, based on a model that assumed that each sero-discordant couple had 100 sexual encounters per year. The cumulative probability of transmission to the sero-discordant partner each year was 0.0022.

Chin, a leading epidemiologist of HIV who was involved in the international response to AIDS for 20 years remarked that ‘all published sex partner studies have shown that the risk of HIV transmission via sexual intercourse is a minuscule fraction of the risk associated with most other sexually transmitted diseases’ (Chin 2007, p. vi).

Cofactors such as the presence of another sexually transmitted infection can decrease or increase the probability of infection, but most estimates of transmission of HIV do not take these into account (Pilcher et al. 2004). Gray et al. (2001) highlight factors that increase the probability of infection, such as the HIV-1 viral load of the HIV-1 infected partner, younger age and genital ulceration. Their study found that transmission probabilities per coital act were highest among younger people and increased with HIV-1 viral load. Wawer et al (2005) also found higher rates of transmission during early- and late-stage infection, higher HIV load, genital ulcer disease, and younger age of the index partner. Gray et al. (2001) also found that higher infectivity in younger women could be a result of biological factors such as cervical ectopy, which might facilitate HIV-1 transmission. Assuming that some participants in the studies of HIV transmissibility had cofactors that would raise infectivity, presumably without any cofactors HIV transmission probabilities would be even lower than the average transmission probabilities cited above.

Despite factors that may increase or decrease susceptibility to HIV, transmission probabilities are low. There is no empirical research on the sexual behaviour of the male fisi and no evidence that this sexual practice has a higher transmission rate than other sexual practices that are common within Malawi. While a fisi may be more likely to be HIV positive than the average male, it is the case that intercourse with a fisi is usually a single act of intercourse and is far from an everyday occurrence: since intercourse within marriage is much more frequent and the use of condoms in marriage is infrequent (Chimbiri 2007), regular marital relations are thus more likely to lead to infection than one-time intercourse with a fisi. For HIV prevention purposes, it would be far more useful to focus on more frequent practices, such as transmission within marriages or stable couples.

During a one-off sexual act the probability of HIV-1 transmission is around 1 in 1000. Although there are factors that can increase transmission (such as genital ulcers), or decrease risk of transmission (condoms). The emphasis on eliminating the practice is due in part to the fact that accurate knowledge about the low probability of HIV has not been disseminated and, I believe, in part to the ways that policy makers and practitioners view Africans, and, since these practices are considered to be rural, the way they view rural and relatively uneducated Malawians.

My fieldwork was conducted in 2008–2009, but there is no reason to believe that there was a subsequent change in the epidemiology of HIV. If anything, the increase in reported use of condoms and the effects of antiretroviral therapy, which was just beginning to be introduced in my study period, on reducing the viral load (and thus infectiousness) of those who are HIV+, are both likely to have reduced the transmission probabilities even further.

Conclusion

In this chapter, due to the interdisciplinary nature of this research, I show how a number of theories influenced by argument. First, using the approaches used within the anthropology of development I provide a critique of HIV policy making. Second, and in order to understand how policy was constructed based on misconceptions, I draw on elite and policymaking theories to demonstrate how the policy process is being mediated by the agendas of elites as opposed to biomedical facts. Third, I use postcolonial theory to highlight how the elites are interpreting for themselves the colonial narrative that is founded on a binary opposition; civilised (the elites) and the uncivilised (the rural uneducated population) (Galtung 1971). This then enables the elites to distance themselves from those living in rural areas, allowing them to maintain a position of power and access to the resources flowing in from the aid community.

In this chapter I also review literature on HIV epidemiology. Epidemiological studies have estimated the risk of HIV-1 transmission. Although Malawians believe that HIV transmission is inevitable in a single act of unprotected intercourse (Anglewicz and Kohler 2009), epidemiologists found that the average rate of HIV transmission is 1 in 1000. These findings demonstrate that HIV is not easily transmitted. This is relevant to my study because the fisi practice occurs as a one-off heterosexual act and therefore it is statistically unlikely that this practice contributes significantly to the spread of HIV.

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Authors and Affiliations

  1. 1.Department of Global Development and PlanningUniversity of AdgerKristiansandNorway

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