The Diseased Body and the Global Subject: The Circulation and Consumption of an Iconic AIDS Photograph in East Africa

Abstract

This article focuses on a photographic image that has become iconic of the journey of AIDS patients in Kenya: the representation of a young man's emaciated body “before treatment” with antiretroviral therapy (ART), and another of the same man “after treatment” and the restoration of his health and life. Showing one of his patients in Haiti and taken by the medical anthropologist and activist Paul Farmer, the photograph traveled to Kenya where it was made into an AIDS-education poster and used as a key tool in ART programs. With its strong “conversion” narrative, the poster seeks to convert viewers to a biomedical way of seeing, and experiencing, disease and infection. I explore the production, circulation and reception of this image, its social history and its agency, as it entered into local moral economies concerning HIV, visibility and value, and drew globalized connections, discourses and practices into novel forms of self-fashioning. In being stretched across different scales, and in being displayed in public as well as domestic spaces, this photographic object creates new relationships between these spaces and the actors who inhabit them.

Notes

Scientists’ and colonial medical officers’ photographs of, for example, leprosy, yaws and elephantiasis—the tropical medic's “catalogue of horrors” [Vaughan 1991: 31]—sit alongside their amateur ethnographic collections of “exotic” humans. These photographic collections document both the “relentless empiricism” of colonial medical science—everything was “touched, labelled, catalogued” [ibid.: 32]—and the violence of these representations of Africans as objects of study and classification [Butchart 1998].

David Campbell's project on the visual economy of HIV and AIDS [www.david-campbell.org/visual-hivaids] explores the way HIV/AIDS has been pictured through photography from 1981 to 2007, and focuses on photojournalist images produced for key U.S. and U.K. newspapers, as well as the work of photojournalists who have undertaken special projects on HIV/AIDS.

The dramatic effect of ART on AIDS patients is widely describe in the literature as “the Lazarus effect”; stories of this restoration of life are recounted “to amaze, to reassure, and to convince” [Whyte 2014: 3–4].

For example, Tropical Hookworm, part of a silent film made in Tanganyika in 1936, depicts a man showing his symptoms to an African health assistant along with slides displaying written messages (in English) about etiology, infection and prevention, while Smallpox (Nigerian Film Unit) presents the narrative of an African refusing vaccination and falling ill as a simple parable.

Similarly, in her study of Victorian scientific photography, Jennifer Tucker [2005] argues that social networks of power and authority were as important then to the “objectivity” of scientific photographs as was the assumed relation between visuality, objectivity and truth.

But see Heald [2002].

There is a lively interdisciplinary field of research on HIV/AIDS “edutainment,” which focuses on the effectiveness of messages, experimentation with formats and the evaluation of participatory interventions, whether in film, theater, music or visuals [e.g., Barz and Cohen 2011].

During the 1990s western Kenya experienced some of the highest HIV prevalence and AIDS-related mortality rates in East Africa (life expectancy in Kenya dropped from 60 years in 1990 to 45.5 years in 2002; adult prevalence levels were estimated to be 15 percent in 2001 [UNAIDS 2002; USAID Country Profile 2003]). At that time antiretroviral therapy (ART) remained prohibitively expensive. This situation changed in 2004 when an Indian pharmaceutical company, Cipla, radically lowered the price of generics, the gap between North and South access to treatment rose to a global spotlight, and the U.S. government, through the U.S. Presidential Emergency Fund for AIDS Relief (PEPFAR) together with the Global Fund, began financially supporting free ART. Between 2004 and 2008 PEPFAR dispersed $1,346.9 million for HIV/AIDS intervention in Kenya, and access to ART increased, from 11,000 people on ART in Kenya in 2003 to almost 229,000 by September 2008, and 410,300 in 2010.

For a discussion of ART programs in Kenya and the new biopolitics of care, see Prince [2012].

This hyper-agency of the photographic poster is akin to the circulation of images by human rights campaigns and activist causes which seek, often through displaying and circulating shocking images of human rights violations and human suffering, to persuade viewers, whether as individual citizens or governments or international institutions, to act [Keenan 2004].

Paul Farmer (Department of Social Anthropology, University of Oslo), personal communication, March 2013.

This double move—the use of an individual to stand in for a collective experience by reducing a general construct to a specific embodiment—is, as David Campbell argues, common to AIDS photography. “The individual aggregate has to be personal enough to convey the details of a particular life, but equally impersonal so those details do not derail a larger generalization” [2008: 4]. I am grateful to Lukas Engelmann for pointing me to Campbell's work.

The link to these pictures had expired by the time this article was going to press, but the keywords still bring the pictures up on the Internet.

I was not able to find out why a Kenyan was not used; after all, there were many projects providing ART to Kenyans before the arrival of PEPFAR-funded programs.

People in western Kenya, where the poster was circulated, were astounded and disbelieving when told that the person depicted was not Kenyan but Haitian.

See also http://www.david-campbell.org/visual-hivaids/.

I am grateful to Lukas Engelmann for suggesting this phrase.

On “pluralist” and “participatory” photography, see Bleiker and Kay [2011].

I am grateful to Richard Vokes for pointing this out to me.

His photograph should be considered alongside the thousands of photos of AIDS victims on the Internet, which show not self-projection but abjection; such images dominated AIDS coverage in the 1980s but are still circulating today.

Photographs of HIV-positive and of AIDS treatment programs are common in Kenya; see http://www.miacollis.com/#/kenya/hiv-aids-treatment/egpaf9.

Additional information

Notes on contributors

Ruth J. Prince

RUTH J. PRINCE is Associate Professor in medical anthropology at the University of Oslo and researcher at the Norwegian National Centre for Migration and Health. Publications include The Land is Dying: Contingency, Creativity and Conflict in Kenya [Berghahn Books 2010], written with Wenzel Geissler, and Making and Unmaking Public Health in Africa: Ethnographic and Historical Perspectives [Ohio University Press 2013], edited with Rebecca Marsland. She is co-editor of Medical Anthropology Quarterly's special issue, “What is Life Worth? Exploring Biomedical Interventions, Survival and the Politics of Life” [2012]. Her current research is on a Soviet-built hospital in Kenya. E-mail: [email protected]