MISTREATED

Image of a circle of people sitting outside on a variety of plastic chairs and benches. Some are sitting on the ground. Many are wrapped in blankets. In the background are a number of shacks made out of corrugated metal and wood. The sky is a deep and cloudless blue above them.
 Photo by author.

As global health institutions and aid donors expanded HIV treatment throughout Africa, they rapidly “scaled up” programs, projects, and organizations meant to address HIV and AIDS. Yet these efforts did not simply have biological effects: in addition to extending lives and preventing further infections, treatment scale-up initiated remarkable political and social shifts.

In Lesotho, which has the world’s second highest HIV prevalence, HIV treatment has had unintentional but pervasive political costs, distancing citizens from the government, fostering distrust of health programs, and disrupting the social contract. Based on ethnographic observation between 2008 and 2014, this book chillingly anticipates the political violence and instability that swept through Lesotho in 2014.

This book is a recipient of the Norman L. and Roselea J. Goldberg Prize from Vanderbilt University Press for the best book in the area of medicine.

Cover of the book 'Mistreated: The Political Consequences of the fight against ADIS in Lesotho.' Cover depicts a circle of people sitting outside on a variety of plastic chairs and benches. Some are sitting on the ground. Many are wrapped in blankets. In the background are a number of shacks made out of corrugated metal and wood. The sky is a deep and cloudless blue above them. The text of the book title and author's name are in lighter blue and white against the sky.

Mistreated

The Political Consequences of the Fight Against AIDS in Lesotho

Published by Vanderbilt University Press, 2017

256 pages, 6in x 9in, 9 photos, 4 figures

 Praise and endorsements

"Mistreated is a timely, people-centered critique of the global health enterprise. Grounded in close-up, careful, ethnographic engagement and offering rich and nuanced theoretical insight, the book takes up HIV in Lesotho as a site not only of health, illness, and interventionism, but of the transformation of politics and subjectivity. Vividly narrated, this is a powerful and much-needed call for the democratization of global health policies."

—João Biehl, author of Will to Live: AIDS Therapies and the Politics of Survival and co-author of When People Come First: Critical Studies in Global Health

"Nora Kenworthy's new book is the finest example of a new wave of ethnographic studies documenting the impact of the HIV epidemic, and of the responses that it has generated at every level, from the global to the local. Kenworthy's analysis provides key insights into the political dimensions of the epidemic—not only into the more abstract dimensions of biopower and governmentality, but of the ways in which the politics of AIDS plays out in the everyday experience of people confronting the epidemic on the ground. This is critical social research at its very best."

—Richard G. Parker, Mailman School of Public Health, Columbia University, editor-in-chief of Global Public Health

"This book should be required reading in any course on global health. It leads us to consider the legacy and unintended consequences of HIV scale-up, scale-down on recipient societies dependent on external aid and to question the HIV experience as a template for future global health projects. Kenworthy provides us with a multi-site ethnography that aptly illustrates ways in which global health is becoming a form of governance undermining struggles for democracy in African states by introducing yet another form of colonialism."

—Mark Nichter, author of Global Health: Why Cultural Perceptions, Social Representations, and Biopolitics Matter

"The little country of Lesotho is easy to overlook. It is completely within South Africa's borders, has no natural resources or strategic value...The economic, social, and political pressure have combined with the HIV virus to give Lesotho the unenviable distinction of having the worst epidemic in the world. Kenworthy's book on this often ignored country is excellent. She shows a depth of understanding that is exceptional. It should be read by Southern Africanists, epidemiologists, and all who are concerned by the AIDS epidemic. It is not, however, a comforting read."

—Alan Whiteside, OBE, CIGI Chair in Global Health Governance, Balsillie School of International Affairs/Wilfrid Laurier University, and Professor Emeritus, University of KwaZulu-Natal

Reviews

• Marc Epprecht, writing in the International Journal of African Historical Studies: 

“This sophisticated analysis is achieved in a highly accessible manner in part through Kenworthy’s outstanding skill as a storyteller. She relates often with great poignancy the stories of the diverse people she interviewed and observed during her field work, from dying and bewildered patients, to volunteer community health counsellors, to nurses, to donors and government officials, to garment factory workers and their embittered supervisors. 

How not to despair when good intentions can be so catastrophically co-opted? Kenworthy does not claim to have an answer. Suffice to say, however, that she ends her brilliant book with a nod to Frantz Fanon. We all need to acknowledge the political costs of our ostensible good intentions as a starting point to imagining a better future. I will be assigning this book as a required text for my undergraduate students who want to fix the world.”

• Sarah L. M. Davis, writing in Political and Legal Anthropology Review: 

“Kenworthy’s book is the one I personally found myself underlining whole paragraphs of and referring to repeatedly in discussions with colleagues, activists, and policymakers working in global health. I passed it along to the Global Fund’s Fund Portfolio Manager for Lesotho, who read it in one sitting. Mistreated is a must­read for anyone working in HIV finance. This ethnographically rich contribution perfectly illuminates how major influxes of capital can distort local politics, and how donor initiatives — with the best intentions — may do lasting harm in the attempt to do good.”

“the unfortunate reality is that “politics of recipiency” is a term that deserves to have a much wider life and usage in global health.”

• Nancy Kaddis, writing in World Medical and Health Policy:

"Kenworthy weaves a painfully detailed picture of life for many residents of this country. In adding the complexity that the HIV epidemic brings to such a nation, the reader begins to understand the political, social, and economic consequences that global health initiatives present to Lesotho’s citizens. In many ways, these initiatives inadvertently and indirectly erode the efforts toward the democratization and transition to self-rule. Kenworthy demonstrates an intricate understanding of these complexities. This book should be required reading for political scientists, public health officials, and global health workers who are at all interested in modern-day Lesotho or other developing countries struggling with HIV treatment and prevention."

• Eva Vernooij, writing in Medical Anthropology Quarterly: 

“Kenworthy’s aim is to change the narrative of how stories of global health are told and how its recipients and their desires are represented. The author’s compelling yet concise writing style make it a powerful ethnography, suitable not only for teaching at undergraduate and graduate levels in medical anthropology, global health, and international development studies, but also for non- academics engaged in global health.”


Teaching guide for Mistreated

A teaching guide for Mistreated - with additional resources, readings, films, and suggested assignments - is freely available here: 

Mistreated Teaching Guide