Paper short abstract:

Drawing from an ethnography of sex work and HIV/AIDS policies in Mali, this presentation highlights how structural dimensions of global health policies – projectification, scale-up and metrics – embed, and how these entanglements result in coercion, overtesting, and the absence of linkage to care.

Paper long abstract:

A defining feature of global health – understood as the set of institutions and policies aiming at intervening “into the lives of other peoples” (Packard 2016) as it emerged since the 1990s – is projectification (Hubmann 2021). The hegemonic form of global health policies is indeed the project, i.e. policies designed and implemented according to temporally bounded and linear frames. Although this trend goes much beyond global health, the way projectification affects the outcome of health policies is particularly striking in countries with weak infrastructures and public services, where it entails that whole sectors are subject to pause or sudden interruption (McKay 2018). Another dimension of global health that received particular scholarly attention in the last decade is the rise of metrics (Adams 2016). Drawing from an ethnography of sex work and HIV/AIDS policies targeting sex workers in Bamako in the early 2010s, this presentation highlights how these trends unfold in a period marked by the scaling-up of the fight against HIV/AIDS. I will describe how the rapid and exponential rise of funds dedicated to key populations intertwines with projectification and metrics, and scrutinize how these entanglements play out and shape everyday activities of HIV/AIDS programs that aim to test sex workers for HIV. This analysis unveils how larger trends and a specific temporal regime embed in a specific context, and how this leads to unintended consequences such as coercion in care, overtesting, and the absence of linkage to care for HIV positive sex workers, thus exacerbating preexisting vulnerabilities and increasing inequalities.