WINNER, 2017 RACHEL CARSON PRIZE, SOCIETY FOR THE SOCIAL STUDIES OF SCIENCE

In 2002, Sierra Leone emerged from a decadelong civil war. Seeking international attention and development aid, its government faced a dilemma. Though devastated by conflict, Sierra Leone had a low prevalence of HIV. However, like most African countries, it stood to benefit from a large influx of foreign funds specifically targeted at HIV/AIDS prevention and care.

What Adia Benton chronicles in this ethnographically rich and often moving book is how one war-ravaged nation reoriented itself as a country suffering from HIV at the expense of other, more pressing health concerns. During her fieldwork in the capital, Freetown, a city of one million people, at least thirty NGOs administered internationally funded programs that included HIV/AIDS prevention and care. Benton probes why HIV exceptionalism—the idea that HIV is an exceptional disease requiring an exceptional response—continues to guide approaches to the epidemic worldwide and especially in Africa, even in low-prevalence settings.

In the fourth decade since the emergence of HIV/AIDS, many today are questioning whether the effort and money spent on this health crisis has in fact helped or exacerbated the problem. HIV Exceptionalism does this and more, asking, what are the unanticipated consequences that HIV/AIDS development programs engender?

Speech and Song at the Margins of Global Health tells the story of a unique Zulu gospel choir comprised of people living with HIV in South Africa, and how they maintained healthy, productive lives amid globalized inequality, international aid, and the stigma that often comes with having HIV. By singing, joking, and narrating about HIV in Zulu, the performers in the choir were able to engage with international audiences, connect with global health professionals, and also maintain traditional familial respect through the prism of performance. The focus on gospel singing in the narrative provides a holistic viewpoint on life with HIV in the later years of the pandemic, and the author’s musical engagement led to fieldwork in participants’ homes and communities, including the larger stigmatized community of infected individuals. This viewpoint suggests overlooked ways that aid recipients contribute to global health in support, counseling, and activism, as the performers set up instruments, waited around in hotel lobbies, and struck up conversations with passersby and audience members. The story of the choir reveals the complexity and inequities of global health interventions, but also the positive impact of those interventions in the crafting of community.

One of the most relevant social problems in contemporary American life is the continuing HIV epidemic in the Black population. With vivid ethnographic detail, this book brings together scholarship on the structural dimensions of the AIDS epidemic and the social construction of sexuality to assert that shifting forms of sexual stories—structural intimacies—are emerging, produced by the meeting of intimate lives and social structural patterns. These stories render such inequalities as racism, poverty, gender power disparities, sexual stigma, and discrimination as central not just to the dramatic, disproportionate spread of HIV in Black communities in the United States, but to the formation of Black sexualities.

Sonja Mackenzie elegantly argues that structural vulnerability is felt—quite literally—in the blood, in the possibilities and constraints on sexual lives, and in the rhetorics of their telling. The circulation of structural intimacies in daily life and in the political domain reflects possibilities for seeking what Mackenzie calls intimate justice at the nexus of cultural, economic, political, and moral spheres. Structural Intimacies presents a compelling case: in an era of deepening medicalization of HIV/AIDS, public health must move beyond individual-level interventions to community-level health equity frames and policy changes