Amelia Hiepler

ANTH 392

Dr. Luchok

10/16/2023

Susser Reaction Paper

Neoliberalism is generally thought of as “the philosophical view that a society’s political

and economic institutions should be robustly liberal and capitalist, but supplemented by a

constitutionally limited democracy and a modest welfare state” (Vallier, 2021). Neoliberals

endorse a free-market economy to promote economic prosperity. While neoliberalism does

support social welfare, it is wary of excessive government spending. Overall, the spread of

neoliberalism has negative implications regarding healthcare in low and middle income

countries.

One of the goals of Susser’s book, AIDS, Sex, and Culture: Global Politics and Survival

in Southern Africa, was to prove the relationship between neoliberalism and the spread of

HIV/AIDS in southern Africa. I believe that overall, the spread of neoliberalism harbors negative

consequences for HIV/AIDS prevention and treatment. While neoliberal institutionalism is not

inherently bad in the fight against HIV/AIDS, many policies make low and middle income

countries (LMIC) reliant on big capitalist countries such as America. Susser wrote, “based on

cooperation between corporate interests and the state, neoliberal policies emphasize market

competition over collective and public endeavors, making commodities of resources previously

held in common, and reducing public services” (2009). These large corporations value profit

over everything else, including public services that benefit the people. When public services are

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put on hold to prioritize economics, specifically the economics of large capitalist countries, the

overall health and well-being of the community suffers.

One example Susser gives of how neoliberalism affects HIV/AIDS is how the President’s

Emergency Plan for AIDS Relief (PEPFAR) created in 2003, while providing funding, does not

include prevention strategies and educational tools to protect the population. According to Susser

(2009), “this gap in funding for prevention, combined with constraints on comprehensive sex

education and reproductive health, limits the possibilities for women and men to protect

themselves from HIV infection” (p. 46). PEPFAR follows the United States policies which

focuses on treatment rather than prevention and does not teach comprehensive sex education.

More than 55% of the funding for PEPFAR is required to go to the purchase of patented US

drugs rather than the generic, cheaper drugs. This mandate significantly lowers the quantity of

drugs that can be brought worldwide. PEPFAR chooses to value profit for US pharmaceuticals

rather than the well-being of the recipients.

In the article, “To Open Oneself is a Poor Women’s Trouble” by Sydney Spangler, we see

how neoliberalism institutions affect women in childbirth and their financial situation. Tanzania,

where this study took place, adopted WHO’s Focused Antenatal Care (FANC) package which

allows providers to conduct clean deliveries with sterile supplies which results in less worry

about infectious diseases. However, some facilities required women to buy their own drugs.

Coupled with the growing trend for providers to own pharmacies, this confluence of events made

it difficult for poor families to purchase the proper supplies necessary for a successful birth

outcome. Increasing financial barriers to proper supplies further ostracized poor families within

their communities. A growing view amongst Tanzanians is, “individuals must strive for

self-reliance and if they don’t, the results are their own fault” (Spangler, 2011, p. 486). As this

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society begins to turn towards capitalism, poor families cannot pull themselves out of poverty

and their risk of HIV/AIDS increases. According to the American Psychological Association, “a

lack of socioeconomic resources is linked to the practice of riskier health behaviors, which can

lead to the contraction of HIV'' (2022). The neoliberal institutions that are becoming more

prevalent in Tanzania, provide stopgap measures that only temporarily aid Tanzanians. These

institutions do not effectively connect common people to the riches promised by economic

liberalization. Trickle-down economics cannot appropriately remove barriers to economic

self-sufficiency. As these programs adjust to the local level, they have undermined the women

that they intended to help. In turn, Tanzanian people have increased odds of developing diseases

such as HIV/AIDS .

Another story that Susser tells is how the influence of capitalism in the Ju/’hoansi

community led to diminished autonomy amongst women and a cultural change of the Ju. The Ju

people are hunters and gatherers which means that they have an egalitarian society where women

have a voice and opinion just like men. The Ju value community and relationships over material

goods. When neoliberal ideals came to the Ju, such as commercialization and ecotourism, the

social order of the Ju changed. With the introduction of stronger alcohol, as opposed to the home

brew that the Ju were accustomed to, men became more violent with their wives and there are

multiple accounts of husbands murdering their wives under the influence of this new alcohol.

Men were afraid of the power dynamic changing and took these fears out on their wives. Women

in turn lost a lot of the autonomy and voice that they once had. But all in all, the Ju community is

a success story. They show that an increasingly capitalistic society does not have to suffer acute

growing pains. Through a series of efforts by many groups including the Nyae Nyae

Conservancy, NGO’s, and San women in leadership, many of these effects were reversed.

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Shebeens, establishments that sell liquor, were closed down which limited access to alcohol, new

clinics were built, and there’s a plan in place to protect plant life (Susser, 2009, p. 196). This is a

story where the influence of neoliberalism had the ability to destroy a culture, but instead the Ju

were able to use this to their benefit to grow their community and economy. Neoliberalism is not

a fully negative ideal. The Ju are a rare case, but it is important to note that with the proper

precautions and support, neoliberalism can be a positive attribute to a community.

I think that the political economy approach is useful for examining HIV/AIDS in Africa

but I don’t think that it shows the whole picture. Political economy is, “the study of how politics

affects the economy and how the economy in turn shapes politics” (Frieden, 2020). As we have

seen throughout Susser’s book, politics and policies play a large role in LMIC receiving aid to

combat HIV/AIDS. These policies bring together a lot of money to send aid to LMIC, but they

often neglect to consider the culture of these countries. Without considering the social dynamic

of each country that aid is sent to, fighting HIV/AIDs will not be completely beneficial. It is vital

to understand the full picture of the culture to properly create social programs. Social

determinants of health, which is where one is born, works, and lives, can affect one's health and

quality of life. To fully examine HIV/AIDS in Africa you must look at both political economy

and social determinants of health to create helpful and sustainable public health initiatives.

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Works Cited

American Psychological Association. (2022). HIV/AIDS and socioeconomic status. American

Psychological Association.
https://www.apa.org/pi/ses/resources/publications/hiv-aids#:~:text=Living%20in%20pov
erty%20can%20also,individual%20at%20risk%20of%20infection.

Rupa Chanda (2020) The political economy of economic policy - IMF F&D, IMF. Available
at:https://www.imf.org/Publications/fandd/issues/2020/06/political-economy-of-economi
c-policy-jeff-frieden (Accessed: 11 October 2023).

Spangler, S. (2011). To Open Oneself is a Poor Women’s Trouble: Embodied Inequality and
Childbirth in South-Central Tanzania. Medical Anthropology Quarterly, 25(4), 486.

Susser, I. (2009). AIDS, sex, and culture: Global politics and survival in Southern Africa. John
Wiley & Sons.

Vallier, K. (2021, June 9). Neoliberalism. Stanford Encyclopedia of Philosophy.

https://plato.stanford.edu/entries/neoliberalism/