UC Berkeley

This dissertation concerns HIV/AIDS prevention and control in contemporary Vietnam, as an assemblage of Vietnamese Socialist governance, international NGO and US government mechanisms, and new biomedical regimes based on expert knowledges and international "best practices." It maps the emergence of HIV/AIDS in Vietnam, the rise of the complex of state practices, spaces and discourses created to deal with it, the unfortunate entanglement of this apparatus with that set against "social evils," and the rendering of HIV/AIDS a biological marker of socio-moral contagion. It examines the deadly consequences of this entanglement, the authorities' subsequent attempts at disentanglement following shifting epidemiological, political and economic conditions and Vietnam's internationally acclaimed success against SARS. It marks the new forms of exclusions and inequalities in health this generated. Broadly, I argue there was a shift from an emphasis on "The People" to one on "The Human" as the object at the center of this HIV/AIDS prevention and control apparatus, along with a shift from external enforcement (by authorities) to internal adherence (by oneself, to techno-scientific and expert discourses and practices). With the shift from enforcement (a present and past-oriented mode) to adherence (a mode that moves from the present forward), the near future has now become a target of and problem for government.

As new and massively increased resources for HIV/AIDS prevention and control become available new contests over jurisdiction and precedence are breaking out between sectors of this apparatus dedicated to public security and health and human services, as well as central and local health authorities. Under these conditions new life-saving and harm-reduction programs effected and protected through and under interpersonal and political arrangements often classified in the foreign and domestic press as "corruption" are forcing reexamination of the ethical status of these practices. I argue that following my informants' stress on the "uses" of corruption, rather than their naming, a more nuanced portrait of contemporary power relations and constraints emerges, one that sheds light on the transformation, in these milieu, of the emerging ethical terrain of HIV/AIDS prevention and control in Vietnam.

Third, I examine PEPFAR (US President's Emergency Plan for AIDS Relief), investigating the friction at the meeting points between a pair of incongruous bureaucracies, their effect on local financial, facility and human resource management, and the promotion of a certain regime of accounting and audit practices. These new technologies represent a curious marriage of neoliberal rationalities and humanitarian ethics that operate by refiguring political problems in other domains as non-ideological and non-political health problems, within the framework of what I term an "ethics of an economy of virtue." Here I track the penetration of neoliberal logics and calculations into the domain of humanitarian intervention. Truth games effected through the deployment of statistics, images, anecdotes and narratives collapse a broad range of meanings upon the subjected bodies of the ill, bodies and stories meant to stand in not only for those innumerable "others like them," but the exchangeable, comparable virtue of the deployer.

The final chapter is a fleshing out of the framework I present in the preceding chapters, using the parallel stories of two exemplary figures; a famous and controversial Saigon social worker, and a relatively unknown young woman, a homeless heroin addict and "graduate" of the Vietnamese carceral regime. These stories highlight the benefits, constraints and vulnerabilities actors working on HIV/AIDS in Vietnam within an economy of virtue face, as well as enable us to trace certain turning points in their lives against the background of the minor history of HIV/AIDS in Vietnam that I have set out.