The Paradox of Secrecy

The IS Academie Education and International Development organised a public lecture on the 7th of October from 14h to 16h at the University of Amsterdam. During this public lecture, Serena Cruz (visiting scholar at the University of Amsterdam & PhD Candidate at Florida International University) discussed the HIV risk management practices among female commercial sex workers in Kampala, Uganda, focusing on effectiveness of HIV programs targeting ‘at risk’ populations.

Invitation lecture Serena CruzFollowing the Risks of HIV Treatment: The Paradox of Secrecy

In this lecture Serena Cruz (UvA Visiting Scholar) reflects upon her slum-based ethnographic study of HIV risk management practices among female commercial sex workers in Kampala, Uganda . Serena chose “follow the risks of HIV treatment” out of the brothel in order to focus on one of the most difficult aspects of women’s HIV risk management—access to healthcare. What she discovered was a series of corrosive anti-social practices that extended from a central tenet in Uganda’s HIV programming. At the core of these programmatic efforts was a strong prioritization of individual behavioral change that emphasizes practices that were antithetical to women’s survival. Herein lies one of the greatest dilemmas for women practicing sex work. In a cultural context that derides people for selling sex, many women question the safety of exposing what they do in order to manage their HIV more responsibly. Serena discusses the fear women faced when having to chose between keeping quiet about their profession or confiding in medical staff, who were often found to isolate and/or shame patients. Serena asserts that ultimately, in the face of these choices, women come to believe they do not deserve the support of their peers or medical advisors, and as a result will often choose secrecy even when it increases their risk of death. In response, Serena contends that HIV programs targeting ‘at risk’ populations must become comprehensive and community-centered in their efforts to provide effective HIV care. She argues this begins with reconstituting the orthodoxy of clinical and medical responses as well as moving providers away from technocratic dogma and individuating approaches towards strategies that incorporate the complex interpersonal aspects of survival in slum-based sex trades.