Essay --

During the eleven year long Sierra Leonean civil war, reports of systematic sexual violence against women and girls during the war resulted in international concern over a potential ‘crisis’ of HIV/AIDS in the country. In order to manage the imagined impending outbreak, the Ministry of Health and Sanitation (MoHS) in Sierra Leone received $15 million from the World Bank to create the Sierra Leone HIV/AIDS Response Program [SHARP]. In this paper, I point to the work that the global crisis narrative of HIV/AIDS does to shape specific forms of intervention. In Sierra Leone, the global health interventions associated with HIV/AIDS are further targeted at vulnerable populations, particularly war-affected women and girls, who are often framed as both abject victims in need of care (read: at risk) and potential vehicles of HIV/AIDS transmission in need of control (read: risky). In my conclusion, I ask whether the vision of HIV/AIDS vulnerability communicated by SHARP is indica tive of an uneven or differential landscape of health citizenship in post-war Sierra Leone. The contemporary model of global health intervention is rooted in colonial and post-colonial histories of debt, structural adjustment, the devolution of the state and the rise of multilateral aid-driven health development. As Sparke (2013) illustrates, the growing global health industry increasingly relies on a ‘new Washington Consensus,’ which frames improvements in population health as integral to social and economic development in nations of the Global South. Combating ‘diseases of poverty,’ such as HIV/AIDS, global health interventions often take the form of short-term ‘technocentric’ solutions that are limited in scope and vertical in implementation (Foley & Henrixson 2... ...ent-funded initiatives act as ‘quasi states’ that produce state-like effects of control, regulation and legitimacy. The involvement of these entities in the creation and implementation of HIV/AIDS policies in Sierra Leone simultaneously disrupts national narratives of health citizenship and creates a global moral politics of intervention (Benton 2012; Kenworthy forthcoming). Through the continued utilization of a crisis model of care to address global health emergencies, the international community perpetuates the mobilization of differential forms of health citizenship that are envisioned at the global scale yet enacted and negotiated in a variety of ways at the national and local scales. In the context of the global health industry, such differential health citizenships are practiced through the prioritization of certain bodies for care to the detriment of others.