"I am a dead woman" Embodying and resisting dependency among women living with HIV in Papua New Guinea - Berghahn Journals
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“I am a dead woman”
Embodying and resisting dependency among women
living with HIV in Papua New Guinea
Holly Wardlow
Abstract: HIV/AIDS can be understood as “an epidemic of signification” (Treichler
1987) not only about dangerous sexuality but also about dangerous relations of
dependence. I begin by examining newspaper articles and nongovernmental or-
ganization reports to show how they pose alarmist questions about AIDS-related
dependency, such as who will care for “AIDS orphans” and how will labor deficits
be managed. I then turn to the Papua New Guinea context and focus on the experi-
ences of women living with HIV who often narrate themselves as embodying state
dependencies on foreign aid for their antiretroviral medications. In contrast, they
typically resist their kin’s attempts to position them as wayward dependents who
should be grateful for being given food and shelter.
Keywords: antiretroviral therapy, dependence, gender, HIV, Papua New Guinea
Thirty years ago, Paula Treichler wrote a now While the moral panic around sex endures, I
classic and canonical essay in which she spoke of suggest that, in fact, AIDS has always also been
AIDS as an epidemic of signification. As she put a moral panic and epidemic of signification
it, “the AIDS epidemic—with its genuine poten- about dependency. This alarm about depen-
tial for global devastation—is simultaneously an dency manifests at multiple scales, from the
epidemic of a transmissible lethal disease and an global and institutional to the corporeal and
epidemic of meanings, or signification. Both ep- intimate, and focuses on such issues as: who
idemics are equally crucial for us to understand, will and who should care for the dependent
for try as we may to treat AIDS as “an infectious sick and dying, who will and who should care
disease” and nothing more, meanings continue for the young and old dependents who remain,
to multiply wildly and at an extraordinary rate” what new and dangerous international and fa-
(Treichler 1987: 32). At that point in time, the milial relations of dependency will be created,
proliferating significations were largely clus- how will the state be burdened, which nongov-
tered around sexuality: depending on which ernmental (NGOs) and corporate actors will
“risk group” was being represented, their sexual help shoulder the burden, and so on. Indeed,
desires and practices were characterized as ex- the independent/dependent binary suggests
cessive, perverse, or immoral. that these two epidemics of signification are
Focaal—Journal of Global and Historical Anthropology 90 (2021): 11–21
© The Authors
doi:10.3167/fcl.2021.90010212 | Holly Wardlow
deeply connected: the moral panic around sex AIDS and dependency panic
is, at least in some contexts, a moral panic about
excessive independence (that is, the indepen- While many of the early newspaper articles
dence or freedom to engage in what is consid- about AIDS in North America focused on the
ered unrestrained, selfish, or transgressive sex), wild excesses of “gay bathhouse culture,” some-
which has, in turn, led to a moral panic about what later articles examined the devastating toll
excessive dependence (that is, the dependence that AIDS was taking on the productive, wage-
of people living with HIV on medicines, health earning, tax-paying demographic in sub-Saharan
care systems, food supplementation, state finan- Africa and the profound impact this was having
cial assistance, etc.). on both private enterprise and public services.
In this article, I first trace a few ways in which For example, a 1990 New York Times article
the theme of dependency permeates discourses asked, “What does it mean if a mine loses 20 per-
about the AIDS pandemic across a range of loca- cent of its skilled workers, an army 20 percent
tions. Then, turning to the Papua New Guinean of its troops? How far is society set back when
context, I examine how the state’s dependency many scarce teachers, doctors and engineers
on both donor organizations and corporate die prematurely?” (Eckholm and Tierney 1990).
social responsibility initiatives to fund AIDS Another New York Times article from 1998 re-
prevention and treatment is funneled down to ported, “In nearby Zimbabwe, a personnel offi-
the community level and becomes embodied in cer confesses that he has hired three people for
HIV-positive patients, who are constructed as each semiskilled job, expecting two to die in
the dependent recipients of outsiders’ benefi- training,” and it observed, “The damage at the
cence. Indeed, some of the women I interviewed family level is easy to grasp. The typical bread-
described themselves as “dead,” by which they winner in Africa has 10 dependents, and out-
meant that only an unreliable supply of anti side South Africa there are no welfare systems
retrovirals (ARVs) from elsewhere kept them . . . the cost of medicine and a funeral means
alive. they often have to eat less, sell land or cattle,
Their families, in turn, often tried to dis- or take healthy children out of school. That re-
cursively position them as formerly wayward, turns a once-ambitious family directly into the
but now chastened, dependents who, in their hopeless cycle of poverty at its nadir—illiterate,
weakened and discredited condition, should ill-nourished children hoeing small plots of corn
be grateful for being taken in. This discur- to avoid starvation” (McNeil 1998). And, a 2003
sive positioning sometimes intersected quite Harvard Business Review article very bluntly
brutally with a social organization of gen- asserted, “Why should executives be concerned
der in which women do not own or control about AIDS? Very simply, AIDS is destroying
the land they farm or the houses they live the twin rationales of globalization strategy:
in. As the owners of land and houses, male cheap labor and fast-growing markets. . . . Rising
heads of household had the power either to absenteeism and higher employee turnover due
evict HIV-positive female kin or give them a to HIV/AIDS have forced companies to employ
safe haven. Nevertheless, women living with and train more people than usual. For instance,
HIV often resisted being positioned as dis- managers in companies in Zambia and Congo
graced dependents who owed their families invest in training each worker to handle two or
remorse and gratitude. They asserted counter- three tasks, or they hire two or three workers for
narratives in which their kin were to blame for every job on the expectation that at least one will
their HIV infections because of past failures die” (Rosen et al. 2003).
to provide support and nurture; consequently, This kind of reporting emphasized wasted
they argued, their families owed them a debt of training, undependable labor, inefficient and
care and were obliged to take them in. potentially unprofitable businesses, the crum-“I am a dead woman” | 13
bling of already unreliable social services, and zania, 45 per cent in Uganda, more than
the loss of a generation of consumers. Not al- 50 per cent in Kenya and around 60 per
ways explicitly articulated, but underpinning cent in Namibia and Zimbabwe. . . . HIV/
these narratives, were fears about “developing AIDS is straining elderly people already
nations” falling off of their developmental tra- struggling to make ends meet. (UNICEF
jectory and becoming even more dependent 2007: 30)
than they already were on bilateral and multi-
lateral aid. Conversely, many scholars observed Here we can see that gendered relations of kin-
that the structural adjustment policies man- ship and care are narrated as an intensification
dated by the World Bank and the International of dependency and measured as a dangerous
Monetary Fund exacerbated the AIDS crisis distortion of “dependency ratios.” At a popula-
in low-income countries by requiring govern- tion level, the dependency ratio is convention-
ments to remove subsidies on food, fertil- ally defined as the number of dependents—that
izer, and fuel and to implement “user fees” for is, persons aged zero to 14 and over the age
health care and education, thereby aggravating of 65—to the number of independents—that
economic precarity, food insecurity, and the is, persons aged 15 to 64. What this report is
chronic parasitic conditions that contribute to suggesting is that at the household level, the
HIV transmission and infectiousness (Schoepf dependency ratio of AIDS-affected families is
et al. 2000; Stillwaggon 2005). In this view, it becoming frighteningly unmeasurable since the
was not AIDS that derailed economic devel- number of independents is zero, while the num-
opment and created dependency; rather, it was ber of dependents, both old and young, is ever-
development policies themselves that had pre- increasing. The outcome, as studies from a range
cipitated the AIDS crisis and worsened relations of disciplines indicate, is declining agricultural
of dependence at multiple scales. productivity, poor educational outcomes for the
In the domain of the familial, an iconic im- younger generation, and deteriorating physical
age of AIDS in Africa in the 2000s has been the and mental health for both older and younger
elderly grandmother caring for the orphaned generations (Block 2014; Bock and Johnson
children of her deceased adult children. The 2008; Chazan 2008; Drah 2014).
significance of the “AIDS orphan”/grandmother Jean Comaroff has suggested that the AIDS
dyad is that of a kind of dependency squared, pandemic has “affected our very sense of his-
as it were: the dependent elderly caring for the tory, imposing a chronotope of its own” (2007:
dependent young, in an environment in which 197). If so, the Time of AIDS has entered a new
the demographic segment that is usually con- period: the Era of Treatment. And arguably, in
structed as “independent”—that is, the produc- this era of treatment, the epidemic of significa-
tive and income-earning—are missing. A 2007 tion regarding dependency is intensified, not
UNICEF report says, for example: ameliorated—there are now concerns about
who is going to feed and care for not only the
The strain of caring for orphans is telling orphaned children but also for the people who
on female-headed households, which have are HIV-positive and continue to live and are in
among the highest dependency ratios. treatment but are weakened and may not be able
Many of these households are headed by to engage in hard or sustained physical labor—
elderly women, often grandmothers, who may not, in other words, be able to embody the
step in to raise orphans and vulnerable chil- cheap labor force essential to the globalization
dren when their own children sicken and strategy, as the Harvard Business Review article
die. Grandparents—particularly grand- would have it. Moreover, the crisis about depen-
mothers—care for around 40 per cent of dency in the era of treatment is a crisis about
all orphans in the United Republic of Tan- kinship, generation, and gender: the question14 | Holly Wardlow
of who will and should care for dependents is other, and a country’s categorization informs its
often, more concretely, a question of who has national HIV/AIDS policies and resource allo-
female kin to care for them and who does not. cation. By describing its epidemic as “mixed,”
Are there enough able-bodied, elderly women Papua New Guinea signals that prevention and
to care for others? treatment strategies need to be tailored accord-
It is perhaps in part because of moral anxiet- ing to specific geographical location. Tari, Hela
ies about dependency that there are now many province, the site of my research, is near some
articles and policy documents about ARVs in- of the nation’s most valuable resource extraction
tensifying hunger and increasing people’s ca- sites, such as Barrick’s Porgera Joint Venture
loric and nutritional needs (Kalofonos 2010). gold mine and the Papua New Guinea Liquid
While this is factually true, it is also the case Natural Gas project, jointly operated by Exxon-
that the personage of the HIV-positive patient- Mobil, Oil Search Ltd., and a few smaller com-
in-treatment has come to be figured as a hyper- panies. Proximity to resource extraction sites
dependent—a person who cannot produce as produces greater HIV vulnerability (Hammar
well as other adults but consumes more than 2010; Shih et al. 2017; Wardlow 2020), and typ-
other adults. Notably, the ethnographic research ically, HIV prevalence is higher in these areas.
about ARV hunger and the free food supplemen- In this article I draw primarily on interviews
tation provided to people living with HIV by with 30 women living with HIV. Far fewer men
humanitarian organizations often reveals moral were seeking out testing and treatment during
crises occurring at the nexus of kinship, house- the years of my research from 2010 to 2013, and
hold food insecurity, and humanitarian inter- of the 8 formal interviews I had with men, I cut
vention. Specifically, the moral logic behind food 4 of them short because I felt they were too sick
supplementation for people living with HIV is to continue (this was not true of any of my in-
often unclear to the household members who terviews with women). Most of these men had
have taken them in and cared for them, since refused to seek help until they were so unwell
all members are suffering from hunger, and the that others made the choice for them, and two of
HIV-positive are sometimes seen as the most them died over the course of my research, while
morally suspect and undeserving (Kalofonos none of the women did. The reluctance of men
2010; Prince 2012). They embody, as I have sug- to seek out HIV testing and their typically much
gested, the morally problematic excesses of both later, and sometimes too late, entry into care, is
independence and dependence. a widespread global problem (Shand et al. 2014)
and is attributed to a range of factors, including
men’s aversion to acknowledging vulnerability
AIDS in Papua New Guinea or dependency. Notions of dependence have, in
other words, life-and-death consequences.
With a prevalence of approximately .9 percent,
the HIV epidemic in Papua New Guinea has
recently been characterized as “mixed” (PNG AIDS and nation-state dependencies
DOH 2018), a term that is meant to indicate
that in some regions of the country it is a “con- On a national scale, Papua New Guinea con-
centrated” epidemic, in which HIV is primar- tributes very little financially to its own AIDS
ily found in key vulnerable groups, such as sex programming and is almost completely depen-
workers, but has not greatly affected other peo- dent on bilateral and multilateral aid for its HIV
ple, while in other regions it is a “generalized” prevention, testing, and treatment initiatives
epidemic, which is defined as a prevalence of (Nitsoy 2012). Indeed, this dependency has en-
one percent or more in the general population. abled new non-state entities to establish offices
Countries are typically categorized as one or the in the country and become important actors“I am a dead woman” | 15
in national HIV/AIDS policy formulation and and beyond the project areas affected by its
program implementation. Historically it was pri- resource extraction activities, by building the
marily Australian AID (AusAID) that strongly technical capacity of small health centers and by
influenced Papua New Guinea’s national policy maintaining provincial physical infrastructure,
about HIV and paid for its testing, treatment, such as roads and bridges. Indeed, what made it
and prevention programs. Within the last 10 an effective health project implementing agency,
to 15 years, however, the Asian Development in part, was that its parent mining company, Oil
Bank, the Global Fund to Fight AIDS, Tuber- Search Ltd., maintains roads, bridges, and air-
culosis and Malaria, and PEPFAR have also strips in the country in order to transport its
stepped in to fund specific projects or program labor and supplies, and the Oil Search Health
components. Foundation was able to piggyback on this in-
So dependent is the country on external en- frastructure to access patients in Hela province
tities for its HIV/AIDS programming that for and to create and maintain ARV distribution
many years it was actually an oil company—not networks. In sum, not only is the state highly
the national Department of Health (DOH) or dependent on donor aid for its AIDS program-
an international NGO—that served as the offi- ming, but also clinical staff and patients are de-
cial Principal Recipient for Global Fund grants pendent on corporations for delivery of their
worth tens of millions of dollars, a highly un- essential AIDS medicines and for the infra-
usual situation. The DOH had mismanaged the structure that enables this delivery. In short, at
first Global Fund grant, jeopardizing possible fu- the national level, the dependencies created by
ture assistance. As one Global Fund audit report HIV facilitate the production of new kinds of
put it, the weaknesses of the DOH “included assemblages of care composed of corporate, hu-
non-compliance with the grant agreement, lack manitarian, and governmental elements.
of supporting documents, unreconciled differ-
ences and weak monitoring, which led to US$2.7
million worth of unsupported and ineligible ex- Embodying state dependencies
penditures being recovered” (Global Fund 2019:
11). Furthermore, it was determined that no At the provincial and community scale, health
NGOs in the country, national or international, workers, at least the ones I spoke with in Hela
had the technical capacity at that time (the mid- province, were well aware of the state’s depen-
2000s) to apply for or manage the next round of dence on bilateral, multilateral, and corporate
funding. And so Oil Search Ltd. created the Oil assistance for its AIDS programming, and they
Search Health Foundation in order to manage occasionally used this information to try to dis-
money from the Global Fund and to monitor cipline their HIV-positive patients. For exam-
other recipient organizations’ projects in Papua ple, I heard clinic staff inform newly diagnosed
New Guinea for the Global Fund. patients that it was their duty to adhere to the
As this information suggests, HIV can create ARV regimen because: “Foreign donors have
dependencies not only between the state and its made these drugs available to you. The Papua
bilateral or multilateral donors but also between New Guinea government doesn’t pay for your
the state and corporate actors. Moreover, much drugs. Other countries, because they are sorry
as in other countries, mineral, gas, and oil ex- for people in Papua New Guinea, are paying
traction sites create HIV vulnerability in Papua for these medicines. So be reliable, don’t waste
New Guinea, but it is also mineral, oil, and gas them, don’t be defiant.” In other words, they
extraction companies that distribute much of the attempted to cultivate obedience in patients by
ARV treatment. In Tari, the Oil Search Health positioning them in a global biomedical-moral
Foundation significantly scaled up testing and assemblage in which the pity felt by the foreign
treatment throughout Hela province, both in donor for the distant, suffering, dependent other16 | Holly Wardlow
motivated a life-saving gift that had to be repaid trying to convey their utter ontological depen-
through dutiful compliance with the drug reg- dence on ARVs. During their months without
imen. The implication was that patients owed medicine, as they began to experience repeated
their very lives not to the nation-state that was bouts of malaria, respiratory infections, and skin
providing them with clinical care but to the for- ulcers, these patients expressed doubt that the
eign entities that paid for their ARV medicines. nation-state would be capable of doing what-
This dependence was felt all the more acutely ever might be required to entice foreign donor
during one of my fieldwork periods in 2012 organizations to resume their assistance. Their
when the country ran out of ARVs. When I in- assumption was that it was the state that had
terviewed them, some patients had been without somehow defaulted in its dependency relation-
their medicines for three months, and none of ships and was ultimately responsible for the lack
them assumed that their access to ARVs would of ARVs in the country, and in this assumption
resume. ARVs only became freely available in they joined a chorus of Papua New Guinean
Papua New Guinea in 2007, and they were thus citizens who have expressed consternation or
still relatively new in Hela when I began my re- resignation about the negligent, ineffective, or
search, and they were most certainly not taken absent state (Knauft 2019; Street 2012). In short,
for granted by the women I interviewed. More- patients experienced themselves as the embod-
over, most of these women were widows, and ied outcomes of state-level dependencies: if the
the arrival of ARVs marked a turning point for state maintained its relations with powerful
them between death and life. As they often put benefactors, they might live; if the state failed to
it, “My husband died before the AIDS medi- do so, they would die.
cines came. The medicines didn’t come in time The families of some of the women I inter-
for him, but they came in time for me.” In the viewed reinforced their feelings of ontological
Ugandan context, Susan Reynolds Whyte and indeterminacy by cruelly reminding them that
Godfrey Etyang Siu have described this as ex- they were dependent on possibly evanescent
periencing a kind of “historical contingency”— medicines or telling them that they weren’t
that is, a sense that one’s very life has depended “really alive.” Such assertions constructed ARV
on specific historical events, such as the arrival therapy as an unnatural life support in pill form
of ARVs: “For the HIV-positive people who and implied that women living with HIV in-
managed to access treatment, a kind of gener- habited a liminal space between life and death.
ational consciousness emerged—an awareness Often what seemed to trigger such angry out-
that they differed from their predecessors, for bursts were vexing entanglements of interde-
whom there was no Second Chance. . . . Histori- pendence in which women living with HIV
cal contingency was evident as well in the way a were cast by their kin as dependent, and they,
few worried about whether their treatment pro- in turn, struggled against being viewed in this
grammes would continue” (2015: 21). In Tari, it way. As previously mentioned, most of the
seemed pure luck to the women I interviewed women I interviewed were widows, and typi-
that effective drugs became available when they cally their husband’s kin had refused to permit
did, and most believed that ARVs could vanish them to continue living on his clan land after
just as quickly and unexpectedly as they had his death. Their recourse was usually to ask
appeared. married siblings to take them in. Such requests
Some of these women spoke of themselves were sometimes brutally rejected. For example,
as “dead”: “I’m a dead woman,” they would say, after Shelly’s husband died, her brothers refused
“only the medicine is keeping me alive.” Through to let her move back home:
such assertions they were sometimes expressing
wonderment and gratitude that ARVs had ar- My family yelled at me and called me an
rived in time to save them. But they were also AIDS woman in public. They wouldn’t“I am a dead woman” | 17
take me in—they evicted me, they in- tion—as dependents, laborers, caregivers, and
sulted me, they hit me, they told every- so on. I suggest that in the case I am analyzing
one I had AIDS, they cut me with a bush here, widowed or divorced women living with
knife (she showed me a large scar on her HIV ask to be incorporated into the households
shoulder) and forced me out. They said, of kin as adult female persons who have typi-
“You yourself found this sickness. Where cally fulfilled their obligations by bringing in
you found it, we don’t know, but you have bridewealth for their natal families, producing
it and you brought it back here. Take it children for their husbands’ families, and car-
away. You cannot live here.” ing for pigs and sweet potato fields. However,
the moral suspicion attached to their HIV-
Ostracized by her family, Shelly was homeless positive status (Wardlow 2017, 2020; see also
when I met her and carried a plastic tarp with Hammar 2010 and Lepani 2008) often over-
her so that she could sleep in people’s fields whelms other aspects of their personhood, and
when necessary, a situation I had never before they are instead ascribed the more precarious
encountered in the Tari area, although Law- position of a dependent whose ability to remain
rence Hammar has described similar kinds of in the household is contingent on her behavior.
expulsion and abandonment of people living Such ascription is equivalent to a demotion
with HIV, especially women, in other areas of from full personhood. As Michael Main has
Papua New Guinea (Hammar 2010). This was argued, Huli people value “a staunch individu-
an acutely gendered predicament. Although the alism that respects and celebrates autonomy of
men I interviewed experienced social rejection expression and choice” (2020: 119), and while
in other ways, none of them were forcibly ex- autonomy may be more circumscribed and less
pelled from their homes or land, precisely be- celebrated for women, feeling free to speak one’s
cause it was their home and land. In contrast, mind is nevertheless a fundamental aspect of
because Huli women do not own land, or the full personhood regardless of gender, an aspect
homes built upon it, they can be forced out, that is curtailed when in a position of depen-
and a few of the women I interviewed had been dence. The women I interviewed often empha-
physically expelled from their homes without sized that being cast as a beholden dependent
their belongings. Remaining household mem- entailed silencing themselves. Discursively
bers took their pigs and harvested their crops. constructed as less valuable and perhaps even
More commonly, women were taken in by dangerous household members, they often cen-
family members, but they were made to feel as sored themselves, fearful that too strong a show
if they were dependents who should be grate- of autonomy or opinion might lead to their
ful for the household’s generosity, a situation eviction.
which they chafed against, discussed later in
this article. Commenting on James Ferguson’s
argument that, in South Africa, relations of so- Resisting the ascription of dependence
cial dependence have long been “the very foun-
dation of polities and persons alike” and that The women I interviewed seemed resigned to
seeking dependence can be analyzed as “a mode being ontologically dependent on their medi-
of social action” (2013), Tania Li suggests that cines and, by extension, on the beneficence of
modes of social incorporation might be a more foreign donors and the competence of the na-
productive analytical framework for assessing tion-state in managing its political relations. In
how people try to make claims on others and contrast, they typically resented being ascribed
how these claims are accepted, negotiated, or a needy, dependent role by the kin who took
rejected (2013). Li suggests there are multiple them in, and they pushed back against these
ways in which people seek social incorpora- constructions of their identity.18 | Holly Wardlow
One way in which they resisted ascriptions suffered from chronic back and leg pain and did
of dependence was by incorporating themselves not feel she could cope with the six-hour jarring
into these households as crucial laborers. For round-trip journey on a hard wooden bench
example, they would take on the full respon- over a rutted dirt road. As Sarah explained it,
sibility for washing the household’s dishes and her mother should have known—did, in fact,
clothes. Even those who said that they felt too know—that Sarah was too young to be sent
weak or tired to do more arduous labor, such as alone on a daylong journey on a road that was
tending to sweet potato fields, caring for pigs, plagued by crime: “I told her, ‘It is your fault
or fetching buckets of water from a stream, said that I have this sickness. You were the one who
that they were well able to sit in one place and did this. You were the one who told me I had
wash things. The ascription of dependence was to go to Mendi and buy those goods. It is be-
a constant battleground, and household labor cause of you that I was on the road and I found
was a key way in which women living with HIV this sickness.’” Sarah was clearly traumatized by
tried to demonstrate that, far from being depen- what had happened to her and had become fear-
dent, they were essential and productive house- ful about leaving her household; she was only
hold members. willing to sell betel nut just outside the family
Another important way in which they re- gate. When her mother scolded her for not going
butted attempts to cast them as household de- to the larger Tari market where she would find
pendents was through implicating their kin more customers, Sarah was quick to respond that
in their stories about how they came to be in- her mother was the tene of all her current woes
fected, often suggesting that their kin were ul- because of her failure to prioritize Sarah’s safety.
timately responsible. Specifically, they asserted Similarly, Lucy, a woman who looked to be
that their kin were tene of their HIV infections. in her early fifties when I interviewed her in
Tene is the Huli word for tree roots, cause, or 2012, blamed her older brother for her HIV-
origin, and just as a tree trunk emerges as a uni- positive status, not the man who infected her.
tary form from a mostly unseen web of tangled She had a disastrous marriage when she was
roots, an event—such as becoming infected much younger, and upon the dissolution of this
with HIV—may initially appear to have a singu- marriage, she moved into her brother’s house-
lar cause but will reveal itself as having emerged hold and dutifully cooked and cleaned for him
from a complex web of past interactions (Gold- and his children for a number of years. And
man 1983). Thus, according to my interlocutors, then, one night, they had an altercation and he
other people, often family, played a part in cre- beat her. As she explained it, “He didn’t like the
ating the situation in which a person came to way I’d prepared his dinner. I’d been caring for
be HIV-positive. Ultimate culpability for HIV his household for years, and then one night he
infection, therefore, was sometimes attributed lost his temper about having to eat sweet potato
not to the infected person’s own individual acts, all the time, and he hit me. So I left. . . . I went to
or even to the infecting sexual partner, but to a dawe anda,1 I befriended a man there, I went
their kin’s failures of care. home with him, I stayed, and I caught AIDS.”
For example, Sarah, a woman in her late According to Lucy, this man had been her only
teens, was infected with HIV when the bus she sexual partner after more than a decade of absti-
was on was held up at gunpoint by a gang, and nence, and he was the one who had transmitted
the female passengers were raped. Rather than HIV to her. However, she blamed her brother for
blaming these men for her infection, she blamed this infection. He was the one who had unjustly
her mother. She had been sent by her mother to beaten her, triggering her own outraged exodus
buy betel nut and wholesale cigarettes in Mendi, from his household. Furthermore, Lucy ex-
the closest large town, to sell for a profit back in plained, their mother had died when they were
Tari. Her mother did not go herself because she young, and being the firstborn daughter, she had“I am a dead woman” | 19
felt obliged to drop out of school and care for her to experience themselves as the corporeal man-
younger siblings. She had therefore “been like a ifestations of these state dependencies. At the
mother” to her brother, and yet he had lost his household level, the family members of women
temper and hit her. It was his fault that she went living with HIV may attempt to position them
to the dawe anda in the first place, she said, and as formerly wayward and excessively indepen-
thus his fault that she became infected. dent persons who are now problematically de-
My interlocutors deployed such narratives pendent on others’ generosity and forbearance.
to suggest that their kin were obligated to help Indeed, in some cases, families view their past
them. Since failures of care on the part of kin excessive independence as having brought about
were responsible for their being infected, these their current excessive dependence, and they
kin now owed them a debt of care. The story are therefore viewed as embodying both—that
about infection became, in a sense, a duel about is, dependent on family and clinic, but liable
who owed whom in the relationship: was the to engage yet again in reckless, risky, indepen-
person living with HIV a wayward and chas- dent behavior that might endanger others. The
tened dependent who was indebted to kin for women I interviewed resisted such ascriptions.
being willing to take her in, or did kin owe a With their health and strength largely restored,
debt to the person living with HIV because of they were eager to be viewed as “normal”—that
their negligence and abuse in the past? How a is, like any other person, and not as someone
woman came to be infected constituted a narra- whose personhood is determined by their HIV
tive battle that could determine whether she was status or who imposes some sort of extraor-
seen as a beholden dependent or as someone to dinary burden on their kin (Wardlow 2020).
whom amends needed to be made. Thus, women living with HIV often narrated
The women I interviewed did not always win their trajectories quite differently—not as an arc
this narrative battle. Lucy’s brother, for example, from irresponsible independence to chastened
refused to accept that his violent behavior had dependence but rather from a failure of kinship
played a role in her infection. But, this strategy care to a situation in which the debt of care to
often did work for women who had been in- them either was being paid or was not.
fected by their husbands when it was their par-
ents or brothers who had chosen the husband,
particularly if women had sacrificed their own Acknowledgments
choice of marital partner in order to abide by
the wishes of family. In these cases, kin often The Canadian Social Science and Humanities
did accept that since they had chosen a wom- Research Council (Standard Research Grant
an’s spouse, they bore part of the responsibility #331985) funded the research for this article. I
for her infection, and so they did, in fact, owe a am also grateful to the Papua New Guinea Na-
debt of care. tional Research Institute for affiliation during
the research. Thank you to three anonymous re-
viewers and to Ståle Wig, who gave me excellent
Conclusion advice for revising this article. And finally, many
thanks to Keir Martin and the other organizers
The era of treatment creates complex assem- of the 2018 Gendered Ascriptions of Depen-
blages of testing, diagnosis, and care in which dence workshop in Oslo.
people living with HIV are dependent on dis-
tant others for their medications and, thus, for
life itself. Indeed, the Papua New Guinea state Holly Wardlow is Professor of Anthropology at
is highly dependent on donor and corporate as- University of Toronto, Canada, and the author
sistance, and people living with HIV may come of Wayward Women: Sexuality and Agency in a20 | Holly Wardlow
New Guinea Society (2006) and Fencing in AIDS: Global Fund to Fight AIDS, Tuberculosis and Ma-
Gender, Vulnerability, and Care in Papua New laria. 2019. Audit report: Global Fund grants in
Guinea (2020), both with University of Califor- Papua New Guinea. https://www.theglobalfund.
nia Press. org/en/oig/updates/2019-09-27-audit-of-grants-
ORCID: https://orcid.org/0000-0002-8762-665X in-papua-new-guinea/ (accessed November 14,
2020).
Email: hwardlow@chass.utoronto.ca
Goldman, Laurence. 1983. Talk never dies: The
language of Huli disputes. London: Tavistock
Publications.
Notes Hammar, Lawrence James. 2010. Sin, sex and stigma:
A Pacific response to HIV and AIDS. Wantage,
1. Dawe anda are an interesting hybrid of male UK: Sean Kingston Publishing.
ritual spaces and brothels (Wardlow 2006: Kalofonos, Ippolytos. 2010. “All I eat is ARVs”:
193–195). The paradox of AIDS treatment interven-
tions in central Mozambique.” Medical An-
thropology Quarterly 24(3): 363–380. https://
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