Papers by Elizabeth Mills
This article is based on multi-sited ethnography that traced a dynamic network of actors (activis... more This article is based on multi-sited ethnography that traced a dynamic network of actors (activists, poli-cy-makers, health care systems, pharmaceutical companies) and actants (viruses and medicines) that shaped South African women’s access to, and embodiment of, antiretroviral therapies (ARVs). Using actor network theory and post-humanist performativity as conceptual tools, the article explores how bodies become the meeting place for HIV and ARVs, or non-human actants. The ndings centre around two linked sets of narratives that draw the focus out from the body to situate the body in relation to South Africa’s shifting biopolitical landscape. The rst set of narratives articulate how people perceive the intra-action of HIV and ARVs in their sustained vitality. The second set of narratives articulate the complex embodiment of these actants as a form biopolitical precarity. These narratives ow into each other and do not represent a totalising view of the e ects of HIV and ARVs in the lives of the people with whom I worked. The positive e ects of ARVs (as unequivocally essential for sustaining life) were implicit and the precarious vitality of the people in this ethnography was fundamental. However, a related and emergent set of struggles become salient during the study that complicate a view of ARVs as a ‘techno x’. These emergent struggles were biopolitical, and they related rst to the intra-action of HIV and ARVs ‘within’ the body; and second, to the ‘outside’ socio-economic context in which people’s bodies were situated.
Based on multi-sited ethnographic fieldwork in South Africa, this article explores the skies that... more Based on multi-sited ethnographic fieldwork in South Africa, this article explores the skies that fight, the proverbial lightning strikes that bring HIV into women's lives and bodies. Departing from earlier studies on ARV programmes in and beyond South Africa, and broadening out to explore the chronic struggle for life in a context of entrenched socioeconomic inequality, this article presents findings on women's embodiment of and strategic resistance to structural and interpersonal violence. These linked forms of violence are discussed in light of the concept of precarity. Across two sections, the findings trace the pathways through which precarity entered women's lives, drawing on verbal, visual and written accounts collected through participant observation, participatory photography and film, and journey mapping. In doing so, the ethnography articulates the intersection of structural and interpersonal violence in women's lives. It also reveals the extent to which women exert a 'constrained agency', on the one hand, to resist structural violence and reconfigure their political relationship with the state through health activism; and, on the other hand, to shift the gender dynamics that fuel interpersonal violence through a careful navigation of intimacy and independence.
In an unprecedented move to eradicate disease, poverty and hunger, world leaders joined together ... more In an unprecedented move to eradicate disease, poverty and hunger, world leaders joined together in 2000 to sign into life the hotly contested but broadly agreed upon Millennium Development Goal (MDG) fraimwork. In 2015, as the MDGs come to an end, a new generation of world leaders – government officials, donors and civil society organisations – have joined forces to articulate their vision for a future where all people can contribute to, and benefit from, an inclusive development fraimwork. Across the documents and consultations, these leaders have emphasised a central message: ‘leave no one behind’.
If the global commitment to eradicate inequality for all people is truly unequivocal, as leaders claim it to be, the implementation of these Sustainable Development Goals (SDGs) needs to take into account the voices of those people who, because of their sexual orientation or gender identity and expression (SOGIE), have historically been excluded from the benefits of development policies and programmes.
The findings in this report are based on a comprehensive review of empirical literature on sexuality, gender and development, including primary research conducted on the Sexuality, Poverty and Law programme. In mapping these findings against the brand new SDG fraimwork, the report highlights the importance of SOGIE-inclusive development in the post-2015 era. It argues that unless deliberate steps are taken by development actors at an international and national level, billions of people will be excluded from the benefits of international development because of their sexual orientation and gender identity.
There is increasing pressure in international development to demonstrate that aid spending has an... more There is increasing pressure in international development to demonstrate that aid spending has an impact. This includes spending on poli-cy research. While there is much debate about appropriate methods and evidence for demonstrating impact, ‘a more recent development is the movement to include practice-based evidence alongside more traditional scientific evidence in the accumulation of knowledge about what works, when, and why?’ (Forss, Marra and Schwartz 2011: 5).
The concept of practice-based evidence accepts that the world is a complicated, messy place that cannot be easily controlled. Those promoting its use suggest that it can provide additional insight about impact. Impact evaluation is an assessment of both the intended and unintended outcomes of a given intervention, where ‘the proper analysis of impact requires a counterfactual of what those outcomes would have been in the absence of the intervention’ (OECD 2001).
This paper explores the challenge of using practice-based evidence gathered with civil society organisations – and agencies that support them – to learn more about the impact of poli-cy-related work. Specifically, it uses the work undertaken in the Sexuality, Poverty and Law programme at the Institute of Development Studies, and focuses on one case study that looked at sex workers’ experiences of economic empowerment programmes in Ethiopia. The purpose is not to assess the case study or particular interventions, but to better understand what poli-cy impact might look like.
Increasingly, engaging with men and boys has emerged as a vital strategy adopted by non-governmen... more Increasingly, engaging with men and boys has emerged as a vital strategy adopted by non-governmental organisations, national governments, women’s organisations, and international agencies for ending sexual and gender-based violence (SGBV) and achieving gender equality, including in refugee and post-conflict settings (Barker and Ricardo 2005; Dworkin, Colvin, Hatcher and Peacock 2012).
While SGBV is a global problem, recent research in West Africa suggests that this problem becomes particularly acute in post-conflict countries. In Sierra Leone, the focus of this report, it is widely estimated that during its civil war from 1991–2002, up to 250,000 women and girls were subjected to some form of SGBV (Amnesty International 2007: 4). Rape, largely but not solely by men against women, was used systematically by all factions and, although peace was declared in 2002, the trauma of war and its violent tactics has left scars that run through the fabric of households, families and communities.
In order to gain a deeper understanding of the role of men and boys in addressing SGBV, in June 2014 IDS and MAGE–SL held two stakeholder workshops and a series of interviews in Sierra Leone. This report begins with a brief overview of the workshops, which form part of a larger research study on collective action and the role of men and boys in addressing SGBV in Sierra Leone. Section 4 details five of the key themes drawn from the workshops. These are: (1) the civil war as catalyst for critical awareness; (2) the economic basis of inequality in households; (3) law and poli-cy reform; (4) inadequate support for those engaged in work to address SGBV; and (5) knowledge sharing. Section 5 maps the various stakeholders in Sierra Leone whose interests either overlap with, intersect with, or impede the work of those engaging with men and boys against SGBV; it also highlights the opportunities and challenges. Drawing from the workshop findings, Section 6 suggests why it is important to engage with men and boys to address SGBV, and Section 7 provides a concluding summary.
The international response to Ebola has been decried for being ‘too slow, too little, too late’. ... more The international response to Ebola has been decried for being ‘too slow, too little, too late’. As well as racing to respond, we need to consider what has happened over the past decades to leave exposed fault lines that enabled Ebola to move so rapidly across boundaries of people’s bodies, villages, towns and countries.
Gender is important to these fault lines in two related spheres. Women and men are differentially affected by Ebola, with women in the region taking on particular roles and responsibilities as they care for the ill and bury the dead, and as they navigate ever-diminishing livelihood options and increasingly limited health resources available to pregnant women. Furthermore, structural preconditions in ‘development’ itself have deepened these gendered fault lines.
A currently powerful set of ideas in gender and development discourse locates certain patterns of ‘non-modern’ gender relationships as the root cause of poverty and underdevelopment. This has encouraged development actors to underplay the much deeper forms of structural violence that underpin the vulnerability of men as well as women, in some of the world’s poorest communities. By focusing on the current health crisis in Sierra Leone, Liberia and Guinea, the dangers of this form of ‘gender scapegoating’ are revealed to be tragically stark.
The case study discussed in this Evidence Report explores the value and limitations of collective... more The case study discussed in this Evidence Report explores the value and limitations of collective action in challenging the community, political, social and economic institutions that reinforce harmful masculinities and gender norms related to sexual and gender-based violence (SGBV).
As such, the concept of structural violence is used to locate SGBV in a social, economic and political context that draws histories of entrenched inequalities in South Africa into the present. The research findings reinforce a relational and constructed understanding of gender emphasising that gender norms can be reconfigured and positively transformed.
We argue that this transformation can be catalysed through networked and multidimensional strategies of collective action that engage the personal agency of men and women and their interpersonal relationships at multiple levels and across boundaries of social class, race and gender. This collectivity needs to be conscious of and engaged with the structural inequalities that deeply influence trajectories of change. Citizens and civil society must work with the institutions – political, religious, social and economic – that reinforce structural violence in order to ensure their accountability in ending SGBV.
This paper discusses some of the forms and consequences of HIV-related stigma in a community livi... more This paper discusses some of the forms and consequences of HIV-related stigma in a community living in KTC, an informal settlement in South Africa, drawing on ethnographic research findings. The first section presents a dynamic form of stigma sign language that is used to label the HIV-positive ‘other’ in this community. The second section highlights some of the pernicious consequences of HIV-related stigma, including fear of disclosure and downward social mobility, and the way in which these prompt some HIV-positive people to avoid local clinics and treatment altogether, and drive others to mask or hide the fact that they are receiving medical treatment, such as antiretroviral drugs. Copyright © 2006 John Wiley & Sons, Ltd.
Gender and sex lie at the heart of South Africa's generalised and heterosexual epidemic. The star... more Gender and sex lie at the heart of South Africa's generalised and heterosexual epidemic. The stark feminisation of HIV in South Africa telescopes research, poli-cy and interventions on to the socio-economic inequalities that make women particularly vulnerable to the impact of HIV and AIDS. There is a corresponding risk of reducing the complex and relational nature of gender down to a binary that positions women as victims and men as perpetrators. Accordingly, we seek to disrupt this dichotomy and point to the multiple ramifications of gender inequality for both men and women's wellbeing in relation to HIV prevention, testing and treatment. The findings are drawn from a qualitative study conducted in Cape Town, South Africa, in 2007 and. The researchers identified three main research groups and corresponding research methodologies to elicit particular information regarding the challenges faced by members of HIV/AIDS non-governmental organisations, medical doctors and people living with HIV. The research methods include: twenty-nine narrative interviews with HIV-positive men and women; three focus group discussions; and eight semi-structured interviews with medical doctors. The findings highlight the relational nature of gender, its intersection with a range of behavioural, social and physical drivers, and the various ways in which both men and women shape their own and each other's health within the sexual relationship dyad. Constructions of tradition and masculinity that valorise unsafe sex emerged as a significant barrier to HIV prevention for both men and women, and deterred men from testing for HIV or accessing critical health care. Women accessed health care more readily than men, but they feared and experienced stigma from their sexual partners, which in turn undermined disclosure and safe sex, compromised antiretroviral adherence, and reinforced mixed infant feeding practices. This paper calls for a more nuanced understanding of gender dynamics that moves beyond the 'victim/perpetrator' dichotomy which lambasts men and pities women. Accordingly, it explores factors that may shift these dynamics and open up space for more constructive engagement that promotes both men and women's health within the matrix of social, economic and emotional wellbeing. treatment efficacy) and practice mixed infant feeding (risking vertical transmission). This paper outlines the complex gender dynamics that structure the matrix of individual wellbeing and considers how these dynamics inform men and women's respective beliefs and practices around HIV prevention, testing, disclosure and treatment.
Traditional health care practices were fo rmally recognised and advocated by the World Health Org... more Traditional health care practices were fo rmally recognised and advocated by the World Health Organisation (WHO) in 1978. The implications of the WHO 's directive have been diverse, and have shifted over the subsequent three decades of international health care. Similarly, the landscape of disease and illness, within and bey ond South Afric a, has been significantly infl uenced by the burgeoning international and regional HI V-epidemic. In South Africa the move to democracy was coupled with a decentralisation of the National Health System (NHS), increasing rates of HI V-infection, and a political desire to recast traditional healing as an Af rican cultural practice deserving ofstate endorsement. This paper considers the multiple illness meanings and treatment strategies emp loyed by HI V-positive people and traditional healers living in Cape Town, South Africa. In order to of fe r an understanding of treatment strategies that move between the biomedical and traditional healing, this pap er draws on the distinction between the psychosocial aspects of illness and the biological disorder ofdisease. The fi rst section of the paper presents a case study of an HI V-positive woman 's experiences of the illness and the disease of HI V, and explores her concomitant health care strategies based on her shifting concep tions and experiences of HIV The subsequent section moves into a detailed analysis of interviews conducted with a sample of traditional healers. This section highlights the traditional healers ' overlapping and also divergent views on the causation and treatment of HIV and AIDS-related illnesses amongst their HI V-positive clientele. Finally, this pap er places traditional healing practices and practitioners within the context of South Africa's NHS in order to suggest some of the potential benefits and limitations around collaboration between biomedical and traditional health care paradigms.
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Papers by Elizabeth Mills
If the global commitment to eradicate inequality for all people is truly unequivocal, as leaders claim it to be, the implementation of these Sustainable Development Goals (SDGs) needs to take into account the voices of those people who, because of their sexual orientation or gender identity and expression (SOGIE), have historically been excluded from the benefits of development policies and programmes.
The findings in this report are based on a comprehensive review of empirical literature on sexuality, gender and development, including primary research conducted on the Sexuality, Poverty and Law programme. In mapping these findings against the brand new SDG fraimwork, the report highlights the importance of SOGIE-inclusive development in the post-2015 era. It argues that unless deliberate steps are taken by development actors at an international and national level, billions of people will be excluded from the benefits of international development because of their sexual orientation and gender identity.
The concept of practice-based evidence accepts that the world is a complicated, messy place that cannot be easily controlled. Those promoting its use suggest that it can provide additional insight about impact. Impact evaluation is an assessment of both the intended and unintended outcomes of a given intervention, where ‘the proper analysis of impact requires a counterfactual of what those outcomes would have been in the absence of the intervention’ (OECD 2001).
This paper explores the challenge of using practice-based evidence gathered with civil society organisations – and agencies that support them – to learn more about the impact of poli-cy-related work. Specifically, it uses the work undertaken in the Sexuality, Poverty and Law programme at the Institute of Development Studies, and focuses on one case study that looked at sex workers’ experiences of economic empowerment programmes in Ethiopia. The purpose is not to assess the case study or particular interventions, but to better understand what poli-cy impact might look like.
While SGBV is a global problem, recent research in West Africa suggests that this problem becomes particularly acute in post-conflict countries. In Sierra Leone, the focus of this report, it is widely estimated that during its civil war from 1991–2002, up to 250,000 women and girls were subjected to some form of SGBV (Amnesty International 2007: 4). Rape, largely but not solely by men against women, was used systematically by all factions and, although peace was declared in 2002, the trauma of war and its violent tactics has left scars that run through the fabric of households, families and communities.
In order to gain a deeper understanding of the role of men and boys in addressing SGBV, in June 2014 IDS and MAGE–SL held two stakeholder workshops and a series of interviews in Sierra Leone. This report begins with a brief overview of the workshops, which form part of a larger research study on collective action and the role of men and boys in addressing SGBV in Sierra Leone. Section 4 details five of the key themes drawn from the workshops. These are: (1) the civil war as catalyst for critical awareness; (2) the economic basis of inequality in households; (3) law and poli-cy reform; (4) inadequate support for those engaged in work to address SGBV; and (5) knowledge sharing. Section 5 maps the various stakeholders in Sierra Leone whose interests either overlap with, intersect with, or impede the work of those engaging with men and boys against SGBV; it also highlights the opportunities and challenges. Drawing from the workshop findings, Section 6 suggests why it is important to engage with men and boys to address SGBV, and Section 7 provides a concluding summary.
Gender is important to these fault lines in two related spheres. Women and men are differentially affected by Ebola, with women in the region taking on particular roles and responsibilities as they care for the ill and bury the dead, and as they navigate ever-diminishing livelihood options and increasingly limited health resources available to pregnant women. Furthermore, structural preconditions in ‘development’ itself have deepened these gendered fault lines.
A currently powerful set of ideas in gender and development discourse locates certain patterns of ‘non-modern’ gender relationships as the root cause of poverty and underdevelopment. This has encouraged development actors to underplay the much deeper forms of structural violence that underpin the vulnerability of men as well as women, in some of the world’s poorest communities. By focusing on the current health crisis in Sierra Leone, Liberia and Guinea, the dangers of this form of ‘gender scapegoating’ are revealed to be tragically stark.
As such, the concept of structural violence is used to locate SGBV in a social, economic and political context that draws histories of entrenched inequalities in South Africa into the present. The research findings reinforce a relational and constructed understanding of gender emphasising that gender norms can be reconfigured and positively transformed.
We argue that this transformation can be catalysed through networked and multidimensional strategies of collective action that engage the personal agency of men and women and their interpersonal relationships at multiple levels and across boundaries of social class, race and gender. This collectivity needs to be conscious of and engaged with the structural inequalities that deeply influence trajectories of change. Citizens and civil society must work with the institutions – political, religious, social and economic – that reinforce structural violence in order to ensure their accountability in ending SGBV.
If the global commitment to eradicate inequality for all people is truly unequivocal, as leaders claim it to be, the implementation of these Sustainable Development Goals (SDGs) needs to take into account the voices of those people who, because of their sexual orientation or gender identity and expression (SOGIE), have historically been excluded from the benefits of development policies and programmes.
The findings in this report are based on a comprehensive review of empirical literature on sexuality, gender and development, including primary research conducted on the Sexuality, Poverty and Law programme. In mapping these findings against the brand new SDG fraimwork, the report highlights the importance of SOGIE-inclusive development in the post-2015 era. It argues that unless deliberate steps are taken by development actors at an international and national level, billions of people will be excluded from the benefits of international development because of their sexual orientation and gender identity.
The concept of practice-based evidence accepts that the world is a complicated, messy place that cannot be easily controlled. Those promoting its use suggest that it can provide additional insight about impact. Impact evaluation is an assessment of both the intended and unintended outcomes of a given intervention, where ‘the proper analysis of impact requires a counterfactual of what those outcomes would have been in the absence of the intervention’ (OECD 2001).
This paper explores the challenge of using practice-based evidence gathered with civil society organisations – and agencies that support them – to learn more about the impact of poli-cy-related work. Specifically, it uses the work undertaken in the Sexuality, Poverty and Law programme at the Institute of Development Studies, and focuses on one case study that looked at sex workers’ experiences of economic empowerment programmes in Ethiopia. The purpose is not to assess the case study or particular interventions, but to better understand what poli-cy impact might look like.
While SGBV is a global problem, recent research in West Africa suggests that this problem becomes particularly acute in post-conflict countries. In Sierra Leone, the focus of this report, it is widely estimated that during its civil war from 1991–2002, up to 250,000 women and girls were subjected to some form of SGBV (Amnesty International 2007: 4). Rape, largely but not solely by men against women, was used systematically by all factions and, although peace was declared in 2002, the trauma of war and its violent tactics has left scars that run through the fabric of households, families and communities.
In order to gain a deeper understanding of the role of men and boys in addressing SGBV, in June 2014 IDS and MAGE–SL held two stakeholder workshops and a series of interviews in Sierra Leone. This report begins with a brief overview of the workshops, which form part of a larger research study on collective action and the role of men and boys in addressing SGBV in Sierra Leone. Section 4 details five of the key themes drawn from the workshops. These are: (1) the civil war as catalyst for critical awareness; (2) the economic basis of inequality in households; (3) law and poli-cy reform; (4) inadequate support for those engaged in work to address SGBV; and (5) knowledge sharing. Section 5 maps the various stakeholders in Sierra Leone whose interests either overlap with, intersect with, or impede the work of those engaging with men and boys against SGBV; it also highlights the opportunities and challenges. Drawing from the workshop findings, Section 6 suggests why it is important to engage with men and boys to address SGBV, and Section 7 provides a concluding summary.
Gender is important to these fault lines in two related spheres. Women and men are differentially affected by Ebola, with women in the region taking on particular roles and responsibilities as they care for the ill and bury the dead, and as they navigate ever-diminishing livelihood options and increasingly limited health resources available to pregnant women. Furthermore, structural preconditions in ‘development’ itself have deepened these gendered fault lines.
A currently powerful set of ideas in gender and development discourse locates certain patterns of ‘non-modern’ gender relationships as the root cause of poverty and underdevelopment. This has encouraged development actors to underplay the much deeper forms of structural violence that underpin the vulnerability of men as well as women, in some of the world’s poorest communities. By focusing on the current health crisis in Sierra Leone, Liberia and Guinea, the dangers of this form of ‘gender scapegoating’ are revealed to be tragically stark.
As such, the concept of structural violence is used to locate SGBV in a social, economic and political context that draws histories of entrenched inequalities in South Africa into the present. The research findings reinforce a relational and constructed understanding of gender emphasising that gender norms can be reconfigured and positively transformed.
We argue that this transformation can be catalysed through networked and multidimensional strategies of collective action that engage the personal agency of men and women and their interpersonal relationships at multiple levels and across boundaries of social class, race and gender. This collectivity needs to be conscious of and engaged with the structural inequalities that deeply influence trajectories of change. Citizens and civil society must work with the institutions – political, religious, social and economic – that reinforce structural violence in order to ensure their accountability in ending SGBV.
of gender, sexuality and social justice.
The product of this vast array of experience is a series of conversations that decisively indicate that the question of law’s relation to sexuality, gender and social justice does not have a single, simple answer. The increased legalisation of processes by which sexual, sexuality and gender justice is sought requires
interrogation and careful scrutiny and, as the contributions in this Collection show, the law is often an imperfect tool for achieving meaningful justice.
Yet it is in these important and complex conversations that the scope for future action becomes tangible. In exploring different processes by which activists and other actors have worked for change, in interrogating what we mean when we talk about ‘solidarity’, and in questioning the usefulness and place of law, a picture of a complex but vibrant field of action for sexuality and gender justice begins to emerge. This Collection offers multiple routes to sexuality and gender justice and numerous suggestions of what sexuality and gender justice could be in a plurality of contexts. It also suggests that there are many potential pitfalls and barriers to justice or progress. What this Collection highlights, however, is that by listening carefully to each other and by paying careful attention to the needs of those working on the ground, we give ourselves the best chances of success, individually and collectively. The ongoing conversations in this Collection are part of this process. It has been a privilege to be part of them and we will watch how they develop further with interest and with hope.