Governmentality and security in the US President's Emergency Plan for AIDS Relief (PEPFAR)

This article offers a critical theoretical exploration of the US President's Emergency Plan for AIDS Relief (PEPFAR). The article examines the background to PEPFAR and its reauthorization in Washington DC in 2008 through the conceptual lens of governmentality. Building on existing work, it interprets PEPFAR as a programme for securing the welfare of populations. It also qualifies and extends this work in the following ways. Rather than representing a break with the history of geopolitics, it argues that PEPFAR emerged out of accommodations between geopolitics and governmentality. This point is developed through two takes on geopolitics, first in terms of the projection of sovereign power, and second in terms of articulations between PEPFAR and geopolitical economies of global health. The article suggests, first, that the geopolitics of sovereign power shaped the timing, scale and form of PEPFAR, and second, that PEPFAR articulated with geopolitical economies of global health through its mobilization of US-based corporations, non-governmental and faith-based organizations. The article extends existing work by examining the role of critical mobilizations in shaping PEPFAR, both in relation to questions of political economy and the contentious politics of life. Reflecting on the politics of global health, it considers the prospects for using ideas of security and the international response to HIV/AIDS as stepping stones towards the development of broad-based health systems. (C) 2010 Elsevier Ltd. All rights reserved.