The Biopolitics of Change: A Foucauldian analysis of Christian healthcare and HIV prevention in Papua New Guinea

Foucault’s notion of biopower analyses the ways in which HIV prevention is understood and practised by healthcare workers from two Christian faith-based health services in Papua New Guinea. HIV prevention practices are biopolitical interventions which carry an imperative to preserve health, effecting a myriad of changes in healthcare workers’ and their client’s conceptualisation of individual responsibility, sexuality and culture. Healthcare workers in this study intrinsically combine Christian moral frameworks with their HIV prevention practices. In fact, modern frameworks of health promotion share a genealogy of “pastoral power” with Christian forms of moral reform, whereby figures of authority heuristically guide others to become self-responsible and active agents of their own wellbeing. Through their engagement with HIV prevention knowledge, people become subjects of power; subjects come to know themselves and justify their actions through a biological existence – one that is sharply defined by an apprehension to HIV risk. There is a call among healthcare workers to defy customary speech taboos and “openly talk about sex”, as it is assumed that once informed by scientific knowledge of sex and its potential health risks, behavioural change would follow. Another assertion is that cultural practices such as polygyny and bride price increase HIV risk. This contradicts to another explanation which suggests that it was the breakdown of culture in the midst of social and economic change that has modified the contemporary practices of polygyny and bride price that have led to HIV. Biopolitical notions of self-reflection and self-reform were first initiated by colonial and missionary power. Today, this knowledge/power continues to circulate via global health programs. This form of self-regulation is more insidious because healthcare workers and their clients in the local community willingly embrace healthcare knowledges via their own active agency. Yet externally produced healthcare and scientific knowledge is often at tension with people’s own experiences in the Papua New Guinean setting. The challenges of HIV prevention can be explained by the contradictions presented in the exercise of power. Subjects are agonised by the freedom offered by autonomous agency and the implicit discipline of dominant frameworks of healthcare knowledge