Access and Belonging in the Age of Viral Epidemic:Constructin Migrants Living with HIV/AIDS in the Finnish Welfare State

This work examines the social construction of migrants living with HIV/AIDS in the Finnish welfare state through the concepts of postmodern illness, social memory and human rights. Taking a qualitative approach, the study explores how narratives of AIDS have been articulated in public policymaking and social practices concerning HIV/AIDS. Through a close reading of Finnish law and health information texts, the thesis examines how the interaction between cultural practices and social structures articulated meanings and absences on the issue of migrants and HIV in Finland. In-depth interviews of people living with HIV, as well as policymakers and practitioners, are also presented. The four primary research questions are: How has HIV/AIDS been constructed as an exceptional health issue internationally and how has it emerged out of globalized trends in socio-economic development, migration, and the traditions of public health and social work? What kinds of stories have been told about HIV/AIDS and how have they been organized as narratives to emplot AIDS in global and local social and health policies? How are migrant identities and rights constructed in Finland, specifically in the intersection of legal, social and health definitions for migrants living with HIV/AIDS? What sense of cultural identity and belonging is constructed at the core of access to Finnish social and health services for people living with HIV/AIDS and how is it manifested? The dissertation first examines how the meanings of globalization and accompanying socio-economic transformations have been articulated towards the end of the twentieth century. HIV/AIDS is considered as the first disease of globalization where patterns of the pandemic mirror global inequalities. The work examines the fragmenting pressures of the neoliberal push for privatization on public health and the welfare state. It then moves on to explore the growth of transnational migration as a consequence of increasing global income inequality and structural violence, which raises new challenges to citizenship, democracy and the basis of the welfare state. Through a discussion of how the AIDS pandemic was storied, the work suggests that the public policy that emerged in the early days of the AIDS pandemic reflected the complexity of diverse narrative plots. Many of the narrative invisibilities and erasures reveal the inequalities of globalized societies on local levels. HIV/AIDS became an exceptional health issue through the common efforts of community action groups and public health professionals. Despite these efforts to construct HIV/AIDS as an exceptional disease requiring special care as well as unique prevention and harm reduction interventions, it remains highly stigmatized disease in most societies and very expensive to treat. This presents great challenges to social work with people living with HIV/AIDS. Finally, the work focuses on the local level of the global story of AIDS. Through an analysis of Finnish texts, such as newspaper articles and academic theses, as well as personal interviews, it traces the chronology and development of the Finnish epidemic. International narratives of AIDS are tied to the shaping of articulations of AIDS policy in Finland. The work moves on to explore how immigration policy in Finland is mediated through social memory. It then locates migrants in Finnish social and health law, arguing that migrants occupy an ambivalent location in constructions of equality in the Finnish social and health care system. Interviews of Finnish people and migrants living with HIV/AIDS as well as professionals and policymakers in the field are juxtaposed to explore the complex terrain of migrants social and health needs as well as the realities of social care in Finland. Through a close reading of health information material produced by AIDS agencies, the work explores the invisibility of migrants in these activities and policies of these agencies and their material. It argues that migrants access to social care can be seen as limited by the lack of recognition of their needs. The paucity of migrant stakeholders and researchers in the development of HIV/AIDS care policy and national prevention strategy can also be seen as a barrier to empowering migrant communities. The interaction between cultural practices and social structures in the Finnish welfare state tends to articulate a culturally normative consensus on care needs. The lack of acknowledgment of cultural competence as an essential element of care and professional training can be seen as articulating indirect discriminatory practices. Finally, the silence and invisibility of migrants in Finnish HIV services is considered through a reflection of two in-depth interviews with migrants living with HIV/AIDS.This work examines the social construction of migrants living with HIV/AIDS in the Finnish welfare state through the concepts of postmodern illness, social memory and human rights. Taking a qualitative approach, the study explores how narratives of AIDS have been articulated in public policymaking and social practices concerning HIV/AIDS. Through a close reading of Finnish law and health information texts, the thesis examines how the interaction between cultural practices and social structures articulated meanings and absences on the issue of migrants and HIV in Finland. In-depth interviews of people living with HIV, as well as policymakers and practitioners, are also presented. The four primary research questions are: How has HIV/AIDS been constructed as an exceptional health issue internationally and how has it emerged out of globalized trends in socio-economic development, migration, and the traditions of public health and social work? What kinds of stories have been told about HIV/AIDS and how have they been organized as narratives to emplot AIDS in global and local social and health policies? How are migrant identities and rights constructed in Finland, specifically in the intersection of legal, social and health definitions for migrants living with HIV/AIDS? What sense of cultural identity and belonging is constructed at the core of access to Finnish social and health services for people living with HIV/AIDS and how is it manifested? The dissertation first examines how the meanings of globalization and accompanying socio-economic transformations have been articulated towards the end of the twentieth century. HIV/AIDS is considered as the first disease of globalization where patterns of the pandemic mirror global inequalities. The work examines the fragmenting pressures of the neoliberal push for privatization on public health and the welfare state. It then moves on to explore the growth of transnational migration as a consequence of increasing global income inequality and structural violence, which raises new challenges to citizenship, democracy and the basis of the welfare state. Through a discussion of how the AIDS pandemic was storied, the work suggests that the public policy that emerged in the early days of the AIDS pandemic reflected the complexity of diverse narrative plots. Many of the narrative invisibilities and erasures reveal the inequalities of globalized societies on local levels. HIV/AIDS became an exceptional health issue through the common efforts of community action groups and public health professionals. Despite these efforts to construct HIV/AIDS as an exceptional disease requiring special care as well as unique prevention and harm reduction interventions, it remains highly stigmatized disease in most societies and very expensive to treat. This presents great challenges to social work with people living with HIV/AIDS. Finally, the work focuses on the local level of the global story of AIDS. Through an analysis of Finnish texts, such as newspaper articles and academic theses, as well as personal interviews, it traces the chronology and development of the Finnish epidemic. International narratives of AIDS are tied to the shaping of articulations of AIDS policy in Finland. The work moves on to explore how immigration policy in Finland is mediated through social memory. It then locates migrants in Finnish social and health law, arguing that migrants occupy an ambivalent location in constructions of equality in the Finnish social and health care system. Interviews of Finnish people and migrants living with HIV/AIDS as well as professionals and policymakers in the field are juxtaposed to explore the complex terrain of migrants social and health needs as well as the realities of social care in Finland. Through a close reading of health information material produced by AIDS agencies, the work explores the invisibility of migrants in these activities and policies of these agencies and their material. It argues that migrants access to social care can be seen as limited by the lack of recognition of their needs. The paucity of migrant stakeholders and researchers in the development of HIV/AIDS care policy and national prevention strategy can also be seen as a barrier to empowering migrant communities. The interaction between cultural practices and social structures in the Finnish welfare state tends to articulate a culturally normative consensus on care needs. The lack of acknowledgment of cultural competence as an essential element of care and professional training can be seen as articulating indirect discriminatory practices. Finally, the silence and invisibility of migrants in Finnish HIV services is considered through a reflection of two in-depth interviews with migrants living with HIV/AIDS