When Diabetes Confronts HIV: Biological Sub‐citizenship at a Public Hospital in Nairobi, Kenya
Open accessAbstract
This article investigates how international donor policies cultivate a form of biological sub‐citizenship for those with diabetes in Kenya. We interviewed 100 patients at a public hospital clinic in Nairobi, half with a diabetes diagnosis. We focus on three vignettes that illustrate how our study participants differentially perceived and experienced living with and seeking treatment and care for diabetes compared to other conditions, with a special focus on HIV. We argue that biological sub‐citizenship, where those with HIV have consistent and comprehensive free medical care and those with diabetes must pay out‐of‐pocket for testing and treatment, impedes diabetes testing and treatment. Once diagnosed, many are then systematically excluded from the health care system due to their own inability to pay. We argue that the systematic exclusion from international donor money creates a form of biological sub‐citizenship based on neoliberal economic policies that undermine other public health protections, such as universal primary health care.
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“[29] focused on the complexities related to access to 6 I.”
- Authors
- Bosire, E., Mendenhall, E., Omondi, G. B., & Ndetei, D.
- Affiliations
- University of the Witwatersrand (ZA)
- Georgetown University (US)
- Kenya Medical Research Institute (KE)
- University of Nairobi (KE)
- Corresponding author
- Bosire, Edna
- Mendenhall, Emily
- Venue
- Medical Anthropology Quarterly
- Publisher
- Wiley
- Published
- 2018-09-12
- Volume
- 32
- Issue
- 4
- Pages
- 574-592
- ISSN
- 0745-5194 (ISSN-L)
- 1548-1387
- PMC
- PMC7611264
- OpenAlex
- W2887494082
- Cited by
- 25
- References
- 41
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 4 · 2022: 2 · 2021: 7 · 2020: 5 · 2019: 3
- FWCI
- 5.70
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Medical Anthropology Quarterly (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Georgetown University
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › HIV/AIDS Impact and Responses
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Keywords
- diabetes mellitus, HIV, out-of-pocket costs, health care exclusion, neoliberalism, public hospital care, patient experience, health care financing, Kenya
- MeSH terms
- Adult, Diabetes Mellitus, Female, Health Services Accessibility, Hospitals, Public, Humans, Kenya, Male, Middle Aged, HIV Infections, Anthropology, Medical
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