The MSM category as bureaucratic technology

Reflections on paperwork and project time in performance-based aid economies

Cal (Crystal) Biruk

16 Dec 2019
doi.org/10.17157/mat.6.4.695

Abstract

The MSM category has traveled far and wide from its invention in US public health worlds in the late-1990s, migrating as well into anthropological scholarship that is critical of its reductionist, biomedicalized, Western, and de-eroticizing logics. While much has been written about ‘MSM’ as a flawed category that misdirects resources in health worlds, or as an imported nominalization that grafts awkwardly onto ‘real’, local, sexual, and gendered selves, my interest in this article is in revisiting the MSM category as a technology that facilitates linkages, processes, and dynamics constituting projects that take form in performance-based aid economies. Long-term, if episodic, work within projects targeting MSM deepens our understandings of the transformations and travels of the MSM category, beyond the dominant biomedical and cultural frames that characterize most anthropological literature. After briefly describing an NGO focused on LGBTI rights that I work with in Malawi, I present vignettes to analyze the work done by the MSM category in sociotechnical infrastructures. I closely read paperwork practices in NGO worlds to illustrate how the MSM category operates as a bureaucratic technology and a unit of accounting and measurement that is the engine behind the reproduction and performativity of projects. Throughout, I highlight how the patchy, contingent, frenetic, and unpredictable rhythms of aid economies are crucial context for understanding the workings of the MSM category. Finally, I reflect on how anthropologists’ embeddedness in such projects might reconfigure the meanings, tempos, and methods of anthropological work and writing.
Boxes of water-based lubricant sachets stacked in a store room, c. 2015.      Photo by author.Boxes of water-based lubricant sachets stacked in a store room, c. 2015. Photo by author.

  

I’m tired of AIDS. Lots of things are going on beyond AIDS. 
– Gift Trapence, Executive Director, Centre for the Development of People 

My colleague and friend Gift, who heads Malawi’s oldest and primary LGBTI-rights organization, has said these words often in the past five years, usually expressing frustration with donors’ and the Malawi government’s narrow focus on HIV/AIDS risk as the sole concern faced by LGBTI Malawians. Members of the LGBTI community express similar sentiments, referencing the personal economic struggles and the social, religious, and familial exclusion that go largely unaddressed by donor funds that primarily aim to increase HIV testing, improve linkage to prevention and treatment, and suppress viral loads. The umbrella term ‘key populations’ has risen to prominence relatively recently, and men who have sex with men (MSM)[note 1]Key populations are groups of people who are at increased risk of HIV transmission and face decreased access to health and other services due to their marginalization and stigma. The groups included under this umbrella term in Malawi include MSM, transgender persons (TGs), injecting drug users (IDUs), and sex workers (namely, female sex workers [FSW], though male sex workers [MSW] are of rising interest). Efforts to close HIV programming gaps prioritize reaching key populations, widely referred to in Malawi as ‘KPs’ or ‘key pops’.
 are widely represented to be at higher risk of contracting HIV than other counterparts in the LGBTI acronym. The MSM category, which has traveled far and wide from its invention in US public health worlds in the late 1990s to span the globe, has a long social life in Malawi. Through its accumulated connotations and metamorphoses we can track shifts in donor interest and political climate; as McKay (2016) shows in her longitudinal study of United Nations’ Country Progress reports on HIV/AIDS, MSM are ‘marginalized but not marginal’ to the global HIV response. Gosine (2013, 478), drawing on work with MSM in the Caribbean, meanwhile suggests that, ‘the idea that MSM pose a risk to heterosexual populations frames arguments for rights to the extent that it becomes almost impossible to address sexual oppression outside the overriding questions of reproduction and public health’. The category has been of great interest to medical anthropologists, too, who have produced a body of scholarship critical of its reductionist, biomedicalized, Western, and de-eroticizing logics.

As I contemplated the call to reflect on ‘making up’ MSM for this special issue, I wondered how I might possibly say something new about this case study par excellence of Hacking’s (1986) dynamic nominalism, wherein groups of people and the terms used to name (and control) them mutually interact through what he calls a ‘looping effect’. Medical anthropological writing on and about MSM (and many other categories caught up in global health projects and worlds) has illuminated how people become intelligible or unintelligible through moralized linguistic containers (Kulick 2005). Turning to my archive of field notes, gray literature, glossy NGO booklets, and email correspondence for inspiration, I observed that it revealed as much about my own anthropological becomings as it did about those supposedly really real people whose lives, actions, transactions, and selves are masked by acronyms like ‘MSM’ that attempt to name them or pin them down.[note 2]In his review of the ambivalences in naming sexual identities and practices, Epprecht (2013, 1–35) notes that ‘capitalization [of proper nouns in the English language] implies a certainty, stability or essential nature that contradicts the main intention of this particular acronym [in his case “LGBTI”]’. In the interest of respectful inclusiveness, he utilizes lowercase forms. Because the focus of this article is on the bureaucratic object of the MSM category and what it does in and for multiple people involved in NGO worlds – and in the interest of a larger project invested in illustrating the normative constraint and liberatory potential inherent in liberal concepts of self, sexuality, naming, and health (see also Lorway 2008) – I retain the capitalized version that is the everyday parlance of Malawian activists and donors.
 In my field notes from an October 2008 National AIDS Commission meeting with members of grassroots groups, focused on disseminating research, I had written:

There are about forty people in attendance, and presenters include the National AIDS Commission Research Officer and Malawian, American and Canadian researchers. The executive director of Malawi’s only LGBTI rights NGO, Gift Trapence, presented findings from a baseline study of the behaviors of MSM in Malawi. As he set up his presentation and displayed the title on a slide, the audience chuckled. The member of an AIDS prevention community organization sitting next to me mumbled: ‘There are none of these MSM here in Malawi’. Audience members loudly expressed similar sentiments throughout his presentation, contradicting his claim that MSM should be a major focus of Malawi’s AIDS effort. 

Returning this past year to that originary moment when ‘MSM’ first caught my attention (and I first met Gift), I could see how the MSM category gave me a knowing wink, whispering ‘second project’. It is in the spaces of global health where I continue to spend time that I have encountered and taken up concepts, problems, and formations deemed interesting, not only by my anthropological peers but also by the global health workers, activists, and donors I have encountered in a ‘field’ crowded with the projects of diverse actors. As Moyer (2015) suggests, the projects undertaken by medical anthropologists, particularly those working in Africa, have been periodized within the temporal arc of the AIDS epidemic, and the funding available for such projects has often mirrored that of the biomedical projects anthropologists are embedded in (Moyer and Igonya 2014; Hörbst and Wolf 2014). My own trajectory resonates here: it was AIDS that initially caught my attention when proposing dissertation research on demographic health survey projects in rural Malawi in the mid-2000s (the era of the Global Fund and PEPFAR launches, and it was the growing interest many years later among donors, activists, and researchers in sexual minorities and AIDS that motivated my current research pursuits.  

The AIDS epidemic in Africa has been a key site for the production of anthropological theory. Medical anthropologists, including myself, have ridden the global health boom’s coat tails (Colvin 2018; Yates-Doerr 2019).[note 3]The anthropological scholarship on AIDS produced since the mid-1980s is crudely glossed as applied and theoretical. Some anthropologists collaborate directly with epidemiologists and policy makers, bringing qualitative methods to the table, while others tend to engage in more ‘traditional’ long-term fieldwork within or alongside projects or patients. Hierarchical assumptions about these forms of knowledge – which tend to elevate theoretical work above applied work – reveal geographical inequalities, as Southern scholars are often compelled to take up applied research questions that satisfy the whims of big funders because their work may be ‘bread-and-butter driven’ (Ugwu 2018, 574). In Malawi, most research completed by Malawians on MSM or key populations has taken the form of consultancies to the Centre for the Development of People (CEDEP), for example, a baseline survey of transgender health, population size estimates, etc. The reports from these consultancies, many of which contain rich evidence, remain unpublished grey literature, while work produced by non-Malawian academics, such as myself, enters elite circuits of knowledge production. (These insights were informed by conversations with Eric Umar, 20 June 2019, and Euclides Gonçalves, 6 April 2018.)
 In general, they have sought to improve interventions, taken issue with assumptions of the universality of categories or logics; revealed the social, political, and economic contexts in which global health operates; and shown how people creatively make do or thrive within the global health infrastructures they navigate. Taken together, this body of work maintains some degree of critical distance from global health and its categories – including ‘MSM’ – mobilizing ethnographic evidence to show how biomedical or scientific categories, metrics, and indicators get things wrong. 

In this article, however, I resist the urge to write in the genre that critiques the MSM category, challenging myself to suspend the medical anthropologist’s desire to show how it fails to describe the people it intends to study or recruit (or to reveal from the ground up how the category and its projects might get things more right). Certainly, my field notes teem with inscriptions waiting to be elaborated into ethnographic vignettes and thereby serve as evidence of the failures, shortcomings, or assumptions inherent in the category’s universalizing logics. In Malawi, as elsewhere, categories become sites of meaning making and value production. Amid a global health boom – of which the rise of ‘MSM’ as identity, sorting mechanism, and project is one symptom – medical anthropological work emanating from the global South in particular has largely taken two main critical approaches, which I classify as AIDS-centric and culturalist. 

In the case of the former, anthropologists ask: how can biomedicine and public health do better when it comes to serving MSM (or, in today’s parlance, key populations)?[note 4]See for example Parker, Aggelton, and Perez-Brumer (2016); Thomann (2016); Kaplan et al. (2016); Poteat et al. (2016); Troung et al. (2016).
 In the case of the latter, they ask: What are the shortcomings of the MSM (or other gender/sexuality identifications) category itself? How does it fail to capture the complexity of local, culturally inflected sexual and gendered identifications and behaviors?[note 5]See for example Kulick (1998); Wright (2000); Manalansan (2003); Valentine (2007); Garcia et al. (2016).
 Between and beyond these two important threads in the literature, a number of anthropologists have traced the travels and workings of sexual and gender categories, showing how they act as important levers through which people make claims toward resources, medicine, and monies, often theorizing categories as artifacts of the AIDS industry and its intersection with the globalizing discourse on human rights and systems of resource distribution (Boellstorff 2011; Cohen 2006; Boyce 2007; Lorway, Reza-Paul, and Pasha 2009; Nguyen 2010; Benton 2015; Jarrín 2016). 

Departing from work that elucidates the complex interplay among desire, self-fashioning, and health discourse, I suggest that the dominant AIDS-centric and culturalist strands in medical anthropological literature about MSM tend toward, first, presuming an ‘authentic’ self that is obscured or not captured by ‘MSM’ (wherein the category becomes somehow ‘fake’ or ‘Western’). While the important scholarship devoted to thinking through MSM as a vulnerable population in the context of AIDS is illuminating, it overlooks the kinds of work done by the category beyond linking people to health or human rights projects that might bring them benefits, medicines, or resources. Here, I analyze the MSM category as a bureaucratic technology that proliferates projects in the era of audit culture. My insights come from time spent within an NGO in the global South, one of the quintessential sites of audit as mode of governance (Strathern 2000), and, as Dilger (2012, 74) suggests, ‘island[s] of biopower and self-care … sustained by the international AIDS industry’. NGOs such as the one described here are conduits for resources and ideas that move and undergo translation across time and space. While much has been written about ‘MSM’ as a category that undergoes unpredictable transformations when it enters into local milieus, my interest lies in viewing it as a technology that facilitates linkages, processes, and dynamics characteristic of and necessary to projects that take form in performance-based aid economies.[note 6]For the purposes of this article, I use the term ‘performance-based aid economies’ to capture a global economy within which funds flow primarily from Northern donors to Southern recipients. Aid is a capacious category including resources ranging from official development support grants, loans, technical training, provision of personnel, humanitarian relief, etc. Aid is framed as benevolent and charitable, even as it has ‘soft power’ effects that compel recipient countries or organizations to align their values or practices with dominant ones. Such aid in Malawi produces entire sectors of (usually temporary) jobs: NGO staff, drivers, enumerators, stipend-receiving volunteers, etc. Another important feature of aid economies is an emphasis, especially since the mid-2000s, on ‘performance’, or on showing that monies received have been used effectively and transparently: performance becomes as indicator of worthiness for future aid. The kinds of tools, practices, bureaucracy, and requirements bound up with this imperative toward accountability feature prominently in the present analysis. In a larger project, I analyze racialized suspicion as it manifests in geographies of aid, where auditing becomes a form of rhetorical and material control over African aid recipients (for some discussions of aid as governance, see Degnbol-Martinussen and Engberg-Pedersen 2005; Mawdsley 2011; Essex 2013; Overton, Murray, and McGregor 2013; Paul 2015; McGillivray and Pham 2017).
 Thus, this article is about ‘MSM’ as category, thing, and technologyrather than simply as an inadequate descriptor for people. ‘MSM’, I suggest, ‘makes up’ and powers the sociotechnical infrastructures it traverses even as it also makes up people.

While processes and practices associated with bureaucracy, such as filling out paperwork, writing reports, or counting beneficiaries, are often cast as technical or boring, I suggest they are as important to understanding the past, present, and futures of MSM as the spaces we imagine harbor the ‘actual’ queer practices and people that escape the MSM category’s technical, imperial, and biomedical creep. Within circuits of resource distribution, people creatively fashion sexual and gendered selves to align with the categories and priorities hinged to support and resources, yet, in this process, they become, as well, proposal writers, beneficiaries, volunteers, paid employees, vulnerable, safer, well-traveled, good negotiators, and so on. Focusing on these engagements, I ask: What can a history or ethnographic analysis of the MSM category tell us about, aside from sexuality, gender, or AIDS? 

After briefly describing the nature of my work with the Centre for the Development of People (CEDEP), an LGBTI-rights NGO in Malawi, I present vignettes – focused on the practices and relations constitutive of paperwork – to analyze the work done by the MSM category in bureaucratic sociotechnical infrastructures. I focus on how the MSM category operates as a bureaucratic technology, a unit of accounting and measurement that is the engine behind the reproduction and performativity of projects. Throughout, I borrow Benton, Sangaramoorthy, and Kalofonos’s (2017) notion of ‘project time’ as an analytic to highlight how the patchy, contingent, and unpredictable rhythms of performance-based aid economies are crucial context for understanding the MSM category as both tool and technology. I end by reflecting on how anthropologists’ increasing alignment with project time reconfigures the meanings, tempos, and methods of anthropological work and writing. 

The ethnographer and the NGO

My approach to structuring this article is inspired by Boellstorff’s (2012, 34) essay that explores in detail the trajectory and nature of his experiences as they informed his own body of scholarship. Building on what he terms a ‘personal activist history’, he emphasizes the importance of taking categories themselves as unfinished and not for granted. For this article, I found myself inventorying my still-growing archive of documents and field notes, hunting for the ‘MSM category’. In so doing, I realized that the category is, indeed, perpetually unfinished, even as it plays crucial roles in knitting together donor interests and local contexts, and enables certain kinds of becomings across all scales of the aid apparatus. 

I first encountered the executive director of CEDEP, Gift Trapence – who is now a long-time collaborator and coauthor – when I happened to attend a 2008 workshop, described below, while I was engaged in another research project that examined the social lives of quantitative health data. I had lunch with him that day, and afterwards began to help out in small ways with the NGO’s projects, including from afar in the years after I left Malawi in 2009. My second research project, then, in line with many responses to the question ‘How did you come to this project?’, emerged organically, without a set plan, and through my personal investment in my friendship with Gift and in the issues his organization was furthering. 

CEDEP was established over ten years ago to address the needs and challenges of vulnerable groups in Malawi, in particular sexual minorities. Its mission includes ‘evidence-based activism’, or utilizing data as leverage to push policy makers to meaningfully address the health and other needs of vulnerable populations. When Steven Monjeza and ‘Auntie Tiwo’ – a man and a trans woman, respectively – engaged in a traditional engagement ceremony (chinkhoswe) in 2009, they were tried for unnatural offenses under a colonial-era anti-sodomy code; CEDEP provided them with legal and other support, boosting its organizational profile (Chanika, Lwanda, and Muula 2013; Biruk 2014; Currier 2018,). CEDEP has been accused in the national media and the political arena of recruiting young people to take up gay lifestyles, has seen arrests and homophobic backlash against its staff, and is regularly accused of being ‘gay for pay’ (see also Currier 2012, 155). Other rights organizations in Malawi have been hesitant to publicly proclaim support for LGBTI rights amid fears of political reprisal (Currier 2015), though this has shifted somewhat following the inclusion of key population conditions on Global Fund monies coming into Malawi (described in detail below). I began spending time with the NGO in 2013, shadowing staff and peer educators, assisting with taking minutes at meetings and policy forums, helping write and edit proposals and reports, and attending human rights and safer sex trainings and workshops. I continue to work with CEDEP in a dual capacity as an interested ally and researcher on trips to Malawi. Thus, this article draws on cumulative experiences I have had and documentary labor I have engaged in as an observant participant in and around NGO worlds, specifically, CEDEP’s. 

Project time, timekeeping, categories

Benton and Sangaramoorthy (2012, 289), in their introduction to a special issue that critically and ethnographically examines modes and logics of quantification, draw attention to the ‘shifting and co-productive relationships between public health, science, and categories of people’. In the course of their discussions, they define ‘project time’ as the ways that data collected at particular moments in time and in particular institutions or contexts (say, an NGO or a panel survey) provide a snapshot of what are taken to be ‘on the ground’ realities. The projectification of the African landscape, that is, the fluorescence of projects in the wake of the AIDS epidemic, is not a smooth and linear story of what happened or what is happening on the ground (Meinert and Whyte 2014). Project time is jumbled, confused, multiple, frenetic, patchy, and contingent. If we were to line up in chronological order, for example, the unimaginable volume of research reports, grant proposals, photographs, published articles, and gray literature produced since 2005 about and within MSM-related projects in one country, we might gain a broad sense of how funding priorities and NGO jargon shifted over time. We would not, however, get more than a cursory glance at, say, how the life of a single MSM-identified person changed – as it intersected with one project, if that project lasted long enough – over ten years. While we may imagine this story to be the purview of the anthropologist, the stuff of narratives versus indicators, part of my point is that anthropological work is increasingly hinged to project time, in ways that puncture the assumption that anthropology necessarily gets at a hidden or different reality (see also McKay 2018; Yates-Doerr 2019). 

CEDEP and other LGBTI organizations operating in the global South are part of a larger social movement that emerges from a shared sociopolitical field. These organizations imagine and work toward better futures and are guided in the present by their aims of future social transformation. Scholars in social movement studies have examined in great depth eventful movements such as antiwar protests, but this literature tends to think of time and temporality through the lens of normative metaphors such as waves, windows of opportunity, peaks and valleys, or ruptures: movements, then, are guided by the invisible hand of time, even as they may capitalize on its cycles (Gillan 2018). 

Few scholars have paid close attention to how the larger sociopolitical field birthed by the aid industrial complex, however, comes to structure the temporalities of movements, agendas, and actors. As Ashley Currier (2012) shows for Namibia and South Africa, for example, LGBTI activists toggle between strategic visibility and invisibility, partly informed by their need to present a particular image or reputation to actual and potential donors at a given moment in time. It is the oscillation between peaks and valleys of donor interest and flows of funds that contributes, as well, to a general malaise on the part of NGOs or grassroots organizations that are acutely aware of the ephemeral nature of projects they are implementing or that are living in fear of their organization being shuttered due to lack of funds (Fan 2014; Lau 2017). Organizations like CEDEP are perpetually in a state of waiting or time lag, distant from the powerful people and places that provide them resources to go about their work and daily lives. It is this spatiotemporal distance between North and South that produces the kind of malleable and uneven time, or multiple temporalities, that emerge within networks of aid (Lewis 2016). 

The affective experience of waiting – a byproduct of colliding temporalities – is common across all scales of the NGO. On one visit to Malawi, for example, I and NGO staff members were meant to set off for a district about two hours from the capital. We needed to go to the bank before departing to collect money for fuel and the per diem stipends associated with holding a training for religious leaders on LGBTI rights. We sat waiting in the car until darkness fell, awaiting confirmation – which did not come that day – that the funds had arrived to the bank from the donor. Staff members fielded angry phone calls from the leaders who had gathered at the designated place, waiting for our arrival. The NGO’s young MSM peer-educator volunteers were used to waiting and complained about how they were not paid their small monthly stipends on time. The NGO’s staff members repeatedly told them that the delays were not the fault of the NGO, but of donors who failed to send the money on time. ‘We just have to wait, there is no choice’, they would say, with resignation. In both cases, the experience of time – and the value it accrues or not – reshuffles transactions, affects, and relations invisible to the donors; experiences such as these never appear on neat and tidy monitoring and evaluation forms, and no indicator counts them.    

Davidov and Nelson (2016, 3) call upon scholars engaged in NGO studies to foreground time as a key analytical category, suggesting that ‘time and temporality are central constitutive elements of any NGO … undertaking or intervention’. Time is ever present in NGO spaces – whether in rhetoric and discussions, activity planning, or funding cycles – talk of ‘wasted time’, a pervasive sense of waiting (for donors to send money, to hear about the outcomes of submitted proposals or grant applications), and a persistent affective sense of being ‘behind’ (in submitting monitoring and evaluation reports to donors, or in organizing quarterly workshops or meetings associated with a grant across the country). Malawi more broadly, by virtue of its status as one of the poorest and most aid-dependent countries in the world, carries connotations of a nation ‘behind’ or out of step with a liberal progress narrative: undeveloped, intolerant of sexual minorities, poor. While donors may subscribe to and reinforce racialized representations of African NGO partners as occupying a different, Other time (‘African time’) (Davidov 2016), these temporal disjunctures reveal instead the awkward misalignments of project time and timekeeping, invested as they are in synchronization, efficiency, and standardization, with countertempos (Barak 2013) that may resist and contest the kinds of timetables that distribute or suspend resources and legitimation within geographies of aid.[note 7]In his historical study of the history of transportation in Egypt, Barak shows how technologies such as the railway – which sought to naturalize European standards of expediency and timeliness – were sites where Egyptians tinkered with standardized time, reshuffling its linearity through practices and relations he terms ‘countertempos’.
 Further, as Sundberg (2019) shows, Tanzanian desk officers’ abilities to mobilize personal connections and local knowledge are nonstandardized and unscripted tactics that speed up the highly formal and ‘slow’ bureaucratic processes characteristic of donor-aid recipient relations.  

The MSM category – among many others – is a technology that links together not only different spaces (say, a Malawian NGO and a European donor office) but also different temporalities (see Pedersen and Nielsen 2013). Beyond its biomedical utility or identitarian complexities, the MSM category is an ambivalent technology that keeps (project) time as much as it opens the possibility of countertempos and projects. It is my hope that this framing allows us to shift attention away from familiar questions of gender/sexuality or health as they intersect with the MSM category, and toward relations and transactions – the sociotechnical infrastructure – in which the MSM category becomes legible, countable, and valuable in a specific time and place. The examples below are drawn from a quintessential and quotidian site of project time and timekeeping: paperwork. Paperwork, I argue, is crucial to our understanding of the ‘translocalization’ of the MSM category (Boellstorff 2011). 

Proliferating paperwork

Since 2005, over the course of my time in Malawi, I have heard countless people – ranging from researchers to rural villagers to NGO staff members to bicycle taxi drivers –  say: ‘AIDS is money’. This phrase indexes the influx of people, money, SUVs emblazoned with the names and logos of organizations, and jobs associated with efforts to reduce the high prevalence of HIV in Malawi.[note 8]The HIV prevalence rate in Malawi has dropped from a high of around 15 percent in 2000 to 9.2 percent in 2018; in 2018, the prevalence among MSM in Malawi was estimated at 7 percent (UNAIDS 2018).
 Notably, Gift himself – even as he heads an organization invested in mitigating HIV rates among key populations in Malawi – has expressed that an overemphasis on AIDS has minimized the NGO’s other efforts, for example those centered on advocacy. Yet, the rhetoric around the epidemic has shifted since the first case of HIV in Malawi. While the specificities of this history are beyond the scope of this article (see Lwanda 2005; Esacove 2016; Dionne 2017), it is important to note that the initial funding and emphasis presumed a heterosexual epidemic. While MSM were first mentioned in Malawi’s national AIDS policy back in 2005, it wasn’t until the Global Fund’s placement of key populations at the core of their global strategy that CEDEP gained hard-won leverage in overcoming barriers to health service delivery and interventions, a strategy that Gift refers to as a ‘public health approach’ to advocacy (Epprecht 2012). As others have shown, this approach seeks to align the decriminalization of same-sex practices with state interests (Puri 2016, 108–109).

In 2015, the Global Fund disbursed its largest ever allocation of funds to any country or organization to Malawi, conditional on their meaningful inclusion of MSM and other key populations in programming and service delivery; this was a result, partly, of CEDEP’s advocacy (see also Makofane et al. 2013). Even before these monies were allocated, however, CEDEP’s advocacy for policy change led to the formation of a technical working group on key populations in Malawi. The evidence they collected about MSM in Malawi compelled the government to meaningfully include MSM (and key populations, more broadly) in national policy. Malawi’s National Strategic Plan for HIV/AIDS (2015–2020) includes MSM, for example, in two national indicators (NAC 2014, Appendix). CEDEP, then, was central to the inclusion of MSM in Malawi’s Global Fund proposal, and their advocacy efforts were aided by the Global Fund’s insistence that efforts to reach key populations be incorporated into country-level proposals across the globe.[note 9]The history presented here was collected from Gift Trapence, personal conversation, 24 June 2019.

The injection of funds into Africa in the mid-2000s from sources like PEPFAR and the Global Fund brought a demand for accountability that could prove the efficacy or failure of models through recourse to evidence and data. This push led to practices of monitoring and evaluation that called upon local partners to engage in new forms of labor rooted in surveillance, counting, and record keeping that produced a deluge of paperwork, what Strathern (2000) has called ‘audit culture’. Paperwork, an audit technology par excellence, is a fitting site to examine the ‘labor in/of time in material timescapes’ (Bear 2016, 496). In human rights and global health/AIDS sectors, enduring interest in the MSM category has increased flows of material resources toward addressing humanitarian and health concerns faced by MSM across the globe. While this influx of funding has benefited MSM and CEDEP, it has also meant high burdens of research participation and exposure for MSM, some of which carry risks and harms such as being outed or blackmailed as they try to collect data (Biruk and Trapence 2018). Donors and foreign researchers have frequently enlisted CEDEP – the only organization with strong links to community members – as an implementing partner for studies that seek to identify the number of HIV-positive MSM, which might thus validate their projects, but CEDEP has found itself struggling to meet the high demands for such data. 

With the influx of PEPFAR and Global Fund monies targeting key populations, however, has come growing interest on the part of other local organizations – many of whom observe that key populations are a major funding interest, but have no experience or connection to LGBTI communities – in garnering such funds. Gift puts it well: ‘Everyone wants to be on the winning team, once it’s winning’.[note 10]Personal conversations with Gift Trapence, June 2019.
 This is a trajectory he has experienced firsthand, which he traces from 2006 when Malawi’s government insisted that MSM did not exist, through a number of years when other organizations – even human rights organizations – refused to collaborate on issues related to LGBTI people amid political homophobia, and to the present, when, quite suddenly, ‘everyone wants a piece of the KP pie [funding attached to key populations]’. In recent years, this has meant that CEDEP, despite being the sole organization with long ties and established trust with the LGBTI community, has been sidelined from Global Fund monies, often because of big donors’ concerns that CEDEP lacks the capacity to manage large sums of money or meet standards for an audit or monitoring and evaluation.[note 11]In June 2018, CEDEP ‘graduated’ from Counterpart International/USAID’s organization certificate process, which means they will be eligible to receive and manage larger sums of money in the future.
 Organizations with no experience, meanwhile, have received Global Fund monies, relegating CEDEP to the status of a mere implementing partner that receives paltry funds, despite doing all of the frontline work of recruitment and implementation. 

With the recent announcement of the Global Fund’s Key Population Investment Fund (KPIF), which will bring US$4 million to Malawi between 2019–2021, meant to be distributed to ‘indigenous KP-led organizations’, CEDEP and allied organizations have begun advocating that true KP-led organizations be at the center of all programming, research, and interventions targeting key populations. In May 2019, this group of organizations established the Diversity Forum to advocate toward this end, following the example of Zambia (AVAC 2019).[note 12]The organizations, all led by Malawian people who are members of key populations, are: Lesbian, Intersex, Transgender and other Extensions (LITE), Female Sex Workers Association (FSWA), Ivy Foundation, Community Health Rights Advocacy (CheRA), Nyasa Rainbow Alliance (NRA), and Gender Links.
 The Diversity Forum, of which CEDEP is secretariat, is comprised of small organizations that have splintered off from CEDEP in recent years, all of which work with LGBTI people. The forum is advocating that all funds earmarked for the Key Populations Investment Fund in Malawi go to them and that this consortium of organizations with links to the community are involved in every step of proposal writing, planning, and implementation.  

Notably, amid an influx of funds – and therefore ability to implement an increasing number of projects on the ground – CEDEP has experienced an increase in paperwork resulting from reporting and audit requirements stipulated by donors. CEDEP is fully donor-funded, and, consequently, the various activities it carries out in a given week or month must align with the timetables, criteria, and expectations associated with the funds provided by a specific donor, producing ‘multiple accountabilities’ (Sullivan 2017). NGO staff members – many of whose salaries are cobbled together from various projects’ budget lines funded by numerous donors – live and work ‘project to project’ (Parks 2008; Prince 2012; Minn 2016; McKay 2018). If an NGO’s proposal for funds for a project is unsuccessful, a staff member may be out of work. In this regard, staff members find their time being split between multiple, concurrent, sometimes competing projects and associated paperwork. 

This version of precarity is increasingly felt among my colleagues at the NGO. Donors create stringent guidelines for how funds are spent, limiting the percentage of funds to be used, for example, to fund ‘operational costs’, including staff members’ salaries, laptops, office space, vehicles, internet costs, or even electricity to power an office. Notably, whereas these items are often seen as ‘wasteful luxuries’ by those not on the ground in Malawi, they are crucial for the implementation of everyday work and continuity of organizational programs. The unwillingness to fund such needs is a manifestation of donor investment in ‘outcomes’, where monies invested in the past can be directly linked to gains or successes measurable in temporal increments that constitute an unfolding future. In this regard, provision of wireless internet – which is essential to the daily functioning of an organization like CEDEP – becomes an unquantifiable variable, beset as well by racialized assumptions that Malawian staff might ‘waste time’ by using data to download films, check personal social media accounts, or engage in other activities not relevant to the work they have been assigned under a specific project. 

Paperwork is a tool that aspires to synchronize, standardize, and commensurate difference. For example, it collects inscriptions like counts or other forms of evidence amassed beneath indicators or metrics that become ‘data’ to prove performance. Storeng and Béhague (2014) show how a focus on ‘capacity building’ has come to mean teaching counterparts in low-income countries how to engage in evidence-based assessment by producing data-based forms of ‘proof’ or learning to translate knowledge from one form to another. Shore and Wright (1999) document the expansion of audit tools and ethos from financial accountancy into other sectors, suggesting that these enable the expansion of neoliberal forms of governance and reduce everything to quantifiable things and templates, altering the felt experience of time itself. Paperwork – and the discourse and practices of timelines and deadlines – makes time itself into an object that can generate value and forms of capital. 

Logging MSM

The MSM category is a key transtemporal hinge (Pedersen and Nielsen 2013) in paperwork projects, a site of labor, invention, performance, and imagination whose operations are foreclosed and enabled by logics and timelines of audit as manifest in geographies of aid. For instance, CEDEP receives invitations to apply for grants offered by numerous foundations and organizations. The application materials differ for each grant but, in general, CEDEP is asked to supply a concept note prior to applying for actual grants, so as to ascertain whether proposed projects align with donor interests or are fundable and feasible. Shortly after submitting this document – which often provides information about past work done by the organization, a discussion of context and the problem(s) to be solved, a rationale for the project, a sketch of project objectives, a list of proposed activities, expected results, and a budget estimate – a donor may invite the organization to submit a full application according to guidelines. Since 2008, MSM have been a dominant target population for interventions by CEDEP. In the proposal writing stage, the category acts as a hinge between past, present, and future, wherein an intervention yet to happen is imagined to, in the future, improve the life conditions or health status of the MSM population in Malawi. This, of course, relies on a projected difference between past and future, often articulated in the ‘needs assessment’, baseline study, or index study that aims to summarize the needs, gaps, or vulnerabilities of MSM. ‘MSM’, when transcribed onto paper or typed in a document, is translated from a category invested in particularity into a universal imperative, where individuals who identify or are identified as MSM become interchangeable counts, data points, or goals. This translation lies at the core of Southern organizations’ ability to perform what Ashley Currier (2012, 133) calls ‘technocratic competency’ to donors.

For example, in June 2017, I was collaborating with CEDEP staff members on a proposal to be sent to a European organization’s grants competition, which aimed to improve sexual health and well-being and advance economic justice for MSM in resource-limited settings. The proposed initiative, we wrote, sought to ‘improve the lives of Malawian MSM by linking them with job skills to enhance their economic earning power’. In addition to a written proposal, the application required a detailed logical framework and timeline that would present the objectives, activities, outputs, outcomes, and impact. (Each of these terms was listed across the top of a table with boxes beneath each to be filled in.) While the timeline – the quintessential manifestation of ‘project time’ – is a tool that makes explicit the cadence to which a proposed project will march, the logistical framework, or ‘log frame’, too, is a tool invested in modulating and synchronizing the tempos of a project. A staple of global health and development worlds, it compels an author to prospectively anticipate and narrate project activities, outputs, and goals in a way that performs logical connections between these categories and aims to make interventions coherent and rational (for a critique of the use of the log frame or logic model within international development, see Krause 2014, 70–91).

Writing the text of a proposal came much more easily to me than did populating log frame tables and timelines. Putting together dangling declarative sentence fragments that would, in the future, performatively enact that which they so authoritatively state struck me as absurd, even comical. For the activity ‘MSM needs assessment’, for example, the associated outcome was ‘MSM needs assessment produced’. Writing a log frame, then, invites authors to fabricate a future that inevitably – at least according to the present and future paperwork that converts space and time into predictable variables (Lorway and Khan 2014) – comes to be. This temporal manipulation enfolds particular paradoxes when indicators take form as counts. For example, for one activity, ‘training 100 MSM in development skills’, the output was a training conducted with 100 MSM. Here, the category MSM seems to operate technically, merely as a way to enumerate attendees of trainings. Anthropologists have shown that indicators and categories such as this are much more fraught with politics than they seem; as Merry (2016, 19) puts it, ‘[indicators] appear more accurate and precise than they are’. Categories direct the flow of aid and enfold assumptions about recipients’ worthiness or fitness (Bhungalia 2015). In his genealogy of the MSM category, Boellstorff (2011, 288) meanwhile concludes, ‘finding a terminology isomorphic with social reality is [im]possible’. 

Whereas ‘100 MSM’ may be taken as proof of an intervention’s efficacy or success by donors in distant offices, anthropologists and NGO staff on the ground are well aware that things are more complex than they seem. For actors on the ground, the flimsiness of numbers such as this one is a ‘public secret’ (Geissler 2013). The log frame populated by such numbers reveals the failure of the MSM category to describe the cultural complexity of a wide diversity of identities and practices on the ground. Yet, the category is also capacious, encompassing not only ‘men who have sex with men but do not identify as gay’ but also self-identified gay men, men who identify as mathanyula, self-identified MSM, male sex workers, beach boys, self-identified trans women, and people who identify as none of these. Further, while ‘MSM’ ‘fails’ to capture complex local sexual identities and practices, it also might operate as a kind of ‘cover’, where it becomes a safer identification than ‘gay’ for some individuals. Indeed, this capaciousness, as Graeme Reid (2013, 153–97) has likewise shown in South Africa, makes workshops into pedagogical sites that give precedence to and hierarchize particular models of categorization (see also Howe 2013). Yet, while it is important to understand exactly how and why the MSM category gets things wrong or fails to capture messy heterogeneity, it is also the case that the category does exactly what it intends to within the context of audit culture: it finds ‘commonality or some shred trait among individuals and ignor[es] difference’ (Merry 2016, 212). MSM works.

The nature of this work only becomes legible against the backdrop of the asymmetrical and power-laden formation of the performance-based aid economy. While the filled-in paperwork produced in a given week, month, or year – made to stand in for ‘success’ – captures a population or count of MSM, it likewise embeds a number of known unknowns, things that do not become data, but, when revealed, enhance our understanding of the MSM category. While many have shown how the category variously compels or encounters resistance from those it interpellates, it is also, paradoxically, something people aspire to be. Claiming ‘MSM’, or perhaps allowing ‘MSM’ to claim you, enlists one into a collective entity whose importance includes but reaches beyond biosociality or therapeutic citizenship (Rabinow 1999; Nguyen 2010). MSM is a key site of labor and value production for those who enter into its embrace: those who attend the training discussed above, for example, may receive per diems, lunch, T-shirts, transport allowances, etc., all coveted, if tiny, forms of payment for labor in a context where permanent and formal work is hard to come by. Indeed, many MSM people come to refer to their activities at the NGO as ‘kugwira ntchito’, the Chewa verb for working. In this regard, whether or not the category MSM ‘works’ to accurately describe or count the people it claims to, these people literally work with and through it.

Time is money, the adage goes. Amid an epidemic that has birthed the phrase ‘AIDS is money’, time and money have become entangled in newly complex ways. The timelines and log frames discussed above manifest the physical spaces where 100 MSM congregate over the course of three years, and also bring new tempos into these individuals’ lives: for some, previously empty time – without a job, for example – that stretched into the future now becomes punctuated by a kind of project time, in which they will attend trainings ‘to build skills for economic empowerment’ and biannual meetings to ‘exchange ideas and share challenges’. The MSM category is a technology that links together multiple temporalities and projects in the age of audit. As much as an identity or a term to describe a vulnerable population or a policy priority, MSM is also a site of labor. Analyzing in detail the people, transactions, and affects it accumulates around it reveals the paradoxes of aid economies. Amid the dominant focus on the cultural ‘contexts’ within which medicine and science operate, the larger geographies of aid in which categories such as ‘MSM’ link Northern agendas to Southern sites have been underexamined. 

Workshops and trainings

‘MSM’ denotes a risk group, an identity, a category of knowledge production, but it is also – at least in NGO worlds – a key site of value production, the motor behind the reproduction of projects, and a metric or indicator. Workshops, as Kosmatopoulos (2014) has shown, can be transported and deployed everywhere without the need for translation. They also import arrangements of time and techniques that come to be seen as technical but are moral and political, including timekeeping tactics. Indeed, workshops can be read as ritualized sites, where time is organized and measured in specific ways that deviate from those in spaces outside the workshop. The workshop is much beloved in the world of international development because it lends itself to easy enumeration in the era of audit (number of MSM trained, number of workshops held, etc.): workshops stand in as a kind of proof of project success (Smith 2003). Further, because workshops carry with them a repertoire of benefits for those who attend them (including per diems, travel allowances, meals), they are, in essence, something both donors and beneficiaries (those targeted by trainings, for example) can agree on (Swidler and Watkins 2009). 

I have attended many workshops (also often called ‘trainings’) in the course of my time with CEDEP. The content shared in these spaces varies depending on audience, but a single MSM-identified individual might be invited to attend multiple workshops on the same general topic (say, LGBTI rights or safer sex) within a year, funded by different donors in each case. The format of workshops is consistent, and embodies ‘project time’, a slice of reality to be captured and recorded onto paperwork that acts as proof that the project is following the timeline, tempos, and logic written into the log frame document. Workshops always begin with a sign-in ritual. At a workshop in June 2017 where MSM-identified peer educators were to be trained in how to counsel other MSM, for example, the first half hour was devoted to this ritual. Each person was expected to write their name in neat block letters, list their position or organization, list the amount of per diem they were to receive, indicate their phone number, and sign their name to indicate they had received the per diem. In the case of this workshop, twelve young men who identified as MSM painstakingly engaged in this ritual, listing their ‘position or organization’ as ‘MSM’. As the sheet moved slowly around the room, the staff member present surveilled the legibility of their handwriting, telling them to cross out or rewrite if she found their penmanship illegible: ‘The donors will think we are inventing MSM’, she said, in eerie resonance with Hacking’s theorizations. Meanwhile, I – or an NGO staff member, in most cases – trailed behind the sign-in sheet, tasked with counting and disbursing per diem and/or travel allowances to each participant. Digging into a bulging manila envelope, this person would pull out handfuls of greenish-yellow kwacha in 2000-note increments and count out the figure for each attendee’s per diem as set by the donor. While the ritual often engendered a kind of awkward silence, sometimes attendees would engage in spirited conversations in the register of complaint, comparing notes on past workshops where they had received a higher per diem or maligning the transport allowance for being paltry, with comments like, ‘These donors don’t know how much it is to go to town in the minibus’. From the other side of the transaction, those receiving per diems drew on memories of projects past to make moral claims in the present (McKay 2012).

In his history of paperwork, Kafka (2012, 117) suggests that it is a site in which power and knowledge are transformed or reconfigured. As others demonstrate, it is less important what documents stand for than how they arrange people around themselves (Riles 2006; Hull 2012). In the space of the workshop, the act of an attendee etching the letters of their name followed by ‘MSM’ is a conjuring trick. Following Hacking (2007, 294), we can see that the MSM category and those who write themselves into it, via this paper form, are a case study of ‘how names interact with the named’. Condensed in this tiny slice of a scene we see resonances of everything we know about the MSM category, namely the gap between it and the people it describes. Yet, the MSM category is also here a bureaucratic technology, one that produces value for donors, for the NGO, and for those who are compelled to sign in as such. All of these dynamics only become visible against the backdrop of aid geographies wherein ‘MSM’ becomes a unit of quantification or measurement of efficacy. ‘100 MSM trained’ is the always already logical outcome of paperwork. MSM cuts out a slice of reality that is of interest, bounding it off from ‘non-MSM’ who are not of interest to donors funding projects invested in sexual minorities. The neatly completed form – made authentic by multiple scrawls of individuals’ handwriting and the inclusion of a local phone number at which they can be reached – performatively enacts that which it counts; the ‘aesthetics of presentation’ embedded in the filled-in form make it legitimate and accurate (Merry 2016, 33).[note 13]In a discussion of audit processes – whereby donors send auditors, often with short notice, to CEDEP’s offices to check up on their accounting accuracy and coverage – a staff member reflected on how phone numbers are a poor measure of accountability. While donors assume they can phone those who signed in at the workshop to ascertain they actually attended, this overlooks local contingencies that make phone numbers feeble means of contacting someone months after they are recorded: people share phones; MSM attend multiple workshops within a month, and may forget which specific one is being asked after; people change SIM cards often (meaning they acquire a new number), etc. While donors may read their inability to reach someone listed as a participant in a workshop from months ago as fabricating data, in reality, phone numbers recorded on a sign-in sheet need contextualization in local relations, norms, and economies.

Directing our attention away from the intersections of categories and people and toward the intersections of categories with sociotechnical infrastructures deepens our understanding of the MSM category as bureaucratic technology; training our lens on the relations, transactions, and tempos that cohere around categories such as this likewise centers the importance of aid geographies not as backdrop to queer projects on the ground but constitutive of them. ‘MSM’ is an indicator, a metric, a technology that links together different places and people, allowing for the production of value and evidence. I have attempted to examine these processes and their entailments beyond identity, health vulnerabilities, or gaps between local and global. As much as ‘MSM’ misses its mark (and seeks out a moving target, as Hacking puts it), it also intermittently sutures together the bureaucracies and infrastructures that medical anthropologists have largely overlooked in critically theorizing the MSM category in the global South.

Project time, anthropology, value, and the MSM category

Sometimes when I sift through Google Drive folders, hard-copy documents, and correspondence that pertain to the time I have spent in or around NGO worlds in Malawi, I feel overwhelmed by the sheer weight of paperwork. I feel a creeping sense that knitting together this archive into a cohesive anthropological story is a herculean task. The tempos of my own periods of ‘fieldwork’ (mostly conducted in two-to-three–month visits and/or in email, Skype, or WhatsApp correspondence since 2013) feel out of step with the eroding, yet still pervasive temporal assumption undergirding anthropological fieldwork: ‘long term’. In Malawi, I slip easily into my role as an intern and ally – or something like it – at the NGO, getting to work writing and editing proposals that are due in less than twenty-four hours, filling in and editing log frames and monitoring and evaluation tools, traveling with staff to distant districts to help with workshops and trainings, taking notes on activities and policy meetings to be filed for later mining in preparing reports for donors, and running to the bank to collect money for per diems, stipends, and transport allowances. This congeries of activities feels affectively faster than what I imagine to be the gold star standard of fieldwork: ‘slow’. Yet, it is also satisfying in its deviation from the kinds of paperwork I participate in in my usual role as a scholar-teacher: when anthropologists submit a grant proposal, for example, we rarely hear back from ‘donors’ within two days to one month (which is common in aid worlds)!

The tempos of academia – the rush to ‘publish or perish’, the effort to meet metrics of quality and quantity, the emphasis on ‘getting good numbers’ on teaching evaluations, etc. – however, are marks of our own embeddedness in performance-based economies that seek to make us into entrepreneurial selves oriented toward the North Star of numbers. It is my entanglement in multiple performance-based economies – in academia and in aid geographies – that has made the MSM category into a site of value production in multiple registers: it has won me (and my NGO colleagues) grants, it has helped me meet publishing metrics and my NGO colleagues meet audit requirements, and it has gotten me invited to conferences and my NGO colleagues invited to workshops abroad. 

The nature of my work in Malawi, not unlike the nature of the NGO’s work, is modulated by ‘project time’, in which an accumulated archive of paperwork stands in for brief and episodic, rather than long and sustained, visits back and forth to Malawi. Yet, in some ways this timeline has proven useful, enabling me to ‘see like an NGO’, to feel acutely project time, and gain a sense of how categories such as MSM become linkages among different people, places, and projects. It has helped me cultivate new ethnographic skills, beyond describing how people really conceive of or live sexual and gendered desire and embodiment outside the MSM category. I have become an aficionado of paperwork and come to realize its crucial importance for understanding how project time intersects with categories of knowledge and value production such as MSM. I conclude with a vignette that reveals how project time, anthropological time, and categories intersect, all refracted through resources and temporalities governed by aid geographies. 

In 2018, I was awarded an anthropological grant that provided funds for a workshop, at which I could share my work with CEDEP with local academics. In crafting this workshop, I found myself wanting to also create a space where Malawian researchers might be linked in to the growing number of opportunities for the production of evidence related to key populations (in particular, MSM). In this regard, with my colleagues Alister Munthali and Gift, I organized a two-day event called ‘Workshops on Research with Key Populations’ at the University of Malawi’s Centre for Social Research (20–21 June 2019), which birthed what we have tentatively called the ‘Programme on Research with Key Populations’, a kind of think tank comprised of around fifteen scholars and members of civil society who study, work with, or have an interest in learning more about key populations. What struck me most about the form of the workshops was their resemblance to NGO workshops I had attended in the past. In line with local norms, for example, I had included in my proposed budget funds dedicated to ‘sitting allowances’ (small stipends for participating) for those who attended. At the end of the workshop on the first day, it was time for the same ritual described above: signing a piece of paper, listing one’s phone number and email, and receiving a set amount of kwacha. I realized, in this moment, that the anthropologist and the NGO are not as different as one might think or as the literature might suggest. 

My agendas and interests, and my efforts to collaborate with local colleagues, were entangled with norms, practices, and rituals established by aid economies and with the rise of the MSM category. The rich discussions, carried out over two days at the University of Malawi, oscillated between two poles: critiques, leveled by local academics, of top-down, universalizing, and essentializing categories like MSM or ‘key pops’, and interest in creating a platform that might access donor or other funds that could permit local researchers to find ways to align their own research and passions with global interest in key pops. This simultaneous critique and complicity is characteristic, I suggest, of anthropology in and of global health today. Here, I appreciate Emily Yates-Doerr’s (2019, 308) helpful suggestion that anthropologists embrace ‘careful equivocation’ in the spirit of collaborating with multiple stakeholders in global health worlds toward what she terms ‘uncommon futures’. 

My trajectory narrated here, from 2008 to the present, reveals important dynamics that arise in geographies of aid, where the tempos of projects may misalign with the projects of people, where workshops are constitutive of identities, and where categories are slippery sites of value production that link people to multiple projects at the same time. Drawing attention to project time, and offering it as an analytic, and bringing into relief the dynamics of performance-based aid economies illuminate how MSM is not merely another proliferating Northern category that fails to capture ‘real’ queers in other places. Rather, it is a category that works in all the ways I have documented here. Time and temporality, as they operate in projects, shift our attention toward when and how the MSM category is at work. The anthropologist enlisted into ‘projects’ not their own, is representative, I think, of many of us who rely on ‘captive populations’, or groups of people accessible within therapeutic settings, support groups, or organizations. Our alignment with project time and its audit logics, as much as our critical distance from them, can produce insights about categories like MSM, which we love to hate, but nonetheless link us, too, to geographies of aid, audit, and project time. 

About the author

Cal Biruk is Associate Professor of Anthropology at McMaster University. Cal is the author of Cooking Data: Culture and Politics in an African Research World (Duke University Press, 2018). Her research and teaching interests are at the intersection of medical anthropology, critical data studies, queer studies, and global health studies. Her current research projects – which focus on geographies of aid in Malawi and on theorizing wearables as queer technologies amid the second fitness boom in the United States – take the form of ethnographic treatments of metrics, indicators, and genres of measurement and counting in the era of Big Data and audit culture(s).

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