When Diabetes Confronts HIV: Biological Sub-citizenship at a Public Hospital in Nairobi, Kenya


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.