Graduation Year


Document Type




Degree Granting Department


Major Professor

Nancy Y. Romero-Daza


Food insecurity, HIV/AIDS, International development, Southern Africa, Water insecurity


In spite of decades-long development programs, Lesotho faces an ongoing problem of water insecurity with far- reaching individual and social impacts. The purpose of this research was to understand how women in Lesotho are impacted by the synergistic epidemics, or syndemics, of water insecurity and HIV/AIDS and how they respond to these forces. Little has been done to address how water insecurity, defined in terms of both sufficient amount and quality of water, catalyzes the syndemic impact on the people of Lesotho. Access to safe and reliable sources of water is crucial for all individuals, particularly those who have been affected by the HIV/AIDS epidemic. First, water is essential for adequate nutrition since it is required for the growing of agricultural products and for the preparation of adequate foods needed to maintain the nutritional health of those already infected with the virus. Second, food and water security is essential for the treatment of AIDS, as the complex drug regimes of anti-retroviral (ARV) medications require reliable and constant access to safe water and nutritious foods to facilitate compliance with medications.

This research was also concerned with understanding the psycho-emotional experience of water insecurity. Water insecurity constrained people's ability to effectively care for their families and, as a result, created additional work and stress. Indeed, quantitative findings revealed that there was a significant relationship between water insecurity and psycho-emotional distress, and that water insecurity predicted higher scores on the Hopkins Symptoms Checklist (HSCL-25), holding constant socio-economic variables and food insecurity. Water security is dependent on many dimensions from adequate availability, secure access, and having enough water for one's daily needs. However, worry about water safety emerged as an important focus in both the qualitative and quantitative data. Water safety was a noted stress in people's daily lives, and significantly predicted increased scores on the HSCL-25.

More broadly, this research theoretically informs critical medical anthropology and development anthropology. While this research was conducted in three villages in the Lesotho lowlands, this research must be contextualized within larger anthropological theory regarding international development and women in relation to it. This research combines several theories used in anthropology, international development, and social geography including political economy and structural violence, post-structuralism and governmentality, and theorizations about space and place to understand how women in Lesotho respond to globalization.

Despite the proliferation of the terms participation and participatory development nearly 20 years ago, these constructs remain important in international development. While the ideology of participation originally stems from activist understandings of the role of communities in development, the use of participation has become depoliticized. As opposed to grassroots mobilization and the foregrounding of local realities, participation often means little more than a method for facilitating project implementation. Furthermore, respondents routinely discussed programs coming into communities and leaving without notice or explanation. It is imperative for donor organizations to consider the ethics of sustainability when planning and implementing new programs. In terms of community programs and grassroots organizing, findings from this research indicate that there are many material and social barriers to participation. Understanding not only women's other responsibilities but also the support they may receive from family and friends is important in any discussion of community participation.

Many feminist critics of development argue that gender and class considerations have not been meaningfully addressed in policy and development programs. As global feminists argue that development aims should understand the heterogeneity of women worldwide, more research on women's perceptions of their vulnerability and their position in society is needed to inform development. Women in the global South are not passive victims and their views are important in delineating the goals and methods of development plans. Furthermore, it is important to recognize that participation may not always be in women's, or men's, best interest and that often activism and collective organizing may be more subtle than expected. In short, neither globalization nor resistance are complete power is contingent and negotiated, and thus this research reaffirms the importance of ethnography in uncovering the lived experience of globalization, or a critical ethnography of globalization.