Adia Benton's HIV Exceptionalism: Development through Disease in Sierra Leone is an indictment of so-called partnerships in global health, in which sites of exceptionalism, discordant with local realities and healthcare needs, are created around specific diseases like AIDS. Benton terms this an ‘ideological verticality, in which HIV is exceptional and requires separate funding, programs and personnel’ (p. 7). At the same time, discourses and practices around HIV/AIDS are also typified by ‘methodological horizontality’; they ‘seep into all kinds of development and health planning’ (p. 7). Her book thus seeks to, ‘describe a complex set of relationships between transnational governance, as exemplified by the HIV treatment regime and global health projects (and others associated with postconflict development)’ (p. 9). The book is organised in three clear interwoven parts: The Exceptional Life of HIV in Sierra Leone; Becoming HIV-Positive; and, HIV and Governance.

The book reads easily, is theoretically informed, and the ethnographic data, while located mainly in the capital of Freetown, is rich. For anyone who has worked in Sierra Leone her depiction of the unnecessary loss of life that results from uneven development and irrational postconflict rebuilding is true to experience. Why is HIV demarcated as ‘exceptional’ in a country with low prevalence? The question of why some bodies, impairments, and diseases matter and others do not, echoes across Sierra Leone's history; the parallel to other ‘sites of exception’ such as Ebola has already been noted.Footnote ¹ Both Ebola and HIV give rise to the indiscriminate use of a top down one-size fits all approach in postconflict contexts. The book also raises questions about the role of transnational advocacy and activism,Footnote ² revealing the need to rethink humanitarian and health interventions so that they are commensurate with local conceptions of health equity, evidence, and realities of social justice. The book does not address the history of how ‘development’ has been structured in Sierra Leone; in particular it does not draw out the importance of Poverty Reduction Strategy Papers (PRSPs) to securing aid from neoliberal institutions. It might have been interesting to explore this, as Benton has nicely in her work on Ebola.Footnote ³ Focusing more on the influence of neoliberalism might also have shed light on ambivalence directed towards the delimited ‘bio/body politics’ of the state, on the popular perception of the state as eating body parts, and on why rational behavioral change models were imposed to advocate for a politics of individual responsibility.

The histories of colonialism and neocolonialism also frame how sites of visibility and invisibility become linked to the body, impairments, and even genes (that is, sickle cell). How are those eugenic constructions reversed and repaired? One might argue for an ontological and epistemological decolonisation of health and humanitarianism in Sierra Leone. Benton cautions that hyper-visibility on a policy level in global health may not yield greater attention to the social or individual experience of living with HIV, nor produce sensitive and multifaceted ways of managing stigma. Yet, if we are thinking critically about what ontologically and epistemologically matters in the global south, in terms of understanding health, illness, disability, and explanations of unnecessary deaths, it does seem that the realms of the moral, secret, and spiritual are rather neglected here.

Nevertheless in highlighting how HIV is made exceptional Benton recovers numerous silences and opens a conversation foregrounding the unarticulated moral epistemologies people struggle with. She also adds to our understanding of why the Ebola outbreak happened, what that epidemic speaks to, and how states of exceptionalism are created. In this sense, this is currently a crucial book to read and learn from.