‘Ministry of Education, indoctrination, out! Ministry of Transportation, out! Ministry of Health, out!’ Looking like a paunchy middle-aged misfit who spends most of his time playing Doom in a dark bedroom, Milei’s infamous viral performance of ministerial purging during the 2023 presidential campaign was portentous. Since taking office, his assault on Argentina’s public health institutions has been relentless and has included measures such as withdrawing from the International Health Organisation and closing the National Cancer Institute. What is at stake, of course, is more than just public health institutions. Milei is attacking a form of ‘health citizenship’, which Carolina Biernat explores through her masterful study of the history of sexually transmitted diseases in early to mid-twentieth century Argentina.

Biernat is one of the leading historians of public health in Argentina. She has published extensively, often in collaboration with Karina Ramacciotti, on a range of themes including the history of child and maternal health, the history of nursing, and the history of social policy, as well as earlier work on migration policy during the ‘first Peronism’. In her latest work, Ciudadanía enferma, she turns to the history of venereal disease in Argentina. Argentina has the most developed historiography on public health and medicine of all Latin American countries. The literature on venereal diseases such as syphilis and gonorrhoea, often connected to the history of prostitution and sexuality, has received extensive attention from scholars such as Donna Guy, Cristiana Schettini, Natalia Milanesio, Maria Luisa Múgica, and Patricio Simonetto, among others. Biernat builds on this work, but her study draws particular and compelling attention to ‘the sociocultural construction of [venereal diseases] within the framework of the reconfiguration of citizenship’ (p. 13).

Going beyond a focus on either the top–down imposition of medicalised gazes and practices or the bottom–up resistance to the construction of a public health order, Biernat considers how ideas, policies and practices shaped the development of what she terms ‘ciudadanía sanitaria’, health citizenship, in Argentina. Over five chapters, she traces how the policies introduced to address the spread of venereal diseases, in particular the measures associated with the 1936 Law of Venereal Prophylaxis (law 12.331), both reflected ideas about, and helped establish, a notion of health citizenship. At the same time, she is careful to draw attention to the agency of various actors, from doctors to sex workers, in negotiating the terms of inclusion and exclusion from this form of citizenship. In so doing, she draws on an extensive and varied set of sources, combining cultural and social history approaches effectively.

In chapter one, ‘Imagining’, for example, Biernat contrasts how the venereal subject (i.e. the person afflicted with a sexually transmitted disease) was represented in adverts for treatments developed by pharmaceutical laboratories in periodicals, on the one hand, and in the posters developed by public health agencies charged with implementing the state’s anti-venereal campaigns, on the other. Whereas the adverts focused on a stigmatised individual responsible for their own health, the posters imagined the venereal subject as a social actor with responsibility towards the national body. Biernat extends the analysis by exploring the letters that individuals sent to the periodical Cultura Sexual y Física in the 1940s, where they discussed their symptoms and sought advice on treatments, in a manner that expressed a certain resistance to submitting to medical treatment. Biernat compellingly concludes that ‘it is the representation of illnesses themselves, the resistance to medicalisation, the search for alternative explanations and treatments, and the demands of the sick that constituted them as subjects of health citizenship’ (p. 50).

In chapter two, ‘Curar’, Biernat reads Argentina’s move from regulationism (the tolerance of prostitution as a ‘necessary evil’ resulting in a system of regulated brothels and registered prostitutes often managed at the municipal level) to abolitionism (the abolition of the system of regulation, though not the prohibition of prostitution itself) as marked by the 1936 Law of Anti-Venereal Prophylaxis, as reflective of greater state intervention in the sphere of public health. This resulted in a process of centralisation through the Departamento Nacional de Higiene, which developed a national plan that sought to provide treatment and drugs such salvarsan and later penicillin in order to address the threat of venereal disease to the national body. With the Peronist government (1946–1955), a discourse of the ‘right to health’ started to take hold, giving new meaning to expanding state capacity in the field of public health. As Biernat notes, with Peronism: ‘The well-being of the population did not arise from a welfare intervention by the State, but from the recognition and guarantee of citizens’ rights’ (p. 77).

Chapters three, ‘Prevenir’, and five, ‘Aislar’, examine the mechanisms used to implement the provisions of the 1936 law, through programmes of sex education and the introduction of a prenuptial health certificate (intended to screen for venereal diseases – only demanded of men) and through medical isolation and compulsory treatment of those deemed infectious. Biernat points to the ambitions of such measures as well as to their limits, which resulted from the actions of numerous actors, including women who sold sex, as well as from the limited capacity and funds that were devoted to them (only one dedicated centre for compulsory treatment was established, the Sanatorio de Previsión Social de Cordóba). In chapter four, meanwhile, Biernat turns to legal sources to examine the judicialisation of venereal contagion, as envisaged by the 1921 Penal Code and the 1936 law. These legal sources offer a fascinating perspective on how judges, doctors, and those afflicted with a venereal disease shaped the developing notion of health citizenship in the legal sphere through the ways in which they intervened in court cases.

In short, Biernat’s study of venereal disease policy in Argentina in the first half of the twentieth century offers fascinating insight into the development of that country’s ‘ciudadanía sanitaria’. Far from romanticising such a notion, Biernat is attentive to the many exclusions that such a development involved – throughout she notes the androcentric focus of policies targeting venereal diseases (with men as the agents of national progress) and the discursive construction of agents of ‘unhealthy citizenship’ (ciudadanía enferma), from sex workers to foreigners, that the actions of the state was supposedly overcoming. She is equally attentive to the many limits of the measures studied, as I have indicated. Crucially, she shows, this was not a simple story of top–down state building – citizenship was demanded and shaped from below. This form of health citizenship, the notion – though imperfectly translated into actual policies – that health is a right extensive to all citizens, had stood out as a distinctive achievement within the Latin American context, which Argentina’s recurrent economic and political crises had not succeeded in fully undermining. That, of course, is Milei’s goal.