Global expectations and local practices: HIV support groups in the Gambia

Abstract

This paper looks at the ways that people living with HIV in the Gambia, as members of HIV support groups, engaged with the programmes available to them in this context. People living with HIV engage with the global in a variety of ways. Following Ong and Collier this paper analyses the way in which people in this context experience and negotiate with the “global assemblage” around international HIV work. This can be observed in everyday practice in the formation of networks and partnerships linking people and their activities into international structures. Using qualitative methods and a grounded theoretical approach, the research followed events around HIV treatment in the Gambia 2006–2007. Looking at the support societies and their members' struggles to gain some material support, findings show how support group members negotiated and expressed agency within the available structures. They make use of accepted frames of international action which bypass the state, presenting an internationally linked “biological citizenship” which brings associated opportunities to access resources. Through the intervention of the president and his “cure” programme, this case also illustrates that people's commitment to the value structures implicit in these funding streams may not be as strong as might be assumed. In these circumstances two alternate treatment programmes, linked to very different values, were on offer, both backed up by the powerful machinery of either the state or international funding. The negotiation by people living with HIV of these avenues through which to acquire benefits and so support and health, calls into question assumptions of a “buy in” to global ideas and values without further scrutiny of the ways in which such assemblages function in different contexts.

Keywords:

• people living with HIV
• support groups
• networking
• global funding and programming

Notes

1. The Global Fund for AIDS, TB and Malaria.

2. “Hundreds accused of witchcraft persecuted in The Gambia”, Amnesty International, 18 March 2009. Retrieved from http://www.amnesty.org/en/news-and-updates/news/hundreds-accused-witchcraft-persecuted-gambia-20090318

3. GAMbian Network of AIDS Support Societies.

4. One clinic had previously had a policy of having “peer counsellors” and reintroduced it around this time; another took on two counsellors, one male one female who worked with the existing counselling team. This was a new development for them, but one which they took on enthusiastically. The third never introduced any kind of peer counselling in their clinic. A major advantage was seen in counsellors being able to say “I have this thing”, and particularly for the women in PPTCT that they could talk to someone who had been through the process themselves.