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Abstract
The provision of free anti-retroviral treatment for AIDS in Zanzibar since March 2005 is the result of enormous struggles at a global scale and has provided immense relief for sufferers. At the same time, the new “medicines of hope”, as they quickly became known, have produced new uncertainties about how best to respond to HIV/AIDS, both for the infected individual and for the society at large. ART programmes make possible a biologised, pharmaceutical life. Drawing on three case studies this paper shows how HIV-positive people struggle to make decisions in an environment characterised by deep uncertainties about the nature and causes of HIV/AIDS in particular, and about the continuity of Zanzibari society in general. It argues that health interventions cannot be orientated to “life itself”; they must be attuned to the contexts in which life takes place. Analysing people's actions and behaviours in the context of their lives-as-lived throws light onto apparently irrational decisions and emphasises the importance of an in-depth understanding of local moral worlds and social contexts.
Notes
1. For a detailed account of the global AIDS Treatment Access Movement, albeit presented largely from a US point of view, see Smith and Siplon Citation2006.
2. UNAIDS, Together We Will End AIDS, 9.
3. UNAIDS Press Release, “Inaugural Global Scientific Strategy.”
4. WHO News Release, “‘Strategic Use’ of HIV Medicines.”
5. Biehl, Will to Live.
6. Biehl, Will to Live; Nguyen, The Republic of Therapy.
7. Cf. Parker et al., “Border Parasites”; Allen and Parker, “The Other Diseases of the Millennium Development Goals” and “Will Increased Funding … Make Poverty History?”
8. Allen and Parker, “Will Increased Funding … Make Poverty History?”
9. Whyte, “Chronicity and Control.”
10. Rose, The Politics of Life Itself.
11. Fassin, 2009: 48.
12. Fassin, 2009: 48.
13. Schenker, HIV/AIDS Literacy, 3.
14. Kleinman, “Concepts and a Model”.
15. Beckmann, “Responding to Medical Crises” (Citationforthcoming).
16. Niehaus, “Part I: Bushbuckridge”, 18.
17. McNeill and Niehaus, “Conclusion”, 119.
18. Cf. Leshabari et al., “Youth Mobility and Unprotected Sex.”
19. UNAIDS, Report on the Global AIDS Epidemic 2008, 215.
20. ZAC, Report on Situation and Response Analysis of HIV/AIDS in Zanzibar, 1.
21. Beckmann, “AIDS and the Power of God.”
22. TACAIDS/ZAC/NBS/OCGS/Macro International Inc. 2007.
23. Beckmann, “AIDS and the Power of God.”
24. Vaughan, Curing Their Ills, 13.
25. Nisula, Everyday Spirits and Medical Intervention, 244. Some observations on patterns of condom use in casual sexual encounters on the tourist beaches in Zanzibar suggest that these racial notions still live on today: several backpackers said they often used condoms with African lovers, less frequently with other white travellers.
26. Vaughan, Curing Their Ills, 66–67. Note, for example, reports from the Zanzibar Medical Officer in which the prevalence of venereal diseases was attributed to the natives – particularly the women – being ignorant, immoral and engaging in casual prostitution (Nisula, Everyday Spirits and Medical Intervention, 243).
27. Iliffe, East African Doctors, 223.
28. Rakelmann, “Local Interpretations of AIDS in Botswana”, 45–6.
29. Cf. Farmer on tuberculosis and antiretroviral treatment (Infections and Inequalities, 191–9, 208, 268–71).
30. Rose and Novas, “Biological Citizenship.”
31. WHO, From Access to Adherence, 1, 7
32. Nguyen, “Antiretroviral globalism, biopolitics, and therapeutic citizenship”, 139.
33. Farmer, Infections and Inequalities, 266–71.
34. One may only think of the allegedly free provision of education and health care, which in fact both had to be paid for.
35. Whyte, et al., The Social Lives of Medicine.
36. Whyte et al., “Treating AIDS.”
37. Biehl, Will to Live.
38. Babu, “The 1964 Revolution.”
39. Payments usually ranged between TSH 150000 and TSH 500000 – expensive, but not unaffordable. Many of my informants had mobilised their social networks to raise it.
40. Parkin, “In Touch Without Touching.”
41. Allen and Parker, “Will Increased Funding … Make Poverty History?”