Global AIDS Medicines in East African Health Institutions

Abstract

In this introduction to the special issue, we follow the journey of global AIDS medicines into diverse health facilities in East Africa, which for decades have been subjected to neoliberal reform processes and increasing fragmentation. The introduction explores the multifaceted and multidirectional connections between global processes and their manifold articulations and experiences “on the ground.” We sketch how individuals, families, and communities dealt with HIV/AIDS-related illness and death before the scale-up of life-prolonging antiretroviral therapy programs, and describe the global policy processes that led to an influx of large volumes of donor support for AIDS treatment programs. We argue that global AIDS medicines have caused dramatic changes in institutional set-ups and care practices. The pharmaceutical medicines travel to the local health care settings with “baggage”: protocols and guidelines on who to treat and why, with strict guidelines on how to ensure adherence; and new notions of responsible and therapeutic citizens. This special issue elucidates the frictions, negotiations, and ambiguities that have shaped the incorporation of global AIDS medicines in local healthcare settings.

Key Words:

• ART administration
• donor support
• globalization
• health systems
• hospital ethnography

ACKNOWLEDGMENTS

We thank the dynamic editor of Medical Anthropology, Lenore Manderson, for her editorial suggestions and thoughtful comments on the articles in this special issue, and the anonymous peer reviewers for their constructive criticism. We are indebted to Victoria Team who kept the whole process going, in between reviews and resubmission, helping us to get the details right.

Notes

The availability of ARVs has not led to the abandonment of alternative healing practices. People continue to look for “traditional” and religious healing along with their involvement in biomedical treatment programs (see Mattes, this issue; Dilger, Burchardt, and van Dijk 2010).

This introduction makes also references to other African countries where appropriate. In the southern African region, there have been many comparable developments with regard to the incorporation of HIV in “traditional” and religious healing practices, relationships of care and support in families and communities, and the more recent introduction of ARVs.

Burials in Eastern Africa have been places of contestation even before HIV/AIDS (cf. Cohen and Adhiambo 1992). However, the large-scale dying of people from the young and middle-aged generation presented a particular challenge for the reproductive cycles and intergenerational care arrangements of rural and urban societies.

This is not to say that there was no treatment activism at all in East Africa. However, while individual activists were involved in establishing access to ARVs, the activism movement has never become as visible and strong as in southern and western Africa. Furthermore, the multiple faces of activism (e.g., from the side of religious organizations) have not been explored systematically.

These distinctions are often not as clear-cut as such labels may suggest (see Leusenkamp 2010).

Additional information

Notes on contributors

Anita Hardon

ANITA HARDON, PhD, is Professor in Anthropology of Care and Health at the University of Amsterdam, Amsterdam, The Netherlands. She conducts comparative studies of health care arrangements, including research on the global diffusion of contraceptive technologies and modern pharmaceutical medicines, and on the scaling-up of HIV/AIDS treatment programs.

Hansjörg Dilger

HANSJÖRG DILGER, PhD, is Junior Professor for Religious Diversity in Transnational Contexts, Freie Universität Berlin, Institute of Social and Cultural Anthropology, Berlin, Germany. He has conducted extensive field work on kinship, belonging, and the morality of illness and death in Tanzania.