No abstract

This article examines the everyday work of participating in pharmaceutical treatment for HIV infection in the context of urgent calls for adherence. Drawing on interviews and focus-group conversations with people taking antiretroviral drugs, the analysis explicates the work that goes into striving for adherence. What comes into view is a form of time work that brings about a temporary alignment between the inner experience of time, standard clock time, and the requirements of the medication schedule. Time work is largely cognitive; the pills, however, must actually be swallowed to complete the dose, occasioning, for some people, additional work to suppress or refashion emotional responses of anger and resistance. Both the time work and the emotional work of taking antiretroviral drugs draw people into forms of self work, including self-examination and self-adjustment, as they develop strategies for 'doing adherence'.

This article responds to a recent call for detailed analyses of research processes that link the intellectual resources of the academy with communities and popular movements. Our discussion focuses on our experiences with the Making Care Visible (MCV) Project, a communitybased, qualitative research initiative conducted in Toronto, Canada, that explored the work people living with HIV/AIDS (PHAs) do to look after their health. This article focuses on the doing of the MCV Project and, in particular, on our use of the concept 'health work'. Our central aim is to demonstrate how the concept methodologically grounded the politics of our research efforts at various stages of our work. To this end, we describe how we used the concept in starting our research, selecting participants and carrying out interviews. Drawing on interview excerpts from Making Care Visible: Antiretroviral Combination Therapy and the Health Work of People Living with HIV/AIDS, we also describe a set of reading practices that helped produce an analysis of the social organization of health work and the ruling character of formal discourses of knowledge about treatment decision making. Overall, our discussion suggests how a particular form of critique is made possible by the conceptual coordination of research practice through the notion of health work.

The doctor-patient relationship and the medical consultation are important resources for the health work of people living with chronic illness. In this article, the author examines physician-based outpatient health care from the standpoint of women and men who live with HIV in conditions of economic and social marginality. She draws on focus group and interview conversations with 79 HIV-positive individuals in southern Ontario. Using the approach of institutional ethnography, she offers a close reading of patients' descriptions of what they consider good doctoring. Areas of best practice that enhance access to health care examined here include doctors' interactional styles, ways of providing treatment options and treatment information, and ways of addressing the specific needs and life circumstances of patients living in poverty and social marginality.

The established social critique of compliance was written in the late 1970s and early 1980s by a group of sociologists and anthropologists. Drawing on a humanist perspective, it argued that compliance operated as a form of medical control over patients that ignored their experiences of medications or defined them in terms of professional expectations. In this paper we draw on the theoretical work of Smith and Foucault and on original research on the 'healthwork' of people living with HIV/ AIDS to revise this critique. Our analysis foregrounds the heterogeneity of power relations exercised through contemporary relations of compliance/adherence. We argue that in the contemporary context of HIV/AIDS, compliance/adherence operates as a fundamental discursive ground of people's healthwork and is constitutive of, rather than hostile to, experience and the self. Considered as a technology rather than concept, adherence groups together a host of strategies designed to cultivate a particular relation of self to treatment in ways that do not operate with the uniform force suggested by the early social critique. At the same time, compliance is not simply about liberal forms of self-governance. It is a site where multiple forms of power-biomedical authority, population-based forms of risk governance, and liberal techniques of the self-intersect in relations of tension, negotiation, and support.