Mobilising and Mediating Global Medicine and Health Citizenship: The Politics of AIDS Knowledge Production in Rural South Africa

Abstract

About IDSThe Institute of Development Studies is one of the world's leading organisations for research, teaching and communications on international development. Founded in 1966, the Institute enjoys an international reputation based on the quality of its work and the rigour with which it applies academic skills to real world challenges. Its purpose is to understand and explain the world, and to try to change it -to influence as well as to inform.IDS hosts five dynamic research programmes, five popular postgraduate courses, and a family of worldclass web-based knowledge services. These three spheres are integrated in a unique combination -as a development knowledge hub, IDS is connected into and is a convenor of networks throughout the world.The Institute is home to approximately 80 researchers, 50 knowledge services staff, 50 support staff and about 150 students at any one time. But the IDS community extends far beyond, encompassing an extensive network of partners, former staff and students across the development community worldwide. This publication is copyright, but may be reproduced by any method without fee for teaching or non-profit purposes, but not for resale. Formal permission is required for all such uses, but normally will be granted immediately. For copying in any other circumstances, or for re-use in other publications, or for translation or adaptation, prior written permission must be obtained from the publisher and a fee may be payable. Minimum SummaryThe paper investigates the ways in which global health messages and forms of health citizenship are mediated by AIDS activists in rural South Africa. It focuses on how international health agencies and NGOs engage with local communities through AIDS prevention and treatment programmes. Some critics regard such global health programmes as conduits for the medicalisation of social life and social problems. From this perspective global medicine is an all-encompassing process that results in systematic normalisation, depoliticisation and disempowerment of patients and citizens. However, this case study draws attention to the agency of the 'targets' of biomedicine. It also highlights the observation that AIDS activists and treatment literacy practitioners are not only concerned with biomedical matters, but are also committed to recruiting new members into their biopolitical projects and epistemic communities. These mobilisation processes involve translating and mediating biomedical ideas and practices into vernacular forms that can be easily understood and acted upon by the 'targets' of these recruitment strategies. However, these processes of 'vernacularisation' or localisation of biomedical knowledge often occur in settings where even the most basic scientific understandings and framings of medicine can not be taken for granted. This ethnographic case study shows that global health programmes, and their local NGO and social movement mediators, often encounter considerable 'friction' not only from powerful national state actors, who may view such prog...

Negotiating therapeutic citizenship and notions of masculinity in a South African village

“…While his work reinforces the main claims made by Nguyen (2005) about the impact that an HIV diagnosis has in transforming a patient's subjectivities and in promoting activism, he remains critical of this concept, in particular in his more recent research with men (Robins, 2009a) and with HIV activists in rural areas of the Eastern Cape Province (Robins, 2009b). His earlier work (Robins, 2005) was conducted in rural and semi-urban areas in South Africa.…”

“…In this regard Robins (2009b) showed that ART activists working in rural settings are subject to 'stiff opposition' from village actors as well as national state actors whom they attempt to recruit into the 'biopolitical projects and epistemic communities.' The resistance is manifest in the form of villagers rejecting scientific authority on HIV and the treatment communicated by the activists, in favour of embracing other explanations of HIV and AIDS and ill health in general -such as belief in witchcraft and the power of traditional medicines.…”

Narratives of HIV disclosure and masculinity in a South African village

“…In this capacity, disclosure may lead to confrontations between activists and their peers, who prefer to deny their health needs as a way to maintain a 'strong' and 'independent' front. According to Robins (2009b), HIV treatment activists received harsh resistances from their communities when they attempted to change communal traditional beliefs about AIDS.…”

Engagements with a Productively Unstable Category: Anthropologists and Nongovernmental Organizations

“…Some authors note the role that for-eigners play in brokering relationships with transnational donors (Davis 2003) or how NGOs fulfill roles typically reserved for states before neoliberalism (Richard 2009). Local populations (Rossi 2006) as well as NGOs (Robins 2009a) were shown to have the ability to shift the contours of international aid. NGOs can be the "glue" to a fragmented neoliberalism (Schuller 2009) or the "friction" as groups across national and cultural boundaries interface (Tsing 2005).…”

“…How does do-gooding relate to similar collective activity? One point of comparison could be that, whereas a social movement is expected to move, NGOs institutionalize: NGOs create projects (Freeman 2014;Lwijis 2009), write reports (Hodžić 2011), respond to auditors (Shore and Wright 2000;Strathern 2000), mediate contact (Robins 2009b;Schuller 2009), and so on. Even in this more focused discussion, it would be misguided to look for rigid criteria that must always be met.…”