No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
Pharmaceuticalization: AIDS Treatment and Global Health Politics
Abstract
This article examines the political economy of pharmaceuticals that lies behind global AIDS treatment initiatives, revealing the possibilities and inequalities that come with a magic bullet approach to health care. It tells how Brazil, against all odds, became the first developing country to universalize access to antiretroviral drugs—a breakthrough made possible by an unexpected alliance of activists, government reformers, development agencies, and the pharmaceutical industry. The article moves between a social analysis of the institutional practices shaping the Brazilian response to AIDS and the stories and lives of people affected by it. It draws from interviews with activists, policy makers, and corporate actors and from longitudinal ethnographic work among grassroots AIDS care services.
Pharmaceutical innovations allow unlikely coalitions that both expose the inadequacies of reigning public health paradigms and act to reform, if to a limited extent, global values and mechanisms (of drug pricing and of types of medical and philanthropic interventions, for example). Treatment rollouts are matters of intense negotiation; their local realizations are shaped by contingency and uncertainty. Such realizations encode diverse economic and political interests, as well as the needs and desires of citizens. These therapeutic coalitions also expose the deficiencies of national and local infrastructures and consolidate novel state-civil society relations.
A pharmaceutically-centered model of public health has emerged as a byproduct of AIDS treatment scale-up and the sustainability of the Brazilian AIDS policy has to be constantly renegotiated in light of global drug markets. A multitude of networks and variations in AIDS care have emerged on-the-ground, and the article explores why AIDS treatment has been so difficult to put into practice among poor Brazilians, who are often stigmatized as noncompliant or untreatable, becoming invisible to the public. Poor AIDS patients live in a state of flux, simultaneously acknowledging and disguising their condition while they participate in local economies of salvation. At both the macro and micro levels, we see a state of triage and a politics of survival crystallizing.
... This article aims to address the process through which ART rollout has altered the actions and engagements of those affected by HIV (Nguyen 2010;Whyte 2014b;McKay 2018). It also illuminates how the process transformed the modes of HIV intervention and how these embraced or rejected sufferers' voices (Biehl 2007). ...
... In terms of situated engagements and normative claims, the rollout of the free nationwide ART program in Ethiopia profoundly altered the forms of HIV care. I argue that this process has largely been facilitated by "new prevention technologies" (Nguyen 2015, p. 50), which accompanied the scale-up of HIV treatment in South Africa (Mahajan 2018), Brazil (Biehl 2007), and elsewhere in the Global South. Such technologies include treatment-as-prevention (TasP), pre-exposure prophylaxis (PrEP), prevention of mother-to-child transmission (PMTCT), and voluntary male circumcision. ...
... However, during the following years, Meseret found her association increasingly marginalized and defunded within the "pharmaceutically-centered model of public health," which emerged as a byproduct of the ART scale-up (Biehl 2007(Biehl , p. 1119. 20 Meles served as the Prime Minister of Ethiopia from 1995 until his death in August 2012. ...
Over the last decades, there has been a worldwide rise of new technologies for controlling the HIV epidemic by expanding antiretroviral medicines. This article examines how the pharmaceutical-driven model of public health, which emerged as a byproduct of antiretroviral treatment (ART) scale-up in Ethiopia, interplayed with local forms of actions, engagements, and voices through which suffering inflicted by the epidemic was cared for. Through the eyes of an Ethiopian woman with HIV, this article illustrates how the increasing emphasis on ART facilitated the defunding of some community-based care practices. Moreover, it rendered the realities of precarious life with HIV invisible in the landscape of therapeutic citizenship. However, for Ethiopians, ART scale-up unfolded amid multiple forms of HIV care practices and relationships that endured stigma, alienation, and uncertainty before and after ART. The experience of surviving the HIV epidemic in Ethiopia provides a vital premise upon which claims of meaningful care are made, and ways to otherwise develop healthcare actions and engagements are sought.
... Estas agências partiram da premissa de que seria possível garantir a segurança ao incluir na análise uma população grande o suficiente gerar estatísticas e para possibilitar uma comparação entre os grupos placebo e ativo envolvidos no ensaio. Entretanto, os/as antropólogos/as têm ILHA -REVISTA DE ANTROPOLOGIA Florianópolis, v. 25, n. 1, e91717, p. 263-285, janeiro de 2023 criticado estes ensaios por tomarem como ponto de partida um corpo biológico universal, ignorando as condições sociais e infraestruturais que influenciam as maneiras como as tecnologias atuam, e por desconsiderarem os benefícios do efeito placebo (ADAMS, 2016;BIEHL;PETRYNA, 2013;EPSTEIN, 1998;SAETHRE;SADLER, 2010). Essas críticas apontam para a necessidade de novas abordagens conceituais que reconheçam que a eficácia é mediada pelo contexto e influenciada pelas expectativas e pelas práticas dos usuários (BRIVES et al., 2016;HARDON;POOL, 2016). ...
... Ele ressalta que essas manobras na regulamentação são atos políticos pesadamente influenciados pelos interesses de corporações multinacionais. Assim como Biehl (2007) mostra como a saúde é crescentemente farmaceuticalizada, Sunder Rajan (2017) desvenda a captura progressiva da saúde pelo capital, um processo no qual a saúde funciona como um index cujo valor pode ser avaliado nos termos estabelecidos pelo mercado. As regulamentações transnacionais envolvidas neste processo incluem direitos sobre propriedade intelectual e acordos comerciais que regulamentam por quanto tempo os detentores de patentes de longo prazo podem manter direitos sobre novas entidades químicas, bem como demandas complexas a respeito de como as pesquisas clínicas devem ser conduzidas ('T HOEN, 2002;DAVIS;ABRAHAM, 2013;BANERJEE, 2016). ...
Esta revisão aborda um conjunto crescente de trabalhos situados na intersecção entre a antropologia e os estudos sociais da ciência e tecnologia (CTS) que examinam como as drogas são tornadas eficazes nos laboratórios, em contextos terapêuticos e na vida cotidiana. Essa literatura ressalta como os interesses comerciais e as preocupações sociais modelam os tipos de efeitos farmacêuticos que são colocados em prática, e como certas eficácias são bloqueadas devido a questões morais. Os trabalhos reunidos aqui revelam como as instituições reguladoras e os atores envolvidos nas políticas públicas de saúde tentam estabilizar as ações farmacêuticas. Ao mesmo tempo, nas linhas de frente do cuidado, farmacêuticos, trabalhadores da saúde e usuários procuram ajustar as dosagens e as indicações, buscando adaptar as ações farmacêuticas a circunstâncias específicas. Nós mostramos que não existe um objeto (farmacêutico) puro que precede sua socialização. Os fármacos não são “descobertos”; eles são constituídos e reproduzidos em relação a contextos mutáveis. Esta revisão delineia cinco áreas-chave nas pesquisas etnográficas e nos estudos CTS que examinam tais drogas fluidas.
... En este movimiento reducen la asistencia sanitaria a la distribución y consumo de medicamentos y obstaculizan la figuración de sistemas sanitarios no estructurados en torno a los fármacos (Gaudilliere y Sunder-Rajan, 2021). particular del proceso de farmaceuticalización de las sociedades actuales, proceso por el cual distintas esferas de la vida cotidiana y de las capacidades humanas son redefinidas como problemas abordables farmacológicamente (Abraham, 2010;Bell y Figert, 2012;Williams et al., 2011), y comparte con ellos la característica de ubicarse en la encrucijada de procesos de globalización y mercantilización de la salud y de las propias experiencias humanas (Biehl, 2007;Nichter, 2003;Petryna y Kleinman, 2006). ...
Este trabajo tiene como objetivo problematizar la cuestión de la subjetividad que se despliega y transforma en el encuentro con los procesos de farmaceuticalización y que se ha identificado con la emergencia de un “sujeto farmacológico”. Como estrategia metodológica se expone y analiza la narrativa de Lucía, participante de una investigación cualitativa realizada en Montevideo entre 2015 y 2017, en la que se indagaba acerca de las significaciones del consumo de psicofármacos ansiolíticos. Para esto, se recurre a las elaboraciones del psicoanálisis acerca del malestar en la cultura, del sujeto y del goce con el propósito de imprimirle un nuevo giro a las críticas que desde este territorio se realizan a la psiquiatría biológica y a la tecnología psicofarmacológica. Los resultados muestran cómo se entrelaza el consumo de psicofármacos con la vida de la protagonista, con las preguntas que ella se hace sobre la causa de su malestar y sobre sí misma, con sus fantasías, deseos, dudas y vacilaciones. Concluimos que, en contraposición a la desaparición del sujeto que desde filas del psicoanálisis se ha anunciado, los procesos de farmaceuticalización, aún en la insuficiencia del fármaco y del discurso biomédico del que se sirven, ofrecen nuevas oportunidades de devenir sujeto y de articulación del deseo que se instauran, no sin contradicciones e incluso al límite de la existencia.
... In diverse societies, community leaders play a pivotal role in bridging the gap between governments and the grassroots. Brazil's strategy of involving local community leaders in public health campaigns led to increased vaccine uptake and trust in health services (Biehl, 2007). Similarly, South Africa can benefit from engaging traditional chiefs, religious leaders, and local influencers in dialogue, ensuring policies resonate at a community level. ...
The research study provides an in-depth analysis of South Africa's political landscape from 2024 to 2029, focusing on the "soft transition" phase. It discusses the historical dominance of the ANC, its challenges, and the evolving political dynamics influenced by a younger, urbanized, and digitally connected population. The report outlines the potential for gradual realignment of power and the necessity for nuanced leadership to navigate the socio-political, economic, and cultural changes anticipated during this period. It emphasizes the importance of collaboration, inclusivity, and strategic planning in fostering a stable and prosperous future for South Africa, urging stakeholders to prepare for both immediate and long-term transformations.
... For us, however, the political economy of pharmaceuticals was not simply a matter of unequal access to medicines; this was also a field in which claims and counterclaims about counterfeit and fake-ness came to thrive. Here, our focus was on how official policy and public health discourse provided an important context for people to make sense of their own everyday pharmaceutical worlds as well as how people moved beyond official messaging (Baxerres and Cassier 2021;Biehl 2007;Cassier and Correa 2019;Cloatre 2013;Dumit 2012;Ecks 2008Ecks , 2013Gaudilliere and Sunder Rajan 2021;van der Geest, Whyte, and Hardon 1996;Greene 2016;Sunder Rajan 2017;Hardon and Sanabria 2017;Hayden 2007Hayden , 2013Hsu 2009;Lakoff, Petryna, and Kleinmann 2006;Whyte, van der Geest, and Hardon 1996). ...
Introduction to the Special Section 'The Long Shadow of Fake Drugs and the Social Lives of Fake-ness', guest edited by Sarah Hodges and Julia Hornberger.
... Em um contexto de privação de recursos e de longas esperas, o dispositivo revolucionárioporém-familiar era a solução perfeita para médicos, gestores de saúde e, claro, para as mulheres. Como a pílula-mágica dos processos de farmaceuticalização (Biehl, 2007), o Essure poderia solucionar rapidamente a demanda por esterilizações sem necessidade de modificações estruturais nos cuidados em saúde. ...
Entre 2012 e 2016, cerca de 2.500 mulheres tiveram o dispositivo contraceptivo Essure implantado no serviço público do Distrito Federal. Embora tenham inicialmente confiado na avaliação dos profissionais da Secretaria de Saúde distrital, as pacientes foram submetidas a reiteradas situações de injustiça epistêmica ao queixar-se de efeitos adversos atribuídos ao dispositivo. Neste trabalho, analiso dois eventos públicos e argumento que, em resposta à quebra de confiança na Secretaria, as mulheres vítimas do Essure passaram a reivindicar um espaço de credibilidade no debate sobre essa tecnologia, questionando a autoridade técnico-científica da instituição e tensionando as relações epistêmicas estabelecidas. .
... Medical anthropology has long emphasized the need to consider the relationship between health system deficiencies and historic processes of structural violence (Farmer 1996). This means accounting for how economic pressures shape material realities of illness, care and (perceived) needs for medication (Biehl 2007). We argue that Spain's and Catalonia's socio-economic history shapes the situated circumstances in which antibiotic prescription and use occur. ...
RESUM
Relacionada amb l’ús extensiu d’antibiòtics i altres antimicrobians, la resistència als antimicrobians és un dels principals reptes de la salut del segle XXI. Les taxes de consum d’antibiòtics a Espanya es troben entre les més altes d’Europa. A partir de la recerca realitzat a la comunitat autònoma de Catalunya, aquest article informa de les conclusions del treball de camp etnogràfic i de les entrevistes semiestructurades amb metges, amb professionals que han treballat en política i recerca d’antibiòtics i amb residents de Barcelona. Defensem que la circulació d’antibiòtics s’ha d’entendre en relació amb els processos històrics més amplis i els sistemes deficients d’atenció sanitària i social que s’han produït al llarg d’aquests.
... Por exemplo, em estudos de imagem do cérebro para TDAH -transtorno amplamente farmaceuticalizado desde sua inserção no manual diagnóstico DSM-IV, ainda que sua primeira versão, TDA, já havia sido inserida em 1980, no DSM-III-supostamente para detectar bases bioquímicas para a condição e efeitos da droga, faltou reprodutibilidade e rigor experimental no tamanho da amostra e na correspondência das idades em grupos de controle e teste (BIEHL, 2007e BARSKY e BORUS, 1995. Além disso, uma vez que a medição direta dos níveis de dopamina no cérebro não poderia ser colhida de pessoas vivas, necessitaram ser inferidos a partir de metabolitos de dopamina no sangue, urina ou líquido cérebro-espinhal -cuja validade de tal medida foi, e continua a ser, questionável. ...
... Though his doctors at the inpatient ward were actively treating his depression, persistent psychotic phenomena, and the sleeplessness that plagued him, the medications meant to address his psychological problems were usually managed by the doctor who oversaw his daily visits to the methadone clinic. Opportunities to pursue psychotherapy and other forms of socially engaged treatment were also comparatively limited, winnowed down by the slow creep of austerity in postdeinstitutionalisation Ireland and what João Biehl (2007) has called the 'pharmaceuticalization' of clinical infrastructures. The clinical response to Sean's substance-use disorder, depression, and psychotic experiences was more medication, sometimes without a long-term consideration of the interactions of the drugs themselves or their effects upon Sean's sense of personhood and self. ...
This research article investigates moral agency in the spaces between the methadone clinic and the inpatient psychiatric ward by exploring the ways dually-diagnosed service users move though ever-more labyrinthine networks of care. I ask: how are patients’ own engagements with the ethical stakes of such care both made possible and delimited by virtue of their proximity to substances that are understood to affect their subjectivities, wills, and capacities for self-governance? Drawing on fieldwork in the community mental health network of Dublin, Ireland, and following my interlocutors’ own reflections, I analyse the moral dimensions of polypharmaceutical treatment for substance use disorder in the context of psychiatric dual diagnosis. I illustrate how various apparatuses of coercion and care apprehend and govern patients who are thought to be both addicted and mad, simultaneously enthralled by one form of the pharmakon and dangerously unreasonable when other medications are absent or neglected. In the space of such medicated subjectivities, a curious but ultimately revelatory claim to authority about the intended and unintended effects of polypharmaceutical treatment takes shape.
... Brazil's very rapid move in this direction was a very clear sign of the high level of political commitment to universal healthcare by the country's political leadership, especially during the presidential tenure of Fernando Henrique Cardoso, from 1995 to 2003 (Galvão, 2005). Such a stance initially involved the country importing generic anti-HIV drugs from India and Thailand, even at the risk of violating international patent agreements, but later also undertaking to develop its own capacity to produce the drugs (see Biehl, 2007;Cataldo, 2008). Thus, 'this policy of biotechnology for the people', as Biehl (2004, 105) aptly described it, was embraced as an exemplary approach for other developing countries to emulate and emerged at the time as 'an important component of international medical activism'. ...
The article focuses on the experience of reinventing oneself post HIV diagnosis when living on antiretrovirals. Six women and men enlisted for antiretrovirals in South African public health facilities were interviewed, and a qualitative analysis was conducted drawing on Foucault's theory of governmentality. For the participants, the prevailing governing rationality of taking personal responsibility for their health is synonymous with self-recovery and restoration of self-determination. From the hopelessness and despair of HIV diagnosis, for all six participants, committing to antiretrovirals enhances their capacity to take back control of their transformation from victim to survivor, and with it, a sense of personal integrity. Yet, an unwavering resolve to use ARVs is not always possible for some of them, is not preferable or is not always desirable, which perhaps signals that for certain people living with HIV, their life-long journey of self-governance with ARVs is likely to be characterized by constant contradictions.
... By the 1970s, the focus shifted, turning ethnographic gaze to the pharmaceutical industry, with scholars examining questions such as the placebo effect (Comaroff 1976). More recent work has examined the pharmaceuticalization of health (Biehl 2007), the search for human test subjects in the "developing world" (Petryna 2009) and the political economy of pharmaceutical investments in trials (Dumit 2012). ...
... In that sense, "pharmaceuticalization" could be a more specific approach to the broader phenomenon of "medicalization" (Bell and Figert 2012). A large strand of social research on pharmaceuticalization has documented some of its concomitant processes like the growing influence of pharmaceutical industry on public policy (Abraham 2010), or the higher dependency of citizens on the entangled regimes of intellectual property and technical safety (Biehl 2007). In a nutshell, pharmaceuticalization covers a dual process of hegemony: on one hand, scientific and medical hegemony over the definition of social issues, and on the other hand, hegemony of the market forces over the way of solving these issues. ...
Medical and pharmaceutical uses of animal life have gone through vast changes in the past centuries. Although the commodification of animals and animal parts is by no means an invention of modernity, its procedures and practices have evolved in multiple ways across time. Most notably, the exploitation of non-human animal life has been increasingly segmented, industrialized, and globalized. The collateral expansion of scientific and market institutions has led to specific modes of rationalization of animal breeding, culture, and trade for pharmaceutical purposes. However, this rationalization process has never been immune to its own matter—and the materiality of non-human commodification processes irrigates seemingly ordered and layered practices. Based upon a study on the international trade of donkey hide, this paper offers a characterization of the current pharmaceutical uses of animal life through a series of epistemic and environmental tensions expressing frictions between the market’s absorptive logic and non-human modes of existence. We describe this set of tensions as ‘feral pharmaceuticalization’ and contend that they offer new perspectives on the analysis of the contemporary pharmaceuticalization process. In addition, such tensions showcase the importance of investigating the expansion of technological markets not only as simultaneous knowledge and milieux (or bodies) making, or as simple science and market hegemonic processes, but also as the construction of new stages of conflict.
... Anthropologists of subjectivity (Biehl 2007;Biehl, Good, and Kleinman 2007) have pressured how subjectification, bodily agency, and nonhuman materiality "emerge through the drug-using/treatment event" (Dennis 2019). Building on European STS and in energetic conversation with queer, feminist, and postpositivist drug researchers in Australia such as Duncan, Duff, Sebar, and Lee (2017); Fraser, Moore, and Keane (2014); Fraser and Moore (2011);Fraser and valentine (2008); Race (2009Race ( , 2017Race ( , 2018, and Vittellone This particular assemblage builds upon the work of Emilie Gomart (2002Gomart ( , 2004, whose late 1990s doctoral research on methadone maintenance in France was directed by Bruno Latour. ...
This essay explores transnational STS as an analytic capable of recognizing the heterogeneities, pluralities, and relationalities of drugs—legal and illegal, products of agriculture or laboratory—as emblematic material-semiotic actors that move between global North, West, South, and East and into and out of bodies. Critical drug studies flourishes as a transdisciplinary knowledge project at the nexus of anthropology, history, sociology, political science, and other knowledge projects. This article situates critical drug studies in relation to the interdisciplinary knowledge project that is transnational STS and to postcolonial, postpositivist, and decolonial STS. The paper responds to the prompt offered by the organizers of a stream of papers in 2020—on “Transnational STS” for the Society for Social Studies of Science (4S): “What becomes visible when nation-state as the only analytic breaks down? What is the role of the nation-state with regard to education, research activities and the regulation of technologies in the contemporary period?” This article deals with the bifurcated regulation of drugs as technologies made legal or illegal by a global colonial, imperial, and nation-state-based regime that has made global drug policy since the early twentieth century. We are witnessing the reconfiguration of this regulatory system within and between nations—making a transnational analytic frame necessary for recognizing the relations facilitated by global drug policy.
... In parallel, a new body of scholarship emerged to interrogate the pharmaceuticalization of health care, the redefinition of an ever-broader range of conditions as pathologies to be medicated, and the subtle shifts in cultural understandings of disease, body, and self, which these processes underwrote (Biehl 2007;Dumit 2012;Greene 2007;Hayden 2007;Lakoff 2005;Metzl 2003;Watkins 2007). It was in the course of the global cross-disciplinary conversation that developed on these topics in the mid-2000s that Healy connected with the two other co-founders of rxisk.org, ...
Through the history of rxisk.org, this article explores some of the Web’s effects on the production and circulation of pharmaceutical knowledge. RxISK is an independent website that solicits reports from patients in order to uncover drug-induced harms which clinical trials and national pharmacovigilance schemes fail to identify. The first part of the article locates the origins of the project in the nearly 15-year struggle to obtain recognition and redress for one particular side effect of selective serotonin reuptake inhibitor (SSRI) antidepressants—their ability to trigger violent or suicidal behavior. That struggle, I show, brought to light the ways in which modern evidence-making practices obscure the harms of pharmacological treatment. The second part, based on interviews with the site’s creators, examines how RxISK’s data collection practices seek to convert the Web from a site for the circulation of misinformation into a usable source of new knowledge about drugs. The project’s originality, I argue, lies in its effort to reframe the relation between anecdote and evidence so as to liberate the patient’s voice from the burden of representativeness. Within this reframed epistemology, the project is also freed from the imperative of large-scale data extraction that increasingly dominates the economy of digital health.
... This article draws on recent studies on pharmaceuticals in the Global South which have shown the role of multinational companies, global pharmaceutical capital, distribution intermediaries and international donors in the organization of the supply and the construction of the medicines market in the Global South (Baxerres and Cassier, 2022;João Biehl, 2007;Peterson, 2014;Petryna et al., 2006;Quet, 2018;Kaushik Sunder Rajan, 2017). Other scholars have shed light on policies developed to acquire and disseminate technical know-how and to access the market, where means shortages and resource-scarce innovation are major concerns (Cassier and Correa, 2008;Chorev, 2019;Mackintosh et al., 2015). ...
The COVID-19 epidemic has highlighted the risks of shortages resulting from dependence on medicine imports. Today's situation where a few companies in the Global North control COVID-19 vaccine production is having dire consequences on African countries' access. However, the challenges surrounding local production of medical products in Africa are long-standing issues dating back to independence. Using Ghana as a case study, this paper looks primarily at how the dependence on medicine imports can be understood as the result of policies implemented since independence, as well as the changes that the Ghanaian State has undergone in reaction to international events and the evolution of the structure of global pharmaceutical capital. It examines the policies associated with the Ghanaian State's project to promote local pharmaceutical production, from independence to the present, and the role that non-state actors such as pharmaceutical companies have played. Based on an historical political economy approach, it highlights how the roles of the State and its forms of intervention have evolved over time, from planning (right after independence), to implementing (during the global crisis of the 1970s–1980s), and finally to regulating (from the 1990–2000s onward). This paper draws on 14 months of PhD research fieldwork (2014–2018). It consists of interviews (n = 50) with Ghanaian actors in the pharmaceutical sector, observations in a pharmaceutical plant in Accra, and research into archives at the Public Records and Archives Administration Department (PRAAD) of the Ministry of Industry.
... This care (of oneself [self-care] 5 or of one's close family [family-care]), realised when attempting to find a medicinal solution to suffering, takes place within the framework of 'self-medicalization' (Fainzang, 2013). It involves medicalizing a phenomenon even before pharmaceuticalizing it (on the concept of 'pharmaceuticalization', see Nichter, 1989;Biehl, 2007;Dumit and Greenslit, 2006;Fox and Ward, 2008;Bell and Figert, 2012;Desclaux & Egrot, 2015). It is therefore pertinent to acknowledge that cure is also practiced within the family sphere, both because the medicines are medical technologies and not simple acts of care, and because such consumption with therapeutic aims is decided, chosen and assessed by lay people themselves. ...
Abstract:
Care and cure are often associated in the literature with distinct spheres of therapeutic work. Care is seen as familial and relational and pertains to solidarity and support, while cure is seen as professional and technical and refers to expertise and competence. Under such conditions, does a practice such as self-medication fall under care or cure? Using ethnographic material on the practice of self-medication, I investigate the validity of distinguishing between these two aspects of dealing with pain or illness, not to show - as the literature sometimes does - that cure and care can be complementary, but that self-medication inextricably entails both care and cure, and that a recognition of the work of cure performed by individuals in this context redefines the agency of the subjects and has a political significance.
Keywords: Self-medication, self-care, empowerment, agency, self-cure.
... 35 For tuberculosis in industrialized countries, this decline by and large took place before the arrival of antibiotics and chemotherapies. These medicines then 28 Brandt (1985 Biehl (2007). 34 Smith (1987); for an update, see Mercer (2014). ...
This article discusses a paradox in the modern history of tuberculosis: its eradication has been seen as imminent ever since it was defined as a condition with a necessary bacterial cause in 1882, but, to date, has failed to arrive. The unwavering belief in an imminent end to tuberculosis mostly illustrates the degree to which modernity trusts in pharmaceutical interventions, whether in the form of Koch's tuberculin cure of 1890, the BCG
vaccine of the mid-20th century, or global health control programs that prioritize mass-treatment campaigns with antibiotics and chemotherapies. These visions of pharmaceutical-based solutions have not only failed to eradicate tuberculosis, but can often
distract attention away from the social causes of the epidemic, such as poor housing and nutrition.
... We build on the work of anthropologists and other scholars who have carefully attended to how antibiotics are entangled with different practices including (but also importantly beyond) medical encounters between patients and healthcare providers. This work includes the analysis of how antibiotics have (via pharmaceuticalisation) come to serve as 'quick fixes' for care, hygiene, and human productivity (Biehl 2007;Chandler, Hutchinson, and Hutchison 2016;Denyer Willis and Chandler 2019), as well as similar challenges faced in animal agriculture and aquaculture (Hinchliffe, Butcher, and Rahman 2018;Fortané 2019). Anthropologists have also described how antibiotics have become essential infrastructure for not only medical, public, and global health practices (Chandler 2019), but also various forms of animal agriculture (Kirchhelle 2020). ...
Medical professionals’ and policymakers’ fear of antimicrobial resistance (AMR) has largely been directed toward antibiotic use in medicine and animal agriculture. In Thailand, however, the use of antibiotics in citrus orchards has raised some concern over their ‘appropriateness’ and there have been calls for reduction—if not complete cessation—of their usage. We explore the emergence of antibiotic use for citrus greening disease (CGD) as part of shifting assemblages of plants, pests, pathogens, and people, as well as of varying climates, technologies, and farming practices. We suggest that rather than being a threat coming from outside orchards, CGD pathogenicity repeatedly emerges from within, and in Thailand appears to have increased alongside, the intensification of agricultural practices. We document how, when antibiotics emerged in the mid-20th century, their ‘pharmaceutical efficacy’ was insufficient to trigger their widespread adoption. Rather, the pharmaceuticalisation of orchards continues to be entangled with the expansion and intensification of mandarin agriculture, and also with the affordability of antibiotics, dissemination of relevant knowledge, and availability of equipment for their injection. Current proposals to reduce antibiotic use risk not taking sufficiently seriously the importance of their role in sustaining intensive orchard practices—and profits.
... The new forms of chronicity explored here are also shaping new types of chronic patients and new forms of patienthood, which are characterised by the intense and complex work that patients and their families have to do to turn their condition into a chronic one. Nowadays, the work of patients is not limited to the self-management of 'old' chronic diseases, such as diabetes, but also includes efforts to remain within the medical system to access new treatments in a context of increasing pharmaceuticalisation (Biehl 2007;Williams, Martin, and Gabe 2011). Furthermore, access to innovative treatments is conditioned by criteria of inclusion and specific regulation that are motivated by biomedical, social and financial aspects. ...
In the introduction to the special issue, Greco and Graber discuss the concept of chronicity and the ways it is used in the contributions to the special issue. Historians have shown that the concept of chronic disease has its origins in policy and has always been fluid and vague; however, the classic literature in sociology and nursing has focused on modelling the evolution of chronic disease rather than on examining the concept itself. In the introduction, chronicity is explored in the ways in which it is transformed by medical innovation. Innovations in biomedicine promise to turn terminal and acute conditions in chronic and to render chronic conditions curable. Even when such promises are not fulfilled, they change the context of the illness and the experiences of patients. In such a context a specific work is required from patients, in terms of adherence to the treatments, but also in terms of pursuing experimental treatments that could make their condition chronic. The introduction offers a critical exploration of the concept of chronicity, highlighting both its fluid definition and the changes linked to medical innovation, and the ways in which it shapes the temporalities and experiences of illness in complex ways that cannot be reduced to simplified schemas and trajectories.
Resumo O artigo objetiva analisar os significados do uso da PrEP entre gays, mulheres trans e travestis no Rio de Janeiro, com base em uma pesquisa sobre a biomedicalização da resposta à Aids. A análise e interpretação dos registros de diário de campo e das entrevistas nos permitiram descrever como o uso dessa tecnologia de prevenção ao HIV se dá simultaneamente com outros recursos biomédicos, intervenções estéticas, dietéticas e exercícios físicos. Argumentamos que tais cuidados de si são conformados em função das expectativas de gênero e classe e dos ideais de saúde de seus/as usuários/as. Os resultados do estudo permitem uma discussão sobre as fronteiras entre saúde, estilo de vida e aprimoramento. Conclui-se que a PrEP parece produzir uma singularização nas formas de produção de si, via aprimoramento biomédico e estético-cosmético, em um encontro sinérgico entre diferentes tecnologias, percebido tanto na rotina de uso do medicamento como no manejo de seus efeitos. Para a maioria das pessoas entrevistadas, a PrEP se acopla a um cuidado de si prévio, o que indica a localização social de seus usuários em termos de classe e gênero e a forma reflexiva a partir da qual descrevem sua saúde e a si próprias.
This article fosters a new relationship between linguistic and medical anthropology by decolonizing foundational conceptions of language and health. It reintroduces John Locke as a philosopher‐physician who used diagnosis of language disorders to impose a regime of communicability—reducing language to exchanging transparent, stable, purely referential signs. By deeming white, elite, able‐bodied European men alone capable of enacting this self‐help program, he connected communicability to whiteness and turned it into a means of evaluating and subordinating all others. Communicability also enabled him to shape how physicians produce knowledge in empiricist, atheoretical, observational fashion. I then trace physician‐philosopher Frantz Fanon's critique of how colonialism denies communicability to racialized subjects. Fanon's analysis of colonial medicine shows how clinical encounters can produce incommunicable subjects. Given that constructions of communicability have become highly visible features of medical education and practice and social‐scientific research on it, the article extends Fanon's analysis of physician‐patient communication more generally to ask if contemporary efforts to regiment clinical interactions and assess the communicable success of patients and doctors alike turn them into sites of incommunicability—assessments of communicable failure—for both parties. The article ends by imagining worlds beyond the oppressive weight of communicability and the stigma of incommunicability.
This article examines the making of clinical care by tracing how music therapists integrate their work within North American hospitals. Situated on the margins of the clinic, music therapists are in pursuit of clinical recognition-to be perceived and understood as valuable to biomedicine. The pursuit of clinical recognition illustrates how the configuration of care is an aesthetic concern, negotiated not only through processes of reasoning and rationalization but also through sensory-affective experiences. Music therapists cultivate a clinical aesthetic to their care by demonstrating clinical efficacy to their medical colleagues and self-fashioning clinical subjectivities through participation in medical rounds and charting. While clinical recognition creates conditions of possibility for music therapists to provide care in biomedical institutions, recognition is perpetually elusive for hospital music therapists. By cultivating sonic atmospheres and connections, music therapists disrupt and exceed a normative clinical aesthetic, illustrating ways of caring in the clinic beyond biomedical scripts.
During the Covid-19 pandemic, certain drugs were touted as ‘miracle cures’. One was hydroxychloroquine (HCQ), an anti-malarial drug, which was used for the Covid-19 treatment, despite a lack of evidence for its efficacy and side effects. After WHO stopped recommending HCQ for the treatment of Covid-19 in July 2020, Turkey insisted on using the drug. This article investigates to what extent health policies that are imposed in the name of the common good are received as il/legitimate at the grassroots. How is HCQ treatment received at the grassroots? What tensions exist, if any, between the government health policies and the public response regarding this treatment? How do the patients and doctors react to the use of HCQ in the treatment of Covid-19? What does the administration of a non-evidence-based drug disclose about the healthcare system in Turkey? This chapter draws on ethnographic evidence collected among medical doctors and patients and on media research on the Turkish government’s recognition of the Covid-19 cases in March 2020 and its decision to stop the use of HCQ in May 2021.KeywordsTurkeyHealthcare systemCovid-19 pandemicHydroxychloroquine
The radically humanistic essays in Arc of Interference refigure our sense of the real, the ethical, and the political in the face of mounting social and planetary upheavals. Creatively assembled around Arthur Kleinman’s medical anthropological arc and eschewing hegemonic modes of intervention, the essays advance the notion of a care-ful ethnographic praxis of interference. To interfere is to dislodge ideals of naturalness, blast enduring binaries (human/nonhuman, self/other, us/them), and redirect technocratic agendas while summoning relational knowledge and the will to create community. The book’s multiple ethnographic arcs of interference provide a vital conceptual toolkit for today’s world and a badly needed moral perch from which to peer toward just horizons.
Contributors. Vincanne Adams, João Biehl, Davíd Carrasco, Lawrence Cohen, Jean Comaroff, Robert Desjarlais, Paul Farmer, Marcia Inhorn, Janis H. Jenkins, David S. Jones, Salmaan Keshavjee, Arthur Kleinman, Margaret Lock, Adriana Petryna
The radically humanistic essays in Arc of Interference refigure our sense of the real, the ethical, and the political in the face of mounting social and planetary upheavals. Creatively assembled around Arthur Kleinman’s medical anthropological arc and eschewing hegemonic modes of intervention, the essays advance the notion of a care-ful ethnographic praxis of interference. To interfere is to dislodge ideals of naturalness, blast enduring binaries (human/nonhuman, self/other, us/them), and redirect technocratic agendas while summoning relational knowledge and the will to create community. The book’s multiple ethnographic arcs of interference provide a vital conceptual toolkit for today’s world and a badly needed moral perch from which to peer toward just horizons.
Contributors. Vincanne Adams, João Biehl, Davíd Carrasco, Lawrence Cohen, Jean Comaroff, Robert Desjarlais, Paul Farmer, Marcia Inhorn, Janis H. Jenkins, David S. Jones, Salmaan Keshavjee, Arthur Kleinman, Margaret Lock, Adriana Petryna
The radically humanistic essays in Arc of Interference refigure our sense of the real, the ethical, and the political in the face of mounting social and planetary upheavals. Creatively assembled around Arthur Kleinman’s medical anthropological arc and eschewing hegemonic modes of intervention, the essays advance the notion of a care-ful ethnographic praxis of interference. To interfere is to dislodge ideals of naturalness, blast enduring binaries (human/nonhuman, self/other, us/them), and redirect technocratic agendas while summoning relational knowledge and the will to create community. The book’s multiple ethnographic arcs of interference provide a vital conceptual toolkit for today’s world and a badly needed moral perch from which to peer toward just horizons.
Contributors. Vincanne Adams, João Biehl, Davíd Carrasco, Lawrence Cohen, Jean Comaroff, Robert Desjarlais, Paul Farmer, Marcia Inhorn, Janis H. Jenkins, David S. Jones, Salmaan Keshavjee, Arthur Kleinman, Margaret Lock, Adriana Petryna
The radically humanistic essays in Arc of Interference refigure our sense of the real, the ethical, and the political in the face of mounting social and planetary upheavals. Creatively assembled around Arthur Kleinman’s medical anthropological arc and eschewing hegemonic modes of intervention, the essays advance the notion of a care-ful ethnographic praxis of interference. To interfere is to dislodge ideals of naturalness, blast enduring binaries (human/nonhuman, self/other, us/them), and redirect technocratic agendas while summoning relational knowledge and the will to create community. The book’s multiple ethnographic arcs of interference provide a vital conceptual toolkit for today’s world and a badly needed moral perch from which to peer toward just horizons.
Contributors. Vincanne Adams, João Biehl, Davíd Carrasco, Lawrence Cohen, Jean Comaroff, Robert Desjarlais, Paul Farmer, Marcia Inhorn, Janis H. Jenkins, David S. Jones, Salmaan Keshavjee, Arthur Kleinman, Margaret Lock, Adriana Petryna
The radically humanistic essays in Arc of Interference refigure our sense of the real, the ethical, and the political in the face of mounting social and planetary upheavals. Creatively assembled around Arthur Kleinman’s medical anthropological arc and eschewing hegemonic modes of intervention, the essays advance the notion of a care-ful ethnographic praxis of interference. To interfere is to dislodge ideals of naturalness, blast enduring binaries (human/nonhuman, self/other, us/them), and redirect technocratic agendas while summoning relational knowledge and the will to create community. The book’s multiple ethnographic arcs of interference provide a vital conceptual toolkit for today’s world and a badly needed moral perch from which to peer toward just horizons.
Contributors. Vincanne Adams, João Biehl, Davíd Carrasco, Lawrence Cohen, Jean Comaroff, Robert Desjarlais, Paul Farmer, Marcia Inhorn, Janis H. Jenkins, David S. Jones, Salmaan Keshavjee, Arthur Kleinman, Margaret Lock, Adriana Petryna
The radically humanistic essays in Arc of Interference refigure our sense of the real, the ethical, and the political in the face of mounting social and planetary upheavals. Creatively assembled around Arthur Kleinman’s medical anthropological arc and eschewing hegemonic modes of intervention, the essays advance the notion of a care-ful ethnographic praxis of interference. To interfere is to dislodge ideals of naturalness, blast enduring binaries (human/nonhuman, self/other, us/them), and redirect technocratic agendas while summoning relational knowledge and the will to create community. The book’s multiple ethnographic arcs of interference provide a vital conceptual toolkit for today’s world and a badly needed moral perch from which to peer toward just horizons.
Contributors. Vincanne Adams, João Biehl, Davíd Carrasco, Lawrence Cohen, Jean Comaroff, Robert Desjarlais, Paul Farmer, Marcia Inhorn, Janis H. Jenkins, David S. Jones, Salmaan Keshavjee, Arthur Kleinman, Margaret Lock, Adriana Petryna
The radically humanistic essays in Arc of Interference refigure our sense of the real, the ethical, and the political in the face of mounting social and planetary upheavals. Creatively assembled around Arthur Kleinman’s medical anthropological arc and eschewing hegemonic modes of intervention, the essays advance the notion of a care-ful ethnographic praxis of interference. To interfere is to dislodge ideals of naturalness, blast enduring binaries (human/nonhuman, self/other, us/them), and redirect technocratic agendas while summoning relational knowledge and the will to create community. The book’s multiple ethnographic arcs of interference provide a vital conceptual toolkit for today’s world and a badly needed moral perch from which to peer toward just horizons.
Contributors. Vincanne Adams, João Biehl, Davíd Carrasco, Lawrence Cohen, Jean Comaroff, Robert Desjarlais, Paul Farmer, Marcia Inhorn, Janis H. Jenkins, David S. Jones, Salmaan Keshavjee, Arthur Kleinman, Margaret Lock, Adriana Petryna
The radically humanistic essays in Arc of Interference refigure our sense of the real, the ethical, and the political in the face of mounting social and planetary upheavals. Creatively assembled around Arthur Kleinman’s medical anthropological arc and eschewing hegemonic modes of intervention, the essays advance the notion of a care-ful ethnographic praxis of interference. To interfere is to dislodge ideals of naturalness, blast enduring binaries (human/nonhuman, self/other, us/them), and redirect technocratic agendas while summoning relational knowledge and the will to create community. The book’s multiple ethnographic arcs of interference provide a vital conceptual toolkit for today’s world and a badly needed moral perch from which to peer toward just horizons.
Contributors. Vincanne Adams, João Biehl, Davíd Carrasco, Lawrence Cohen, Jean Comaroff, Robert Desjarlais, Paul Farmer, Marcia Inhorn, Janis H. Jenkins, David S. Jones, Salmaan Keshavjee, Arthur Kleinman, Margaret Lock, Adriana Petryna
The radically humanistic essays in Arc of Interference refigure our sense of the real, the ethical, and the political in the face of mounting social and planetary upheavals. Creatively assembled around Arthur Kleinman’s medical anthropological arc and eschewing hegemonic modes of intervention, the essays advance the notion of a care-ful ethnographic praxis of interference. To interfere is to dislodge ideals of naturalness, blast enduring binaries (human/nonhuman, self/other, us/them), and redirect technocratic agendas while summoning relational knowledge and the will to create community. The book’s multiple ethnographic arcs of interference provide a vital conceptual toolkit for today’s world and a badly needed moral perch from which to peer toward just horizons.
Contributors. Vincanne Adams, João Biehl, Davíd Carrasco, Lawrence Cohen, Jean Comaroff, Robert Desjarlais, Paul Farmer, Marcia Inhorn, Janis H. Jenkins, David S. Jones, Salmaan Keshavjee, Arthur Kleinman, Margaret Lock, Adriana Petryna
The radically humanistic essays in Arc of Interference refigure our sense of the real, the ethical, and the political in the face of mounting social and planetary upheavals. Creatively assembled around Arthur Kleinman’s medical anthropological arc and eschewing hegemonic modes of intervention, the essays advance the notion of a care-ful ethnographic praxis of interference. To interfere is to dislodge ideals of naturalness, blast enduring binaries (human/nonhuman, self/other, us/them), and redirect technocratic agendas while summoning relational knowledge and the will to create community. The book’s multiple ethnographic arcs of interference provide a vital conceptual toolkit for today’s world and a badly needed moral perch from which to peer toward just horizons.
Contributors. Vincanne Adams, João Biehl, Davíd Carrasco, Lawrence Cohen, Jean Comaroff, Robert Desjarlais, Paul Farmer, Marcia Inhorn, Janis H. Jenkins, David S. Jones, Salmaan Keshavjee, Arthur Kleinman, Margaret Lock, Adriana Petryna
The radically humanistic essays in Arc of Interference refigure our sense of the real, the ethical, and the political in the face of mounting social and planetary upheavals. Creatively assembled around Arthur Kleinman’s medical anthropological arc and eschewing hegemonic modes of intervention, the essays advance the notion of a care-ful ethnographic praxis of interference. To interfere is to dislodge ideals of naturalness, blast enduring binaries (human/nonhuman, self/other, us/them), and redirect technocratic agendas while summoning relational knowledge and the will to create community. The book’s multiple ethnographic arcs of interference provide a vital conceptual toolkit for today’s world and a badly needed moral perch from which to peer toward just horizons.
Contributors. Vincanne Adams, João Biehl, Davíd Carrasco, Lawrence Cohen, Jean Comaroff, Robert Desjarlais, Paul Farmer, Marcia Inhorn, Janis H. Jenkins, David S. Jones, Salmaan Keshavjee, Arthur Kleinman, Margaret Lock, Adriana Petryna
The radically humanistic essays in Arc of Interference refigure our sense of the real, the ethical, and the political in the face of mounting social and planetary upheavals. Creatively assembled around Arthur Kleinman’s medical anthropological arc and eschewing hegemonic modes of intervention, the essays advance the notion of a care-ful ethnographic praxis of interference. To interfere is to dislodge ideals of naturalness, blast enduring binaries (human/nonhuman, self/other, us/them), and redirect technocratic agendas while summoning relational knowledge and the will to create community. The book’s multiple ethnographic arcs of interference provide a vital conceptual toolkit for today’s world and a badly needed moral perch from which to peer toward just horizons.
Contributors. Vincanne Adams, João Biehl, Davíd Carrasco, Lawrence Cohen, Jean Comaroff, Robert Desjarlais, Paul Farmer, Marcia Inhorn, Janis H. Jenkins, David S. Jones, Salmaan Keshavjee, Arthur Kleinman, Margaret Lock, Adriana Petryna
The radically humanistic essays in Arc of Interference refigure our sense of the real, the ethical, and the political in the face of mounting social and planetary upheavals. Creatively assembled around Arthur Kleinman’s medical anthropological arc and eschewing hegemonic modes of intervention, the essays advance the notion of a care-ful ethnographic praxis of interference. To interfere is to dislodge ideals of naturalness, blast enduring binaries (human/nonhuman, self/other, us/them), and redirect technocratic agendas while summoning relational knowledge and the will to create community. The book’s multiple ethnographic arcs of interference provide a vital conceptual toolkit for today’s world and a badly needed moral perch from which to peer toward just horizons.
Contributors. Vincanne Adams, João Biehl, Davíd Carrasco, Lawrence Cohen, Jean Comaroff, Robert Desjarlais, Paul Farmer, Marcia Inhorn, Janis H. Jenkins, David S. Jones, Salmaan Keshavjee, Arthur Kleinman, Margaret Lock, Adriana Petryna
The radically humanistic essays in Arc of Interference refigure our sense of the real, the ethical, and the political in the face of mounting social and planetary upheavals. Creatively assembled around Arthur Kleinman’s medical anthropological arc and eschewing hegemonic modes of intervention, the essays advance the notion of a care-ful ethnographic praxis of interference. To interfere is to dislodge ideals of naturalness, blast enduring binaries (human/nonhuman, self/other, us/them), and redirect technocratic agendas while summoning relational knowledge and the will to create community. The book’s multiple ethnographic arcs of interference provide a vital conceptual toolkit for today’s world and a badly needed moral perch from which to peer toward just horizons.
Contributors. Vincanne Adams, João Biehl, Davíd Carrasco, Lawrence Cohen, Jean Comaroff, Robert Desjarlais, Paul Farmer, Marcia Inhorn, Janis H. Jenkins, David S. Jones, Salmaan Keshavjee, Arthur Kleinman, Margaret Lock, Adriana Petryna
This article was named the winner of the 2021 Enloe Award. The committee commented:This article embodies the spirit of the Enloe Award by helping us conceptualize self-medication abortion as a part of “reproductive governance,” or how multiple actors beyond the state participate in providing and facilitating reproductive health care. This framework is crucial to understanding that access to abortion pills certainly can increase bodily autonomy, illustrating the effectiveness of grassroots feminist activists in meeting the needs of those who wish to terminate pregnancies. At the same time, the manufacturing and distribution of the pills also empower a whole host of actors that promote corporatized care, neoliberal agency, and population management. The article stood out to the committee as an original and exciting feminist intervention in global conversations about abortion access, and we commend the author for the strong theoretical framework, robust methodological approach involving ethnographic research in Mexico, and provocative insights.
ABSTRACT
This article examines two pills that are used to induce abortion in the context of feminist “accompaniment” for self-managed abortion practice in Mexico: misoprostol and mifepristone. For many feminist activists, abortion pills facilitate bodily autonomy in contexts where abortion is legally and socially criminalized. However, my ethnographic research demonstrates that pills are also “territorialized” through assemblages of pharmaceuticalized medicine, where private-sector and civil-society organizations have become protagonists in the provision of abortion health care and the governance of reproductive conduct. Feminist abortion accompaniment works to remedy these limitations by “reterritorializing” pills into new assemblages with practices grounded in principles of solidarity, justice, and bodily autonomy. It is only through these practices that abortion pills become truly revolutionary.
This essay synthesizes key analytical perspectives from the vast social science literature on disease classification spanning various disciplines. The aim is to develop a framework for analyzing changes in Western medicine framed under umbrella terms such as ‘precision medicine’ and ‘personalized medicine.’ I argue that understanding these contemporary changes in the conception and enactment of disease requires attention to historical developments in disease classifications. Spinal muscular atrophy is used as an example case to illustrate this argument. To guide further inquiry into the current move in biomedicine towards precision medicine, I outline two analytical dimensions—material and social interactionist aspects of disease classification—and show how these can be fruitfully combined. Possible starting points and questions for analysis are presented and discussed.
Re-Visioning Psychiatry explores new theories and models from cultural psychiatry and psychology, philosophy, neuroscience and anthropology that clarify how mental health problems emerge in specific contexts and points toward future integration of these perspectives. Taken together, the contributions point to the need for fundamental shifts in psychiatric theory and practice: • Restoring phenomenology to its rightful place in research and practice • Advancing the social and cultural neuroscience of brain-person-environment systems over time and across social contexts • Understanding how self-awareness, interpersonal interactions, and larger social processes give rise to vicious circles that constitute mental health problems • Locating efforts to help and heal within the local and global social, economic, and political contexts that influence how we frame problems and imagine solutions. In advancing ecosystemic models of mental disorders, contributors challenge reductionistic models and culture-bound perspectives and highlight possibilities for a more transdisciplinary, integrated approach to research, mental health policy, and clinical practice.
Opioid agonist medications, such as the buprenorphine‐based Suboxone, are becoming increasingly important tools for caring for people with opioid use disorders. Yet, whether at the level of the family, the clinic, or pharmaceutical companies, the circulation of Suboxone can involve forms of concealment, secrecy, and deceit, even as it is used to provide a vital form of care. In exploring the moral economies that shape the licit and illicit circulation of Suboxone in southwest Virginia, we aim to unpack the logics of obligation, care, and secrecy that emerge within a family network caught in a set of sociopolitical, economic, and therapeutic conditions. In exploring how Suboxone circulates at these different scales—in families, in clinics, and in the global pharmaceutical economy—this article shows how secrets lubricate the social, economic, and moral mechanisms through which relationships are sustained and substances circulate. [moral economy, secrecy, substance use, care, rural United States]
The nexus of “western” and “indigenous” knowledge, toxicity, and biodiversity has transformed biomedical fields ranging from drug development to microbial resistance, yet it has not been marked by just research practices. This chapter delineates the intersections of indigenous and Western knowledge practices in relation to toxic organisms, in order to advance insights that shed light into the ways in which biomedicine has been (or failed to be) committed to justice and solidarity. Due to their porous nature and ability to travel across boundariestoxins – in the forms of potent and potentially poisonous plants and animals – are an ideal place from which to inquire into questions of justice and knowledge. The use of indigenous knowledge of nature for research illuminates central tensions in biomedical research practices today. Despite policies such as Genomic Sover- eignty doctrine, due to histories of manipulation, lack of benefit sharing, and limited indigenous research representation, the relationship between indigenous and Western knowledges is fraught with suspicion and conflict. One particularly salient concern is that patents filed in the global north have claimed ownership over indigenous knowledge and organisms, thus exploiting inequalities and enabling proprietary colonial uses of biodiversity in Latin America. Drawing on ethnographic and historical methodologies, this chapter interrogates landmark cases linked with biopiracy and medical innovation: (1) ayahuasca and (2) the Poison Dart Frog. These two organisms have been identified as important cases, because both have been subject to patents, are at the center of significant biomedical investment, and are deeply embedded in the ancestral knowledge of Latin American indigenous peoples, as well as biomedical innovations and forms of capitalist profit making via pharmaceutical research.
This paper addresses the role emotions play in the social assemblage of medicines and technical processes in the response to the HIV called pre-exposure prophylaxis (PrEP) for HIV. We describe a series of stages and processes in the social construction of PrEP in Brazil from the run-up to the launch of the initiative by the Ministry of Health to the subsequent implementation of the strategy by public health services. To understand the meanings and symbolism assigned to this biomedical technology, we examined the hopes underpinning scientific, government and non-governmental narratives, clinical processes and health policy. The social trajectory of PrEP was influenced not only by these hopes but also by fears and concerns about the impact of this approach to HIV prevention on lifestyles and modes of sexual governance. The evidence used in this study comes from interviews with health professionals and AIDS activists, anthropological fieldwork, scientific articles and documentary analysis. Our findings provide important insights into how emotions have shaped the meanings assigned to PrEP and shed light on the complex game of negotiation involved in defining responses to the HIV epidemic.
In this article, we symmetrically explore the political underpinnings and connections of pharmaceutical drugs during the COVID-19 pandemic. We illustrate some different and shifting dynamics of expert-lay interplay, competing knowledge claims in politically charged environments, as well as actions and actors that can bring drugs to prominence. Focusing on three drugs, ivermectin, remdesivir, and Coronil, we offer three axes on which they can be apprehended within political logics: (a) ivermectin as a “populist drug” in the United States, (b) remdesivir as an “establishment drug” in the United States, and (c) Coronil as a “nationalist drug” in India. These three pharmaceuticals were politicized, and perhaps more surprising, politics became pharmaceuticalized. Trust in these treatments was intimately related to articulations of the threats posed by the pandemic and the best ways of addressing them, both manipulated politically by relatively powerful actors.
Although epidemics are generally understood as lying within the domain of biomedicine, legal and social arrangements play crucial roles in determining whether or not infectious disease outbreaks grow into epidemics and even pandemics. Yet epidemics are challenging terrain for legal regulation. Because epidemics cross political borders and span jurisdictional boundaries, funding for epidemic prevention, preparedness, and response is always inadequate and coordination is difficult. Because epidemics require rapid and nimble responses, governments and international organizations often declare states of emergency, thereby evading some of the usual strictures of law. And because they involve massive uncertainty and rapidly evolving health crises, they require legal actors to work more quickly and with lower standards of proof than is common in law and to intrude on the turf of medical and scientific professionals. Legal contributions to pandemic management could be improved if legal measures such as global treaties and domestic public health law took account of these special features of epidemics.
Expected final online publication date for the Annual Review of Law and Social Science, Volume 18 is October 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
The simulated patient method is becoming an increasingly popular observational method to measure practice behavior in pharmacy practice and health services research. The simulated patient method involves sending a trained individual (simulated patient among other names), who is indistinguishable from a regular consumer, into a healthcare setting with a standardized scripted request. This method has come to be accepted as being well-suited for observing practice in the naturalistic setting and has also been used as an intervention when combined with feedback and coaching. This chapter presents an overview of the method, a brief history of its use, considerations for designing, implementing, and evaluating simulated patient studies, including ethical considerations, as well as methods of analysis and mixed-methods designs.
Ethnography has much to offer research in social pharmacy and health services yet is rarely applied. This chapter provides an overview of the principles of ethnography starting with a brief historical account of the methodology. The first part of the chapter then explains how ethnography can shed light on the social context of pharmaceuticals, thereby introducing new ways of thinking, to researchers in the health and natural sciences. This is done by digging into the epistemology of ethnography, exploring how it differs from other methodologies (qualitative and quantitative), and how it builds on the core principles of constructivism and reflexivity. The second part of the chapter is concerned with how to conduct an ethnographic study, focusing on participant observation and fieldwork. Ethnography literally means “writing about people”; therefore, an entire section is devoted to various ways of writing up ethnographic data, from thick descriptions and field notes to social theory and analysis. Finally, there is a section on ethics, followed by advice on how to move forward with an ethnographic project. The chapter ends with some reflective questions and application exercises for designing an ethnographic study and training observation skills.
Este artigo analisa o papel da produção pública de medicamentos no Brasil, a partir de análise bibliográfica e documental. Examina as principais características da indústria farmacêutica e do mercado de medicamentos em suas dimensões internacional e nacional. Enfatiza, particularmente, a produção de medicamentos do setor público, bem como aspectos da visão governamental sobre o tema. O estudo se fundamenta na análise de documentos oficiais do Ministério da Saúde. A exposição conclui com um diagnóstico da situação atual do parque de laboratórios públicos, que mostra a existência de problemas de ordem política, administrativa e de funcionamento, aliados à baixa capacitação tecnológica e à escassez de recursos humanos qualificados em geral.
The Brazilian experience in producing HIV/AIDS drugs is based on the lawful copying of medicines patented abroad, on a health policy of universal access to antiretrovirals (ARV), and on technological learning, especially in public-sector laboratories through reverse engineering. The information contained in patents has proved to be incomplete and the chemical standards of these molecules are not available in the pharmacopoeias. Chemists at the Rio health ministry's laboratory have had to partially rediscover the qualitative and quan- titative composition of these drugs. They have thus acquired knowledge on the synthesis processes of the active principles of drugs, which they are now able to transfer to pharmaceutical companies. Apart from copying existing drugs, the laboratory also develops research both in-house and in partnership with universities, to create new molecules. The learning process initiated through copying is thus combined with a research policy.
In this article, I investigate how the moral politics of HIV/AIDS activism in South Africa is contributing toward new forms of citizenship that are concerned with both rights-based struggles and with creating collectively shared meanings of the extreme experiences of illness and stigmatization of individual HIV/AIDS sufferers. I argue that it is precisely the extremity of the “near death” experiences of full-blown AIDS, and the profound stigma and “social death” associated with the later stages of the disease, that produce the conditions for HIV/AIDS survivors' commitment to “new life” and social activism. It is the activist mediation and retelling of these traumatic experiences that facilitates HIV/AIDS activist commitment and grassroots mobilization. It is also the profound negativity of stigma and social death that animates the activist's construction of a new positive HIV-positive identity and understanding of what it means to be a citizen–activist and member of a social movement.
The first of a series of papers concerning the evaluation of the dynamics of the AIDS epidemic in Brazil employing techniques of geographical analysis, is here presented. Results of research undertaken in the US (especially in New York City) are compared with those of a recent investigation carried out in the city of S.Paulo, Brazil (Grangeiro, 1994). In both, geographical patterns of socio-demographic variables correlate with different patterns of the spread of the AIDS epidemic through the transmission groups. Recent trends of the AIDS epidemic in Brazil: the displacement toward medium sized cities and expansion frontiers, increasing report of AIDS cases among the poor and underprivileged, changes in the pattern of transmission with proportional augmentation of heterosexual transmission and IDUs as transmission groups, are described and analysed. The geographical distribution of the AIDS cases registered between 1987-1993 in Brazil throughout the Brazilian States is evaluated by means of worksheets, maps, and non-parametric statistics. Results show that Gravimetric Centers (obtained by the use of the calculus spatial means) of AIDS in Brazil are situated within a triangle the sides of which are formed lines joining the three main metropolitan areas of the wealthiest region of Brazil--the southeast, i.e. São Paulo, Rio de Janeiro and Belo Horizonte. These especially S. Paulo, function as points of attraction for these Gravimetric Centers (GCs) towards the south as compared with the GCs of the general population calculated ia accordance with data from the 1980 and 1991 censuses. It is possible to observe a displacement of the GCs toward the northwest over this period in accordance with the migration patterns of the Brazilian population in general, though with a dynamic of its own. These changes in the geographical, socio-demographic and transmission group patterns show the complex nature of the epidemic in Brazil and pose additional difficulties for the development of prevention strategies.
PIP:
An evaluation of the dynamics of the AIDS epidemic in Brazil is presented employing techniques of geographical analysis. Results of research undertaken in the US (especially in New York City) were compared with those of a 1994 investigation carried out in the city of Sao Paulo, Brazil, by A. Grangeiro. In both cases geographical patterns of socio-demographic variables correlated with different patterns of the spread of the AIDS epidemic through the transmission groups. In the 1980s and in the beginning of the 1990s in New York City two kinds of epidemics erupted: one in the White gay community, which was subjected to intense preventive efforts, and the other one among intravenous drug users (IDUs) and young Black and Hispanic women. Recent characteristic trends of the AIDS epidemic in Brazil included the spread toward medium sized cities and to frontiers, cases among the poor and underprivileged, and the increase of heterosexual transmission and among IDUs. In 1994 the prevalence of HIV/AIDS was 36.3 cases per 100,000. In the state of Sao Paulo the rates were 19.2/100,000 in 1992 and 12/100,000 during 1993-94, and in Rio de Janeiro they amounted to 10.2 in 1992 and 9.0 in 1993/94. The incidence rose in the beginning of the 1990s in the southeast and central-east regions (7.0/100,000 in 1991) and in the states of the north, e.g., in Roraima (7.2/100,000 in 1991). The geographical distribution of the AIDS cases registered between 1987-1993 throughout Brazil was evaluated by means of work-sheets, maps, and statistics. Gravimetric Centers (GCs) of AIDS were situated within a triangle formed by the three main metropolitan areas of the southeast encompassing Sao Paulo, Rio de Janeiro, and Belo Horizonte. These GCs, especially S. Paulo, pushed towards the south and the northwest over this period in accordance with migration patterns. These complex geographical, socio-demographic, and transmission patterns pose difficulties for the development of prevention strategies.
Este artigo apresenta algumas considerações sobre o Programa Brasileiro de AIDS, no que diz respeito à distribuição e produção de medicamentos anti-retrovirais, enfatizando as conexões entre as decisões locais com as políticas globais de respostas frente à pandemia de HIV/ AIDS. Destacando os mais recentes desdobramentos no cenário brasileiro e internacional, no tocante a acesso a medicamentos para pessoas com HIV/AIDS, o artigo ressalta a participação da indústria farmacêutica, de governos, da sociedade civil e de organismos do sistema das Nações Unidas no estabelecimento de respostas frente à pandemia. O artigo conclui apontando o ativismo transnacional como uma das respostas ao enfrentamento do poder das grandes corporações farmacêuticas e das leis de mercado - incluindo aí a lei de patentes - impulsionando, desta forma, uma solidariedade global para as pessoas com HIV/AIDS.
No contexto das mudanças ocorridas no sistema de fornecimento de medicamentos em nível nacional no Brasil, com destaque para a desativação da Central de Medicamentos (CEME), e da crescente descentralização das ações de saúde no âmbito do Sistema Único de Saúde (SUS), três estados brasileiros - Paraná, São Paulo e Minas Gerais - elaboraram, dentro da política de assistência farmacêutica, programas envolvendo a distribuição de medicamentos essenciais para a atenção primária de saúde. O Ministério da Saúde está atualmente implementando um programa nacional de aquisição e distribuição de um elenco de 32 medicamentos para a atenção primária ("Programa Farmácia Básica") que deverá ter suas atividades posteriormente descentralizadas. A discussão aqui proposta tem por objetivo fornecer subsídios para a organização e/ou estruturação da assistência farmacêutica estadual no que concerne à atenção primária de saúde, por meio da análise destes três programas pioneiros, envolvendo as atividades de seleção, aquisição, estocagem, distribuição e uso de medicamentos.
Adherence is the milestone of a successful therapy. Over the last decade several authors have addressed the importance of adherence for optimal results of antiretroviral (ARV) therapy. Many health care systems are investing substantial resources to make available contemporary antiretroviral therapy. Despite the large investment in medications, insufficient investments have been made into an integrated adherence component to maximize the impact of these medications. Adherence, unlike drug therapy, cannot be defined as a single method with a defined prescription or formula. Instead, it is the result of a complex interaction between the patient, a prescribed medication and the health system. Many reports are available analyzing each of these components. We have found that critical elements of adherence include the patient's knowledge about the disease and how medications will help achieve a longer and healthier life, together with the motivation to adapt to a new style of life. A trilogy composed of information, motivation and behavioral skills is essential to achieve the maximum desired level of adherence. We have computerized this trilogy in a software program for self-administration in which each of the three components is provided to the patient as many times as necessary to transmit an understanding of the problem and to help make a rational decision to adhere to the ARV treatment program. In this review we analyze several efforts and techniques to improve adherence to any recommended medication that may interfere with the patient's lifestyle and outline how the adherence trilogy can be best used to optimize the ability of ARV therapy to durably suppress plasma HIV RNA to undetectable levels.
The provision of care and support to persons living with human immunodeficiency virus (HIV) in Brazil who also use drugs and/or
alcohol represents special challenges because of the combined effects of addiction, poverty, stigma, and discrimination. This
paper presents details on a program providing both clinic- and field-based care to HIV-infected injection drug users, highlighting
the use of a specialized case management approach to address the clinical and psychosocial needs of this population. This
program includes both a mobile case management team that fosters group discussions and provides individual counseling, and
provision of medical consultations at 2 major drug treatment centers in Rio de Janeiro. The article also describes the experience
of working with injection drug users who regularly attend an outpatient clinic serving marginalized communities through the
use of mutual self-help groups and specialized support groups to address to issue of adherence to antiretroviral therapies
for the treatment of HIV/acquired immunodeficiency syndrome.
More than a third of the world's population has no access to essential drugs. More than half of this group of people live in the poorest regions of Africa and Asia. Several factors determine the accessibility of drugs in developing countries. Hardly any medicines for tropical diseases are being developed, but even existing drugs are often not available to the patients who need them.
One of the important determinants of access to drugs is the working of the patent system. This paper first maps out some facts about the global patent regime that has emerged as a consequence of the conclusion of the WTO-TRIPs Agreement in 1994. Attempts to construct a moral justification of the patent system have been based on three grounds: natural rights, distributive justice, and utilitarian arguments. This paper examines to what extent and on which grounds drug patents can be justified. The final section looks at the so-called ‘Doha Declaration on the TRIPs Agreement and Public Health’, which was adopted by the WTO Ministerial Conference two years ago, recognising the primacy of public health over the interests of patent proprietors.
Three decades ago, the world's ministries of health declared primary health care--the delivery of basic preventive and curative services--a top priority. Since then, however, the world's poorest countries have not met most primary health care goals. Twenty-six years after the Declaration of Alma Ata, we are said to be living in a time of "limited resources," a phrase that construes various health interventions as competing priorities. As HIV has become the leading infectious cause of adult death in much of the world, it is difficult to argue that AIDS prevention and care are not ranking priorities for primary health care, yet precisely such arguments have held sway among international health policy makers. We present new information emerging from the scale-up of an established and integrated AIDS prevention-and-care program, based initially in a squatter settlement in central Haiti, to a second site in rural Haiti. The program includes robust prevention efforts as well as community-based therapy for advanced AIDS; three related components--women's health and active case finding and therapy for tuberculosis and sexually transmitted infections--were central to this effort. We tracked changes in key indices over the 14 months following the introduction of these services to a public clinic in central Haiti. We found that integrated AIDS prevention and care, including the use of antiretroviral agents, to be feasible in resource-poor settings and that such efforts may have favorable and readily measured impact on a number of primary health care goals, including vaccination, family planning, tuberculosis case finding and cure, and health promotion. Other collateral benefits, though less readily measured, include improved staff morale and enhanced confidence in public health and medicine. We conclude that improving AIDS prevention and treatment can help to reinvigorate flagging efforts to promote universal primary health care.
The Brazilian National AIDS Program is widely recognized as the leading example of an integrated HIV/AIDS prevention, care, and treatment program in a developing country. We critically analyze the Brazilian experience, distinguishing those elements that are unique to Brazil from the programmatic and policy decisions that can aid the development of similar programs in other low- and middle-income and developing countries.
Among the critical issues that are discussed are human rights and solidarity, the interface of politics and public health, sexuality and culture, the integration of prevention and treatment, the transition from an epidemic rooted among men who have sex with men to one that increasingly affects women, and special prevention and treatment programs for injection drug users.
Westerhaus and Castro argue that US-negotiated bilateral, regional, and multilateral trade agreements are hindering access to essential HIV medicines in poor countries.
In a recent issue of this journal, Oran Young argued forcefully against the ‘collection of empirical materials as an end in itself and without sufficient theoretical analysis to determine appropriate criteria of selection.” The present paper issues a complementary critique of the opposite failing. Its target is the tendency toward compulsive and mindless theorizing—a disease at least as prevalent and debilitating, so it seems to me, as the one described by Oran Young.
This article addresses the offshoring of clinical trials to middle- and low-income countries, and the complicated ways in which they have become integral to public health and quality of care in these contexts. I focus on the operations of United States-based contract research organizations (CROs), which make up a specialized global industry focusing on the recruitment of human subjects and investigators; they are key players in an outsourced world of clinical development 'service provi- ders'. To get an on-the-ground understanding of the offshored clinical trial, I worked with regula- tors, health services administrators, and research clinicians in Eastern Europe and Latin America, two clinical trial market 'growth regions'. By addressing the strategies of evidence-making that inform clinical trial offshoring, this article identifies the context-specific calculations by which experimental groups are being identified. It also addresses aspects of the clinical trial operational model, in which the failure to predict safety outcomes or a paradigm of expected failure is being exported along with the offshored trial. By highlighting the uncertainties of clinical research, this article points to gaps in systems of human protection as it considers new forms of accountability in private sector science and public health.
The abstract for this document is available on CSA Illumina.To view the Abstract, click the Abstract button above the document title.
The emergence of the new states of Asia and Africa after the decolonization revolutions of the 1950s and 1960s has resulted in a renewed concern with the problems of government in multiethnic, multireligious, and multilinguistic countries. I discuss the issues thus produced, including the viability of states that are not underpinned by a compact and sovereign nation, and the role anthropology can play in clarifying such issues. © 2004 by The Wenner-Gren Foundation for Anthropological Research. All rights reserved.
In this paper, we provide an overview of how the outcomes of the Uruguay Round affected the application of pharmaceutical intellectual property rights globally. Second, we explain how specific pharmaceutical policy tools can help developing states mitigate the worst effects of the TRIPS Agreement. Third, we put forward solutions that could be implemented by the World Bank to help overcome the divide between creating private incentives for research and development of innovative medicines and ensuring access of the poor to medicine. Fourth, we evaluate these solutions on the basis of utilitarian considerations and urge that equitable pricing is morally preferable to the other solutions.
The Dying CityThe AIDS ModelAIDS and DemocratizationScience and ScarcityHow People Become Absent ThingsThe Politics of DeathExtending LifePharmaceutical FuturesNotesReferences
Stories in the Time of Cholera: Racial Profiling during. Medical Nightmare. Charles L. Briggs with Clara Mantini-Briggs. Berkeley: University of California Press, 2003. xxvi + 430 pp., illustrations, maps, tables, notes, bibliography, indexPathologies of Power: Health, Human Rights, and the New War on the Poor. Paul Farmer. Berkeley: University of California Press, 2003. xxiv + 402 pp.In this essay, I review two recent books in the field of health and disease—one dealing with an epidemic and the other with the consequences of structural violence on morbidity and mortality among the poor. Both books are excellent demonstrations of how the alliance between global institutions, the state, and medicine (esp. public health) leads to discrimination on the basis of race and class. Arguing outward from the books, I ask whether new diseases replicate earlier fault lines or whether new kinds of discrimination come into being as other technical and social imaginaries of danger to the social body are generated. I raise some puzzles within the global TB scenario and discuss the appropriateness or lack thereof of analyses based on economic and public-health models.
One-third of all human lives end in early death from poverty-related causes. Most of these premature deaths are avoidable through global institutional reforms that would eradicate extreme poverty. Many are also avoidable through global health-system reform that would make medical knowledge freely available as a global public good. The rules should be redesigned so that the development of any new drug is rewarded in proportion to its impact on the global disease burden (not through monopoly rents). This reform would bring drug prices down worldwide close to their marginal cost of production and would powerfully stimulate pharmaceutical research into currently neglected diseases concentrated among the poor. Its feasibility shows that the existing medical-patent regime (trade-related aspects of intellectual property rights—TRIPS—as supplemented by bilateral agreements) is severely unjust—and its imposition a human-rights violation on account of the avoidable mortality and morbidity it foreseeably produces.
Anthropological Quarterly 79.3 (2006) 483-508
We are accustomed to emphasizing the economic aspects of globalization and it is true that globalization corresponds to a displacement from a primarily industry-based economy to one where working on concepts plays a major role and where trade growth is tied in with financial deregulation and the new approaches this implies in terms of the circulation of capital. It is possible, though, that we have given insufficient weight to the fact that globalization is first and foremost a cultural phenomenon.
We should not see the violence of globalization purely and simply as a process of domination—like some new form of colonialism. The power of its impact is all the greater for the fact that it consists of a profound change in our awareness of time and space. "Globalization as a concept refers both to the compression of the world and the intensification of our consciousness of the world as a whole" (Robertson 1992:8). For Westerners, this notion of a self-contained world expresses itself in a strong feeling of insecurity. It only needs a sector of the economy, for example, to show signs of weakness, for the possibility of relocations to emerge. In the confrontations between staff and bosses that have always punctuated economic life, the outcome used to be that of a solution that took into account local social and economic conditions. Now, we "think globally"—meaning that relocation appears from the outset to be a pertinent alternative. In the face of this prospect, workers are caught in a very simple dilemma: either they accept the "sacrifices" or the company will quite simply disappear. Beyond this recurrent blackmail, what weakens people is the sense of the extraordinary "nearness" of other lands—which are easily identifiable, whether it be a country in Eastern Europe or Asia. There is a sense of temporal "nearness" too, in that in a few weeks or even days one can create a similar company on the other side of the world.
In practice, the compression of time and space can be perceived as a threat, not only because it accentuates the pressure of the invisible hand of the omnipotent market system, but also inasmuch as it makes possible a violent intrusion of alterity into our world. This was the case on September 11, 2001, when a place that represented the quintessence of the market was brutally attacked by a group that incarnated radical exteriority. We realized how easy it was for people we tended to think of as being on the other side of the world to reach the heart of the system by turning peaceful technologies into fatal weapons.
The awareness of globalization, therefore, is more than just the apperception of an ever closer interdependence of economies. It is equally, if not more, a matter of the citizens of the developed countries internalizing a simple, disturbing reality: that they will never again be "safe" from a threatening "elsewhere," hitherto considered marginal and today able to organize itself in a most "modern" manner and burst in. The whole "modernity" position, though, was based on the idea of there being an irreducible difference between all that represents civilization and fits into the scheme of progress and these Others who, while being part of humanity, were nonetheless doomed to the inertia of beings without history. We are part of the same planet, our destinies appear to us to be increasingly intertwined. There too, the evaluation can be interpreted optimistically: the fact that the compressing effect of globalization breaks down certain barriers between societies, overturns prejudices and obliges us to mix is cause for rejoicing. The concepts of cross-fertilization and hybridization have been invoked to describe the possibility finally at hand of a meeting between cultures so long separated and so long isolated by prevailing ideologies. The opposite of this ecumenical vision is an interpretation that highlights the virulence of the tensions generated by another huge present-day reality: that the other side of world unity is that resources and riches have to be shared.
Twenty or so years...
This article focuses on the Brazilian National AIDS Program and its policy of distributing and producing antiretroviral drugs, emphasizing links between local decisions and global HIV/AIDS policies. Emphasizing recent developments in the Brazilian and international scenario with regard to access to treatment for people with HIV/AIDS, the article highlights the participation by the pharmaceutical industry, governments, civil society, and UN agencies in establishing responses to the pandemic. The author concludes by identifying transnational activism as a key response to both the power of pharmaceutical corporations and the law of the market (including patent laws), thus fostering global solidarity for people with HIV/AIDS.
This study describes and conceptualizes the experiences of stigma in a group of children living with HIV in São Paulo, Brazil, and evaluates the impact of access to highly active antiretroviral therapy (HAART) over the social course of AIDS and over the children's experiences of stigma. Through ethnographic research in São Paulo from 1999 to 2001, the life trajectories of 50 children ages 1-15 living with or affected by HIV were studied. Data were collected via participant observation and semi-structured informal interviews and analyzed using social theories on illness experience and social inequality. Our results demonstrate that AIDS-related stigma occurs within complex discrimination processes that change as children reach adolescence. We found that structural violence in the forms of poverty, racism, and inequalities in social status, gender, and age fuels children's experiences of stigma. We also describe how access to HAART changes the lived experience of children, reduces stigma, and brings new challenges in AIDS care such as adolescents' sexuality and treatment adherence. Based on these results, we propose structural violence as the framework to study stigma and argue that interventions to reduce stigma that solely target the perception and attitudes toward people living with HIV are limited. In contrast universal access to HAART in Brazil is a powerful intervention that reduces stigma, in that it transforms AIDS from a debilitating and fatal disease to a chronic and manageable one, belongs to a broader mechanism to assure citizens' rights, and reduces social inequalities in access to health care.
This paper examines the processes for building highly collaborative public-private partnerships for public health, with a focus on the efforts to manage the complex relationships that underlie these partnerships. These processes are analyzed for the African Comprehensive HIV/AIDS Partnerships (ACHAP), a 5-year partnership (2001-2005) between the government of Botswana, Merck & Co., Inc. (and its company foundation), and the Bill & Melinda Gates Foundation. ACHAP is a highly collaborative initiative. The ACHAP office in Botswana engages intensively (on a daily basis) with the government of Botswana (an ACHAP partner and ACHAP's main grantee) to support HIV/AIDS control in that country, which had an adult prevalence of 38.5% HIV infection in 2000 when ACHAP was being established. The paper discusses the development of ACHAP in four stages: the creation of ACHAP, the first year, the second and third years, and the fourth year. Based on ACHAP's experiences over these four years, the paper identifies five lessons for managing relationships in highly collaborative public-private partnerships for public health.
This paper analyzes the role of government production of medicines in Brazil, based on a review of the literature and public documents. It begins by examining the main characteristics of the national and international pharmaceutical industry and market dimensions, mainly in the public sector. The government view was examined through Ministry of Health documents. The article concludes with a diagnosis of the state-owned pharmaceutical industry in Brazil, showing a variety of difficulties faced by the laboratories due to political and institutional constraints, management deficiencies, shortage of qualified human resources, and low technological capability.