UCSF

Antiretroviral (ARV) treatment first became publicly available in Mozambique in June of 2004. The steadily rising count of "lives saved" seems to represent a success story of high-tech treatment being provided in one of the poorest contexts in the world, and in some ways it does, as people with AIDS are experiencing dramatic recoveries and living longer. But the numbers say little about how life has changed for people with the disease. This ethnographic study uses participant observation and in-depth interviews to offer accounts of people living with HIV/AIDS at the start of the "treatment era" in central Mozambique. In a context of chronic underemployment and threadbare public infrastructure, the HIV positive status offered eligibility for free medical care and other material benefits. The number of those eligible for benefits far outnumbered availability, however, triggering intense competition amongst the HIV positive and widespread cynicism about the entire AIDS effort. Extraordinary practices of solidarity did emerge within local organizations, churches, and homes, yet these spaces were fundamentally shaped by scarcity and exclusion. In the AIDS clinic, patients were counseled to "live positively" and maintain a strict lifestyle that included a lifetime of ARV treatment, renouncing the herbal medications of traditional healers, and consenting to voluntary infertility. From their perspective, ARV treatment represented an ambivalent proposition. This dissertation argues that these individually targeted treatment programs have dehumanizing and sociopathic effects, as the broader structures that contribute to suffering and impoverishment remain hidden and intact while the victims of the epidemic are consigned to a social death. By targeting a biological condition, political and economic x concerns are sidelined. These dynamics are crystallized in the hunger that plagues those on ARV treatment. Hunger has both a physiological basis and an existential dimension, as talk of hunger expresses an embodied sense of exclusion and disillusionment.