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8 - ‘Nobody is going to die’: An ethnography of hope, indicators and improvizations in HIV treatment programmes in Uganda

Published online by Cambridge University Press:  05 October 2015

Sung-Joon Park
Institute for Anthropology of Leipzig University
Richard Rottenburg
Martin Luther-Universität Halle-Wittenberg, Germany
Sally E. Merry
New York University
Sung-Joon Park
Martin Luther-Universität Halle-Wittenberg, Germany
Johanna Mugler
Universität Bern, Switzerland
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‘One world, one hope’ Theme of the 11th International AIDS Conference in Vancouver in 1996


Uncertainty in HIV treatment

‘AIDS is not over’, warn Michel Sidibé, Peter Piot and Mark Dybul, representatives of the principal organizations of global health, in a commentary published in the Lancet (Sidibé, Piot and Dybul 2012). A lot is contained in their short claim. The authors explain that 8 million people world-wide were receiving antiretroviral medicines by 2011. AIDS-related deaths have been decreasing as a result of the large-scale provision of antiretroviral therapy. Most of these global health achievements were made in sub-Saharan African countries, which bear the brunt of the global burden of disease. Despite this ‘good news’, one of the reasons why these authors refrain from an optimistic view of the future of the AIDS epidemic is that today, still too many HIV positive people lack access to these medicines.

Currently, the most important global framework to articulate such claims to access to antiretroviral therapy is the Millennium Development Goals (MDGs) project, which defines a set of targets and indicators to measure progress toward the most important development goals of the twenty-first century. Under this project, ‘universal access to treatment’ is defined as one of the targets to ‘combat HIV/AIDS, Malaria and other diseases’. The official list of indicators promoted by UN organizations posits that universal access to treatment is reached when at least 80 percent of the ‘population with advanced HIV infection [have] access to antiretroviral drugs’. The attribute ‘universal’ refers not to all people with HIV, but only to those who, according to official treatment guidelines, are in an advanced stage of HIV infection and thus need treatment. Even with this definition, 8 million is only half of the target to reach 15 million people with access to antiretroviral therapies by 2015 (see also United Nations 2014: 36). Yet, the global prevalence of HIV is actually much higher, currently estimated to be 34 million, as the authors remind us in their review of these indicators (Sidibé, Piot and Dybul 2012: 2058). However, current funding levels of donor aid are not sufficient to cover the 15 million. Health economic models projecting the long-term costs of antiretroviral therapy demand an annual US$22 billion to run treatment programs world-wide, of which US$12 billion alone would be earmarked for the purchasing of antiretrovirals (e.g. Schwartländer et al. 2011; UNAIDS 2012).

The World of Indicators
The Making of Governmental Knowledge through Quantification
, pp. 188 - 219
Publisher: Cambridge University Press
Print publication year: 2015

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Adorno, Theodor W. 1951. Minima Moralia. Frankfurt a.M.: Suhrkamp (English translation: Adorno, Theodor W. 2005. Minima Moralia: Reflections on a Damaged Life. London/New York: Verso)Google Scholar
Barnett, Tony and Whiteside, Alan 2006. ‘HIV/AIDS, Mobilizing and Spending: Current Purposes and Problems’, paper prepared for the High-level Meeting on Trans-Atlantic Collaboration organized by the Center for Strategic and International Studies (CSIS) and Ministère Des Affaires Etrangères, Paris, 12–13 March
Comaroff, Jean 2007. ‘Beyond Bare Life: AIDS, (Bio)Politics, and the Neoliberal Order’, Public Culture 19(1): 197–219
Coutinho, Alex 2004. ‘Capturing the HIV/AIDS Epidemic’, Lancet 364(9449): 1929–30CrossRefGoogle Scholar
Crapanzano, Vincent 2003. ‘Reflections on Hope as a Category of Social and Psychological Analysis’, Cultural Anthropology 18(1): 3–32CrossRefGoogle Scholar
David, Pierre-Marie 2014. ‘Towards the Embodiment of Biosocial Resistance? How to Account for the Unexpected Effects of Antiretroviral Scale-up in the Central African Republic’, Global Public Health 9(1–2): 144–59CrossRefGoogle Scholar
Dewey, John 1920. Reconstruction in Philosophy. New York: H. Holt and CompanyCrossRefGoogle Scholar
Douglas, Mary and Wildavsky, Aaron B. 1982. Risk and Culture: An Essay on the Selection of Technical and Environmental Dangers. Berkeley, Calif.: University of California PressGoogle Scholar
Espeland, Wendy and Sauder, Michael 2007. ‘Rankings and Reactivity: How Public Measures Recreate Social Worlds’, American Journal of Sociology 113(1): 1–40CrossRefGoogle Scholar
Fassin, Didier 2009. ‘Another Politics of Life is Possible’, Theory, Culture and Society 26(5): 44–60CrossRefGoogle Scholar
Feierman, Steven 2011. ‘When Physicians Meet: Local Medical Knowledge and Global Public Goods’ in Geissler, P.W. and Molyneux, C. (eds.), Evidence, Ethos and Experiment: The Anthropology and History of Medical Research in Africa. New York: Berghahn Books, pp. 171–96Google Scholar
Foucault, Michel 1978. The History of Sexuality. New York: Pantheon BooksGoogle Scholar
Foucault, Michel 2003. Society Must be Defended: Lectures at the Collége de France, 1975–76. New York: PicadorGoogle Scholar
Geissler, Paul Wenzel, Zenker, Julia and Rottenburg, Richard 2012. ‘21st Century African Biopolitics: Fuzzy Fringes, Cracks and Undersides, Neglected Backwaters, and Returning Politics’ in Geissler, P.W., Zenker, J. and Rottenburg, R. (eds.), Rethinking Biomedicine and Governance in Africa. Bielefeld: Transcript, pp. 7–22CrossRefGoogle Scholar
GFATM 2009. Follow up Review of the Global Fund Grants to Uganda. Office of the Inspector General Uganda
Hardon, Anita 2012. ‘Biomedical Hype and Hopes: AIDS Medicines for Africa’ in Geissler, P.W., Zenker, J. and Rottenburg, R. (eds.), Rethinking Biomedicine and Governance in Africa. Bielefeld: Transcript, pp. 77–96Google Scholar
Jackson, Michael 2011. Life Within Limits: Well-being in a World of Want. Durham, N.C.: Duke University PressCrossRefGoogle Scholar
Jitta, Jessica, Reynolds Whyte, Susan and Nshakira, Nathan 2003. ‘The Availability of Drugs: What Does It Mean in Ugandan Primary Care’, Health Policy 65: 167–79CrossRefGoogle Scholar
Kaleeba, N., Kalibala, S., Kaseje, M., Ssebbanja, P., Anderson, S., Praag, E. Van, Tembo, G. and , E. Katabira 1997. ‘Participatory Evaluation of Counselling, Medical and Social Services of The AIDS Support Organization (TASO) in Uganda’, AIDS Care 9(1): 13–26CrossRefGoogle Scholar
Katabira, Elly T. and Oelrichs, Robert B. 2007. ‘Scaling Up Antiretroviral Treatment in Resource-Limited Settings: Successes and Challenges’, AIDS 21: S5–S10CrossRefGoogle Scholar
Kleinman, Arthur and Kleinman, Joan 1991. ‘Suffering and Its Professional Transformation: Toward an Ethnography of Interpersonal Experience’, Culture, Medicine and Psychiatry 15(3): 275CrossRefGoogle Scholar
Lear, Jonathan 2006. Radical Hope: Ethics in the Face of Cultural Devastation. Cambridge, Mass.: Harvard University PressGoogle Scholar
Livingston, Julie 2012. Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic. Durham, N.C.: Duke University PressCrossRefGoogle Scholar
Meinert, Lotte, Mogensen, Hanne O. and Twebaze, Jenipher 2009. ‘Tests for Life Chances: CD4 Miracles and Obstacles in Uganda’, Anthropology and Medicine 16(2): 195–209CrossRefGoogle Scholar
Merry, Sally Engle 2011. ‘Measuring the World: Indicators, Human Rights, and Global Governance’, Current Anthropology 52(S3): 83–95CrossRefGoogle Scholar
Ministry of Health 2011. Status Report on the Global Fund Grants in Uganda.Ministry of Health, Republic of Uganda
Miyazaki, Hirokazu 2004. The Method of Hope: Anthropology, Philosophy, and Fijian Knowledge. Stanford, Calif.: Stanford University PressGoogle Scholar
MoFPED 2013. Millennium Development Goals Report for Uganda 2013
Mogensen, Hanne 2010. ‘New Hope and New Dilemmas: Disclosure and Recognition in the Time of Antiretroviral Treatment’ in Luig, Ute and Dilger, Hansjörg (eds.), Morality, Hope and Grief: Anthropologies of AIDS in Africa. New York: Berghahn Books, pp. 61–80Google Scholar
Nguyen, Vinh-Kim 2010. The Republic of Therapy: Triage and Sovereignty in West Africa's Time of AIDS. Durham, N.C.: Duke University PressCrossRefGoogle Scholar
Park, Sung-Joon 2013. Pharmaceutical Government: An Ethnography of Stock-Outs and the Institutionalization of Free Access to ART in Uganda, Ph.D thesis. Department of Anthropology, Martin-Luther University Halle/GermanyGoogle Scholar
Pfeiffer, James 2013. ‘The Struggle for a Public Sector’ in Biehl, Joao and Petryna, Adriana (eds.), When People Come First: Critical Studies in Global Health. Princeton, N.J.: Princeton University PressGoogle Scholar
Redfield, Peter 2013. Life in Crisis: The Ethical Journey of Doctors Without Borders. Berkeley, Calif.: University of California PressGoogle Scholar
Robins, Steven 2006. ‘From “Rights” to “Rituals”: AIDS Activism in South Africa’, American Anthropologist 108(2): 312–23CrossRefGoogle Scholar
Rose, Nikolas and Novas, Carlos 2005. ‘Biological Citizenship’ in Collier, S. and Ong, A. (eds.), Global Assemblages, Anthropological Problems. Malden, Mass.: Blackwell Publishing, pp. 440–63Google Scholar
Rottenburg, Richard 2009a. Far-fetched Facts: A Parable of Development Aid. Cambridge, Mass.: MIT PressCrossRefGoogle Scholar
Rottenburg, Richard 2009b. ‘Social and Public Experiments and New Figurations of Science and Politics in Postcolonial Africa’, Postcolonial Studies 12(4): 423–40CrossRefGoogle Scholar
Schwartländer, Bernhard, Stover, John, Hallett, Timothy, Atun, Rifat, Avila, Carlos, Gouws, Eleanor, Bartos, Michaelet al 2011. ‘Towards an Improved Investment Approach for an Effective Response to HIV/AIDS’, Lancet 377(9782): 2031–41CrossRefGoogle Scholar
Sidibé, Michel, Piot, Peter and Dybul, Mark 2012. ‘AIDS is Not Over’, Lancet 380(9859): 2058–60CrossRefGoogle Scholar
UNAIDS 2012. AIDS Dependency Crisis: Sourcing African Solutions, Issues Brief
United Nations 2014. Millennium Development Goals Report 2014
Van Ufford, Quarles, Giri, Ananta Kumar and Mosse, David 2003. ‘Interventions in Development: Towards a New Moral Understanding of Our Experiences and an Agenda for the Future’ in van, Ufford Q. and Giri, A. K. (eds.), A Moral Critique of Development. London: Routledge, pp. 3–40Google Scholar
Weber, Max 1922/1976. Wirtschaft und Gesellschaft. 5th edn, Tübingen: MohrGoogle Scholar
Whyte, Susan Reynolds 1997. Questioning Misfortune: The Pragmatics of Uncertainty in Eastern Uganda. Cambridge/New York: Cambridge University PressGoogle Scholar
Whyte, Susan Reynolds, Whyte, Michael A., Meinert, Lotte and Twebaze, Jenipher 2013. ‘Therapeutic Clientship: Belonging in Uganda's Mosaic of AIDS Projects’ in Biehl, João and Petryna, Adriana (eds.), When People Come First: Anthropology and Social Innovation in Global Health. Princeton, N.J.: Princeton University PressGoogle Scholar
World Health Organization 2003. Scaling Up Antiretroviral Therapy: Experience in Uganda, WHO Perspectives and Practice in Antiretroviral Treatment. Geneva: WHO
World Health Organization 2009. Rapid Advice: Antiretroviral Therapy for HIV Infection in Adults and Adolescents, available at
World Health Organization 2013. Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations. Geneva: WHO
Zigon, Jarrett 2009. ‘Hope Dies Last: Two Aspects of Hope in Contemporary Moscow’, Anthropological Theory 9(3): 253–71CrossRefGoogle Scholar
Zournazi, Mary 2003. Hope: New Philosophies for Change. New York: RoutledgeGoogle Scholar

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