Counselling Citizens and Producing Patronage: AIDS Treatment in South African and Ugandan Clinics

Global health interventions to provide antiretroviral (ARV) drug treatment for people living with HIV/AIDS in developing countries have linked global and local actors in unprecedented ways. These uneven relationships have been described as creating new forms of citizenship that challenge the liberal understanding of rights and responsibilities bestowed by the state. A comparative case study based on fieldwork from South Africa and Uganda suggests different theoretical understandings of the link between technologies of AIDS treatment and relationships of belonging. Yet, ethnographic data from local clinics in both countries point to similarities that exist across AIDS interventions, and to the importance of counsellors in negotiating the rules of ARVs. Neither patients living with HIV nor the local providers of their AIDS treatment are ‘bare life’ subjects to be acted upon by a global development intervention. As ARV technologies are increasingly prescribed in developing country clinics, diverse social relationships are taught and negotiated as part of the pedagogy of biopolitics. The following discussion demonstrates how local counsellors and clients negotiate the rules of AIDS treatment together for mutual benefit. The article concludes that AIDS treatment creates relationships of therapeutic citizenship and clientship in ways that constrain the possibilities of citizenship and development.