HIV Mass Treatment in West Africa

This project, now completed, extended research on the response to the AIDS epidemic in West Africa to examine the growth of mass treatment pro-grammes as emergent assemblages of law, organisation, science, and technology. Mass HIV treatment programmes were originally conceived as the response to a humanitarian emergency: the impending wave of deaths from HIV in Africa, where the vast majority of the world’s infections are concentrated. They constituted, at first glance, an exceptional response to the usual business of global health. However, closer ethnographic scrutiny reveals several important aspects: First of all, the exception has become the norm: not only because HIV treatment is for life, but because humanitarian emergencies, defined in terms of the impending mass loss of life, now frame global health pro-grammes in general. Second, the organisation of the response, initially conceived of as a ‘vertical’ one-issue programme, has changed as the exigencies of succeeding at mass treatment require the bundling of ever more services: food aid, counselling, income supplementation, etc. The result has been the advent of therapeutic quasi-states, where the health sectors of entire countries are mainly managed by NGOs or American universities. The third aspect has been the emergence of a new science of HIV specifically concerned with managing the epidemic, whose central questions have emerged as a result of the increasing use of biomedical technologies to control HIV. Diagnostic technologies, such as viral load monitoring, and therapeutic interventions, such as viral load reduction, have made new approaches possible in the governing of life in Africa. For example, the notion that systematic, mass treatment of the entire HIV-positive population can be used to eradicate the epidemic has recently become the holy grail of efforts to control HIV, spawning massive clinical trials that hold the potential to generalise new social practices. The findings from this project are now being mobilised in a new project that examines the articulation of global health and global war post-9/11.