The Supply Side of ART: users, drugs, and technologies in organising mass ART-programs in Uganda

This project investigates the co-production of scientific and political orders in the global circulation of technologies and models through which pharmaceuticals are made available in Uganda. The research project asks how pharmaceuticals shape ideas of scientific truth and social justice. How are novel therapeutic apparatuses of life-saving pharmaceuticals emerging in countries like Uganda? How are such live-saving and expensive pharmaceuticals embodied in social, scientific, and political practices in Uganda, where health infrastructures have been exposed to crises, wars, and global humanitarian interventions for many years? In what way do these pharmaceuticals constitute global public goods and what are the scientific, social, and economic implications?


The empirical research clusters around the following themes: (1) “antiretroviral therapy (ART) and the projectification of health”; (2) “availability of medicine and commodity insecurity”; and (3) “epistemic practices and evidence-based global health pharmacy”. All of the themes, each of which builds upon the others, has analytical and conceptual dimensions that speak to various scientific debates and controversies on AIDS, development theory, and global health. For instance, one of the central topics of this project is the stockout of free ARVs in Uganda. In order to understand the significance of these stockouts, opposed to many other things that can run out-of-stock in Uganda every day, it is important to understand the emergence of large-scale infrastructural apparatuses to scale-up access to ART and to institutionalise free access to treatment in Uganda. These apparatuses of mass ART-programmes comprise a broad set of elements such as infrastructures, technologies, regulations, clinical standards, and social technologies, through which HIV patients are constituted as ‘clients’ of a treatment programme. It is through these therapeutic apparatuses that needs for antiretroviral medication and the huge budgets of donor organisations can be made calculable and accountable.


In this respect, the therapeutic apparatuses in making ART and populations calculable can be understood as paradigmatic examples for contemporary forms of institutionalising access to what Adriana Petryna and Arthur Kleinman describe as ‘global pharmaceuticals’. Such apparatuses have in-tended and unintended economic, political, and moral effects that are made visible during the stockout of ARVs. Furthermore, these apparatuses are extremely exceptional and unpredictable where the global circulation of knowledge, moral claims, and technologies is mediated by the thick web of projects and interventions that often replace governmental structures. In addition, the demand for evidence-based interventions in health care and biomedical re-search in Africa to translate these global pharmaceuticals into a therapeutic option has increased significantly over the past few decades. Such evidence-based interventions, however, systematically ignore various questions of political power and mask the situatedness of social practices in producing data and providing health. They thus pose important questions as to how contemporary figurations in global health raise and institutionalise ideas of a human right to access health services and to equality in free access to ART in a highly uncertain context, in which there are lacks in all types of material security.


The project’s three themes are also interlinked through ethnographic re-search as a situated and positioned engagement with moral dilemmas, social conflicts, and, more importantly, anthropological problems that emerge in the co-production of scientific and political orders in the Ugandan AIDS epidemic.

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