A magic bullet for the “African” mother? Neo-Imperial reproductive futurism and the pharmaceutical “solution” to the HIV/AIDS Crisis

Comparative ethnographies of medical research: materiality, social relations, citizenship and hope in Tanzania and Sierra Leone

In this paper we bring together ethnographic research carried out during two clinical prevention trials to explore identities, relations and political imaginations that were brought to life by these different technologies. We highlight the ways in which critical anthropological engagement in clinical trials can help us radically reconsider the parameters and standards of medical research. In the paper we analyse the very different circumstances that made these two trials possible, highlighting the different temporalities and politics of HIV and Ebola as epidemics. We then describe four themes revealed by ethnographic research with participants and their communities but mediated by the specific sociopolitical contexts in which the trials were taking place. In both countries we found materiality and notions of exchange to be important to participants’ understanding of the value of medical research and their role within it. These dynamics were governed through social relations and moral economies that also underpinned challenges to Western notions of research ethics. The clinical trials offered a language to express both disaffection and disillusionment with the political status quo (often through rumours and anxieties) while at the same time setting the foundations for alternative visions of citizenship. Attached to these were expressions of ‘uncertainty and hope’ steeped in locally distinctive notions of destiny and expectations of the future.

Problematising the Discourse of 'Post-AIDS'

This paper reflects on the meanings of 'post-AIDS' in the Global North and South. I bring together contemporary arguments to suggest that the notion of 'post-AIDS' is, at best, misplaced, not least because its starting point remains a biotechnical one. Drawing on aspects of the sub-Saharan African experience, this essay suggests that, despite significant shifts in access to antiretroviral therapy (ART), HIV continues to be fundamentally shaped by economic determinants and social and cultural practices. In this essay, I question the certainty of the discourse of (Western biomedical) 'positive progress' (Johnson et al. 2015), which underpins the 'post-AIDS' narrative, and suggest that living with HIV and AIDS in our contemporary global context is a life lived with ongoing complexity, stigma and chronicity. I suggest that HIV in the Global North shares many characteristics with HIV in the Global South yet differs in significant ways, not least in the fact that a resource-rich context generates an environment where health and social care support is possible, and, mostly, usual. In both contexts, however, the experience of living with a highly stigmatized illness with no cure in both the Global South and North suggests that this is a point of shared experience.

HIV, unwanted pregnancy and abortion--where is the human rights approach?

The HIV/AIDS field is addressing how legal and policy restrictions affect access to health promotion and care, e.g., in relation to criminalization of HIV transmission, drug use and sex work. Work to address the reproductive rights of women living with HIV, particularly regarding unwanted pregnancy and abortion, has nevertheless lagged behind, despite its potential to contribute to broader advocacy for access to comprehensive reproductive health information and services for all women. It is in that context that this paper examines abortion in relation to the rights of women and girls living with HIV. The paper first presents findings from recent research on HIV-positive women's reasons for seeking abortions and experiences with abortion-related care. This is followed by a discussion of abortion in relation to human rights and how this has been both addressed and neglected in policy and guidance related to the reproductive health of women living with HIV. The concluding remarks offer recommendations for expanding efforts to provide comprehensive, human rights-based sexual and reproductive health care to women living with HIV by including abortion-related information and services.