AIDS, citizenship and global funding : a Gambian case study

Making sense of an HIV-positive diagnosis is often a struggle. Across Africa this is mediated by a new globalism in public health; the last decade has seen an array of new international initiatives and funding mechanisms. These dimensions of governance exemplify, in the health sector, an intensified move away from forms of authority based on the pre-eminence of nation states in global arenas, towards an array of new arrangements including global public-private-philanthropic partnerships. This Gambian case study unpicks the picture of an emergent ‘therapeutic citizenship’ (Nguyen 2005) in this context – of condom demonstrations and public disclosures – looking to the strands of authority and governance linked to an epistemic structure initiated by the Global Fund, but that works through a complex web of other organisations and agencies. This suggests that in Gambia in the period up to the end of 2006, the focus of this paper, a localglobal axis which constructed HIV related problems, solutions and related notions of identity and political affiliation had come into being. For people living with HIV in the Gambia, making claims based on their status in this field has been problematic, and their ability to shape proactively what goes on and assert their felt needs often rather limited. Keywords: HIV and AIDS; treatment, antiretrovirals (ARVs); support groups; identities; citizenship; global fund; NGOs; intermediation; The Gambia.