From "medical miracles" to normal(ised) medicine : AIDS treatment, activism and citizenship in the UK and South Africa

This paper compares and contrasts the cultures of activism and illness and treatment experiences of UK and South African AIDS activists. By the 1990s AIDS public health discourse in the UK, and elsewhere in the West, was reconfiguring AIDS as a manageable chronic illness that could be treated much like diabetes. By contrast, the introduction of anti-retroviral therapy (ART) in the South African public health sector in 2000 was described using quasi-religious phrases and narratives: “the Lazarus effect” and “God’s gift of life.” The paper is concerned with investigating these significant differences between Northern and Southern experiences and responses to ARV treatment. It is specifically interested in the ways in which relatively easy access to treatment in the UK has, in certain cases, contributed towards the individualisation, medicalisation and “normalisation” of HIV/AIDS. For example, some of the UK activists I interviewed claimed that the availability of ART through the NHS had “killed activism”. The paper shows how the individualising and depoliticising medicalisation processes associated with NHS treatment programmes stand in stark contrast to South Africa, where the ongoing legal and political struggles for treatment access continue to strengthen and sustain collective forms of social activism and mobilisation. The paper explores the implications of these strikingly different treatment contexts, experiences and responses. These include differences in the availability and quality of treatment and health services, infection and mortality rates, socio-economic profile of PWAs, political cultures of activism, and contrasting government and activist responses to the pandemic. In sum, individualising and normalising processes of “medicalisation” associated with the NHS are increasingly, it would seem, becoming obstacles to collectivist forms of mobilisation.