Mobilising and mediating global medicine and health citizenship : the politics of AIDS knowledge production in rural South Africa

The paper investigates the ways in which global health messages and forms of health citizenship are mediated by AIDS activists in rural South Africa. It focuses on how international health agencies and NGOs engage with local communities through AIDS prevention and treatment programmes. Some critics regard such global health programmes as conduits for the medicalisation of social life and social problems. From this perspective global medicine is an all-encompassing process that results in systematic normalisation, depoliticisation and disempowerment of patients and citizens. However, this case study draws attention to the agency of the ‘targets’ of biomedicine. It also highlights the observation that AIDS activists and treatment literacy practitioners are not only concerned with biomedical matters, but are also committed to recruiting new members into their biopolitical projects and epistemic communities. These mobilisation processes involve translating and mediating biomedical ideas and practices into vernacular forms that can be easily understood and acted upon by the ‘targets’ of these recruitment strategies. However, these processes of ‘vernacularisation’ or localisation of biomedical knowledge often occur in settings where even the most basic scientific understandings and framings of medicine can not be taken for granted. This ethnographic case study shows that global health programmes, and their local NGO and social movement mediators, often encounter considerable ‘friction’ not only from powerful national state actors, who may view such programmes as challenges to national sovereignty, but also from the most marginalised village-level actors. Keywords: HIV/AIDS; mediation; global health; citizenship; knowledge production; South Africa.