Doctoral Dissertation Research: Constructing AIDS Treatment in South Africa: Discourse, Power and Policy

该项目研究了南非政府与由治疗行动运动领导的国内社会运动之间在向艾滋病患者提供抗逆转录病毒（ARV）治疗方面的冲突的历史和后果。在政府和抗逆转录病毒社会运动之间发生激烈冲突后，治疗现在已扩大到所有南非人，但覆盖面仍然存在差距，这似乎是由于以前存在的脆弱和边缘化地区。这个项目研究了社会运动如何利用对他们有利的治疗谩骂，在这个过程中改变了流行的艾滋病毒/艾滋病叙事。此外，本研究将分析目前的艾滋病治疗结构是否体现了ARV社会运动的公平议程。该项目将三角话语分析，政治经济学和批判人种学，通过公平的透镜检查治疗。该项目将有助于了解公平的抗逆转录病毒治疗的历史和可能性。此外，将通过关注当代艾滋病毒/艾滋病公共卫生政策历史发展的政治经济学分析，揭示获得治疗的物质现实。通过分析艾滋病的话语，特别是当占主导地位的话语被颠倒的时刻，本研究将揭示如何社会运动创造了一个新的艾滋病叙事的空间。此外，通过对政策文件的分析，该项目将参照该国的主要治疗叙述，阐明抗逆转录病毒治疗的政治经济学。最后，访谈和参与观察公共卫生诊所的工作人员将根据有目的的抽样技术进行接地项目人种学。 该项目的智力价值在于补充话语权力的理论化，理解国家权力的形式和表达，并在当代健康地理学中测量社会阻力。从经验上讲，该项目特别关注在全球推广抗逆转录病毒药物政策的同时，确定艾滋病政策如何能够确保公平获得。该项目将详细介绍南非目前的抗逆转录病毒疗法。该项目的更广泛影响在于提供对艾滋病治疗政策的细致入微的理解，使南非和其他地方的所有艾滋病毒阳性者，而不仅仅是那些生活在特权环境中的人，都能够获得医疗保健。在大多数国家将抗逆转录病毒疗法扩大到有需要的艾滋病毒阳性公民的时代，这是对文献的必要贡献。艾滋病可能是撒哈拉以南非洲地区对人类福祉的最大威胁，因此这项研究有助于了解如何最好地预防和治疗这种疾病，并为艾滋病毒感染者辩护。作为博士论文研究改进奖，该奖项还将提供支持，使有前途的学生建立一个强大的独立的研究生涯。

This project examines the history and consequences of conflict between the South African government and the domestic social movement led by the Treatment Action Campaign over the provision of antiretroviral (ARV) therapy to people living with AIDS. After a bitter conflict between the government and the ARV social movement, treatment is now being extended to all South Africans, yet there remain gaps in coverage that appear to be following previously existing geographies of vulnerability and marginality. This project examines how social movements engaged the treatment invective to their advantage, changing the popular HIV/AIDS narrative in the process. Further, this research will analyze if the current AIDS treatment structure embodies the equity-based agenda of the ARV social movement. The project will triangulate discourse analysis, political economy, and critical ethnography to examine treatment through an equity lens. This project will allow for an understanding of the history of, and possibilities for, equitable ARV therapy. In addition, the material reality of treatment access will be exposed through a political economy analysis attentive to the historical development of contemporary HIV/AIDS public health policy. By analyzing the discourses surrounding HIV/AIDS, particularly the moments when the dominant discourse was inverted, this research will reveal how a social movement created the space for a new AIDS narrative. Additionally, through an analysis of policy documents this project will illuminate the political economy of ARV treatment in reference to the dominant treatment narratives in the country. Lastly, interviews and participant observation with public health clinic workers will be conducted in accordance with purposive sampling techniques to ground the project ethnographically. The intellectual merit of the project lies in supplementing theorizations of discursive power, understanding forms and expression of state power, and measuring social resistance within contemporary health geography. Empirically, this project takes special interest in establishing how AIDS policy can ensure equitable access at a time when ARV policies are being extended globally. This project will provide a detailed description of current ARV therapy in South Africa. The broader impact of this project lies in offering nuanced understandings of AIDS treatment policy such that all HIV-positive people in South Africa and elsewhere, not just those in privileged environments, are able to access health care. In an era when most countries are extending ARV therapy to HIV-positive citizens in need, this is a needed contribution to the literature. AIDS is perhaps the single greatest threat to human well-being in sub-Saharan Africa, so this study contributes to knowledge about how best to prevent and treat the disease, as well as advocate for people with HIV. As a Doctoral Dissertation Research Improvement award, this award also will provide support to enable a promising student to establish a strong independent research career.