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.