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.