HIV Citizenship in Uneven Landscapes

The HIV/AIDS epidemic has taken on a new course in recent years with expanded access to antiretroviral therapy in the Global South. Although this transition is extending the lives of individuals for years or even decades, it is also creating new relationships between citizens and the state that are driven by resource needs specific to HIV management. This article details findings from an ongoing research project in northeast South Africa that is examining the social and ecological impacts of HIV/AIDS. Qualitative interviews are combined with ethnographic observations of a rural primary care clinic to document the ways in which residents and health care institutions are managing HIV. While initiating care for HIV-positive patients on antiretroviral therapy, clinics and other health care agencies advocate behavioral practices that challenge existing cultural norms and spatial economies, particularly in the realm of nutrition and food access. The importance of accessing certain foods is advocated as necessary for maintaining bodily health, yet this therapeutic citizenship confronts historical systems of inequality produced through spatial segregation. The consequence is that the coupling of drug provision with public health interventions produces uneven opportunities for health management that are mediated by cultural, ecological, and political systems in the era of managed HIV. Key Words: health, health and environment, HIV/AIDS, political ecology of health, South Africa, therapeutic citizenship.