Will to live : AIDS therapies and the politics of survival

著者

書誌事項

Will to live : AIDS therapies and the politics of survival

João Biehl ; photographs by Torben Eskerod

Princeton University Press, c2007

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注記

Includes bibliographical references (p. 425-449) and index

内容説明・目次

内容説明

"Will to Live" tells how Brazil, against all odds, became the first developing country to universalize access to life-saving AIDS therapies - a breakthrough made possible by an unexpected alliance of activists, government reformers, development agencies, and the pharmaceutical industry. But anthropologist Joao Biehl also tells why this policy, hailed as a model worldwide, has been so difficult to implement among poor Brazilians with HIV/AIDS, who are often stigmatized as noncompliant or untreatable, becoming invisible to the public. More broadly, Biehl examines the political economy of pharmaceuticals that lies behind large-scale treatment rollouts, revealing the possibilities and inequalities that come with a magic bullet approach to health care.By moving back and forth between the institutions shaping the Brazilian response to AIDS and the people affected by the disease, Biehl has created a book of unusual vividness, scope, and detail. At the core of "Will to Live" is a group of AIDS patients - unemployed, homeless, involved with prostitution and drugs - that established a makeshift health service. Biehl chronicled the personal lives of these people for over ten years and Torben Eskerod represents them here in more than one hundred stark photographs. Ethnography, social medicine, and art merge in this unique book, illuminating the care and agency needed to extend life amid perennial violence. Full of lessons for the future, "Will to Live" promises to have a lasting influence in the social sciences and in the theory and practice of global public health.

目次

Introduction: A NEW WORLD OF HEALTH The Right to a Nonprojected Future 3 Universal Access to Lifesaving Therapies 7 A Political Economy of Pharmaceuticals 10 Persistent Inequalities 14 Lives "Take me to my father's house" (Edileusa) 20 "Today is another world" (Luis) 22 "If I only had thought then the way I think now" (Rose) 26 "Why will I think about the future?" (Nerivaldo) 30 "A child is what I wanted most in life" (Evangivaldo) 33 "To have HIV ... is like not having money" (Valquirene) 37 "Too much medication" (Soraia) 40 "A beautiful place" (Tiquinho) 43 The Politics of Survival 47 Chapter One: PHARMACEUTICAL GOVERNANCE Globalization and Statecraft 53 The Social Science of a Transforming Regime 55 AIDS, Democratization, and Human Rights 58 A Transnational Policy-Space 64 The Activist State 68 Intellectual Property Rights and World Trade 73 A Country's Disease--Public-Private Partnerships 79 Decentralization and a Magic Bullet Approach 84 Public-Sector Science and the Production of Generic Drugs 87 Scaling-Up 93 The Pharmaceuticalization of Public Health 97 Chapter Two: CIRCUITS OF CARE How Has AIDS Activism Changed? 105 From Passion to Politics 110 The AIDS Industry 115 Micro-Politics of Patienthood 120 Performing Citizenship 125 Grassroots Health Systems 130 A New National AIDS Program 135 On the Street: Violence, Charity, and Pleasure 140 In the Mainstream 155 Measures of Success, Undesirable Realities 160 The Undetectable Virus 164 "It is all about medicines now" 169 In Search of a Comprehensive Approach 172 "There is not just one death" 175 Chapter Three: A HIDDEN EPIDEMIC The Limits of Surveillance 179 AIDS in Bahia 180 Economic Death 184 Pelourinho 190 "I set myself on fire" (Maria Madalena) 194 "They take care of me as if I were family" (Lazaro) 198 Technologies of Invisibility 202 A System of Nonintervention 204 Infectious Diseases Research 206 Medical Sovereignty, Local Bioethics 209 Triage 213 The Social Life of Death Certificates 217 AIDS Therapies and Homelessness 225 "Science makes people equal" 232 Brasilia 236 Chapter Four: EXPERIMENTAL SUBJECTS AIDS-like Symptoms 241 HIV Antibody Test 244 Certainty: Closing the Past 246 Uncertainty: The Window Period 246 A Population of Doubts 250 What Is Socially Visible Is an Imagined AIDS 253 Risk and Prevention Models 257 Libidinal Order 259 Science and Subjectivity 263 Dangerous Worlds of Intimacy 267 Technoneurosis 270 "They own their bodies and are responsible for their actions" 272 Clinical Trials 276 Chapter Five: PATIENT-CITIZENSHIP "On the plane of immanence that leads us into a life" 283 A Place of No Government 286 Pastoral Power 296 Institutional Belonging and Treatment Adherence 303 New Prohibitions 308 "In Caasah we don't just have AIDS--we have God" 312 Religion, Health, Wealth 318 Ambiguous Political Subjects 324 Resuming Sexual Life 327 Beyond Direct Observed Therapy 334 Chapter Six: WILL TO LIVE Lifelong AIDS 339 Human Values 344 Medical Disparities 347 From Epidemic to Personalized Disease 349 Physically Well, Economically Dead 353 Drug Resistance and Rescue Treatments 355 "Medication is me" (Luis) 358 "I am mother and father" (Rose) 363 "It is the financial part of life that tortures me" (Evangivaldo) 368 Conclusion: GLOBAL PUBLIC HEALTH Large-Scale Medical Change 375 "A little more reverence for life" 377 The Future of Treatment Rollouts 379 Pharmaceutical Philanthropy and Equity 383 Where Is the State? 388 A Vanishing Civil Society 393 Understanding the Nexus of AIDS, Poverty, and Politics 396 Local Economies of Salvation 399 The Unexpected and the Possible 404 Acknowledgments 407 Notes 411 References 425 Index 451

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