Gendering the Therapeutic Citizen: ARVs and Reproductive Health

Reproductive Health as a global agenda can provide an opportunity for including “social issues” under its vast umbrella. However, so far reproductive health has failed to go beyond family planning in large-scale, high impact interventions. Now, the impact of the HIV/AIDS pandemic has meant that the primary reproductive health goal of many African women in highly affected communities is to remain healthy long enough to reproduce. The case of ARV treatment in a township clinic in South Africa will demonstrate the need for a genuinely integrated global concept of reproductive health and rights that includes the realities of AIDS and its treatment. This research is in some respects an anthropological examination of AIDS interventions from a political standpoint. In this paper I examine the other side of the issue of AIDS and family planning integration: how are family planning technologies and contraceptive decision making integrated into HIV/AIDS treatment clinics? Reproductive decision making in the context of the AIDS clinic reignites classic debates over the rights of the individual versus the rights of the community, the meanings of motherhood and maternal identity, and the appropriate control of sexuality by the state vis a vis governance of the self. Yet, in the situation of reproductive decision making by HIV positive women, the stakes are higher, the boundaries less discernible, and the meanings even more contingent by the urgency of the disease and the poignancy of the processes of giving life. To begin to understand this, I argue, we must find a way to gender the therapeutic citizen in order to reintegrate the biopolitical struggle of ARVs with the “social issues” percolating within the therapeutic state