Displacing AIDS: therapeutic transitions in Northern Uganda

This doctoral project, entitled 'Displacing AIDS: Therapeutic Transitions in Northern Uganda' examines the biosocial transitions engendered by the treatment of HIV, focusing on antiretroviral therapy (ART/ARV) interventions, and the ways these are intertwined with the social transitions of conflict, displacement and return. The research involved an inter-disciplinary qualitative study with internally displaced communities living with HIV in northern Uganda, during 10 months fieldwork between 2006 and 2009. Northern Uganda has experienced a two decade civil war between the government of Uganda and the Lord’s Resistance Army (1987 to 2006). In 2006, after a cessation of hostilities was signed, hundreds of thousands of the displaced began returning ‘home’. The effects of conflict and social displacement were to significantly shape both the social and medical aspects of ART provision. I argue that northern Uganda was significantly excluded from widespread national community-based responses as a result of the war during the 1990s and early 2000s. Given this background, ART interventions were to engender rapid social transformations among those with HIV, but also in relation to the perceptions of HIV/AIDS in the broader community. I explore these intersecting biosocial and displacement-induced transitions through several streams: the social transitions of forced displacement and the return process; the transitions from illness to a precarious health; from social exclusion to a contested inclusion; transitions between local and biomedical understandings of healing; transitions in authority and biopower; as well as continually shifting forms of identity, support and affiliation. I give particular emphasis to forms of socio-spatial and medico -moral transformations. I argue that ARV interventions have been nested in the social and moral spaces of displacement. In particular the spatial configurations of encampment, involving extreme congestion and lack of privacy, have shaped patterns of disclosure and community and identity formation. The influence of Catholicism, shaped by missionary histories in the region, has also had a strong impact. Themes of militarism, lack of productivity, and encampment have shaped the language and perceptions of HIV and AIDS. Theoretically I engage with debates around biosociality, stigmatisation and ‘clientship’ within the emerging literature on ARVs. I trace the intersections of these questions with those in forced migration studies regarding the social transformations of displacement and return. Furthermore, I use this social analysis to engage with public-health perspectives on ARV provision. I argue that community-based strategies require adaptation to the social contexts of displacement. Such adaptations, involving attentiveness to the socio-spatial specificity of displaced contexts, are critical for the long-term provision and sustainability of antiretroviral therapy to displaced communities. In particular the return phase has created unexpected challenges for treatment continuity, arising from large-scale population movements. The thesis has a strong narrative focus and traces the experiences of several people living with HIV through the paths of displacement and return.This thesis is not currently available in ORA