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Will to Live: AIDS Therapies and the Politics of Survival
     

Will to Live: AIDS Therapies and the Politics of Survival

by Joao Biehl, Torben Eskerod
 

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ISBN-10: 0691143854

ISBN-13: 9780691143859

Pub. Date: 04/27/2009

Publisher: Princeton University Press

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 João Biehl also tells why this policy, hailed

Overview

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 João 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.

Product Details

ISBN-13:
9780691143859
Publisher:
Princeton University Press
Publication date:
04/27/2009
Series:
In-Formation Series
Pages:
480
Sales rank:
1,349,329
Product dimensions:
6.20(w) x 9.20(h) x 1.20(d)

Table of Contents

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
Brasília 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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