"Death is destiny": Sovereign decisions and the lived experience of HIV/AIDS and biomedical treatment in central Mozambique

Abstract

Long time exposure to the threat of death under the form of extreme poverty, hunger and terror warfare turns HIV/AIDS in just another danger. Confronted with the integration of AIDS clinics in general primary health care services some patients in anti-retroviral treatment interpreted the decision as the will to kill them massively and decided to drop-out treatment. The concepts of biopower, bare life, and biological citizenship were useful heuristic devices to explore the complexities of HIV/AIDS biomedical treatment, the production of subjectivities as well as AIDS sufferers' lived experiences. Drawing on two years ethnographic field research from 2007 to 2009 in Manica province and in Maputo—the country's capital—this dissertation shows that HIV/AIDS care and treatment cannot be reduced to access to pharmaceuticals. It also argues that a dilapidated, understaffed and poorly served national health service combined with a decontextualized anti-retroviral treatment delivery model produce exclusion mechanisms that leave out the poorer, illiterate and for the most part inhabitants of rural areas. A biomedical culture and practice associated with some authoritative traits also plays a role in HIV/AIDS patients' lived experience of the illness and their attitudes towards care and treatment. This dissertation suggests that the frequent interface with biomedical services and its disciplinarian apparatus, as well as the requirements of anti-retroviral treatment, constitute a pervasive engagement of people living with HIV/AIDS with "modernity".