This article analyses the complex cultural politics of HIV/AIDS in South Africa. It focuses on how AIDS 'dissident' science impacted on policy discourses and how AIDS activists, together with scientists, the media and health professionals, responded. It also shows how the HIV/AIDS debate and struggles over access to treatment were framed by historically embedded cultural and political interpretations of AIDS that were a product of South Africa's apartheid and post-apartheid history. However, rather than adopting a cultural nationalist response to this historical legacy, activists from the Treatment Action Campaign (TAC) deployed a class-based politics that concentrated on access to anti-retroviral drugs rather than debates on the complexities of AIDS causation. This approach contrasts with attempts by AIDS activists in the United States to influence the production of scientific knowledge on AIDS directly, for example, research funding and protocols for trials. The article discusses how TAC and its partner organisation, Medicins Sans Frontières (MSF - Doctors without Borders), strategically positioned themselves in the struggle for access to AIDS drugs, and how new forms of health citizenship, gendered identities and political subjectivities emerged in the course of these struggles. For example, ideas of bodily autonomy associated with liberal individualist conceptions of citizenship collided with patriarchal cultural ideas and practices that prevent many women from accessing biomedical interventions (for example, contraception, HIV testing and treatment). The biomedical paradigm that underpinned TAC/ MSF campaigns also had to contend with local understandings of misfortune and illness. While TAC's strategies included networking with global civil society organisations such as MSF, Health Gap, and Oxfam, they also involved grassroots mobilisation and an engagement with local socio-cultural realities. This brand of health activism produced solidarities that straddled local, national and global spaces, resembling what Arjun Appadurai and others describe as 'globalisation from below'.
Journal of Southern African Studies - Vol 30 No 3 pp. 651-672