Abstract
This article examines how indifference towards suffering associated with illness has become increasingly prevalent, as well as how initiatives of engagement with people who need care have been systematically dissolved, in contemporary Ethiopian society under the strategy to eliminate the HIV epidemic through universal treatment. The “treatment as prevention” strategy is the key framework of contemporary HIV intervention based on the theory of infectious disease epidemiology, which aims to end the global epidemic of HIV by offering access to antiretroviral treatment (ART) to everyone, including those living on the African continent. The strategy is the remarkable culmination of accumulated public health knowledge that envisages effective control of the epidemic, combined with civil justice that demands treatment for all. However, this article argues that apathy towards the suffering of some HIV-positive people who have failed to re-establish their lives has become prevalent in contemporary Ethiopia. It also argues that the scope of the “treatment as prevention” strategy fails to capture the precariousness of the lives of people affected by the disease.
This article describes some of the salient features of the “treatment as prevention” strategy and their effect on the experiences of some Ethiopians living with HIV using the concept of therapeutic citizenship as a framework. Therapeutic citizenship is defined as the system of claims and ethical projects concerning the use of biomedical knowledge and techniques. It may refer to the associations and networks of HIV-positive people who claim their right to access to ARVs. However, at the same time, it also refers to a biopolitical form of governance that concerns itself with technologies for controlling the risk of infectious diseases. The “treatment as prevention” strategy is a form of risk governance that involves controlling populations in an HIV epidemic. What is remarkable about the strategy is that it “bypasses” the moral and behavioral aspects of personal life by dealing with populations rather than individuals. However, that feature has a dual effect on the individual experience of the HIV epidemic. At the same time, it can also be regarded as a “liberal” project, that is, one that is less concerned about individual (sexual and other) behaviors and the moral issues attached to them. Nevertheless, it also appears indifferent to personal suffering and the precariousness of people’s lives disrupted by the illness.
Ethiopia’s health system, which provides ARVs free of charge to its HIV-positive citizens, can be considered the embodiment of the “treatment as prevention” strategy. The Ethiopian government and the networking body that represents HIV-positive people in the country both receive considerable support from international sources, including the Global Fund to Fight AIDS, Tuberculosis and Malaria. In Ethiopia, the promotion of group activities to facilitate medication adherence has been associated with the half of existing activities to provide more personalized care for individuals and their families affected by the virus.
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