INTL 340 Lecture Notes - Lecture 13: Medicalization, Mantra, Neoliberalism
2 Jul 2018
School
Department
Course
Professor
Week 7 Class 1
Anthropological/ethnographic approaches to Global HIV/AIDS
● Biehl article-Pharmaceuticalization of AIDS treatment in Brazil
○ ethnographic
○ anthropological research
● Method: Combines local-level ethnography with interviews with policy-makers and power-
brokers in AIDS treatment
○ multi-level analysis
● Interested both in the political economy of AIDS treatment and in the local networks of care
and exclusion that follow the implementation of Brazil’s ARV treatment policy
● Brazil-AIDS policy
○ 1996: first “developing” country to adopt universal access to ARVs as a public health
policy
○ 2005: Brazil accounts for 15% of global AIDS patients receiving ARV treatment (even
though only 3% of global AIDS cases)
○ Administered through SUS - national health system
■ already existing public health infrastructure
○ Problem: health system is institutionally weak; AIDS programs partially strengthen
but also point to limitations in public system
● Scaling up
○ scaling up: expanding local-level health initiatives to country-level or internationally
○ Challenges: economic (resources/financing), administrative (need national level
health system that reaches all parts of the population-urban and rural), political
○ Global expansion of AIDS treatment was pushed through global social activism
○ Global access to ARVs as a social justice issue
○ In expanding access to HIV treatment, countries were also able to expand Primary
Health Care
■ EX of human right to health and expansion of Alma-Ata principle of PHC
● ARV politics (how brazil did this)
○ in the mid-1990’s, Brazil begins national production of ARVs via public-private
partnerships
■ had infrastructure to produce the ARVs
○ Brazil also imports generic ARVs from India—>up to 70% price reduction for these
drugs
○ other countries follow suit (ex: South Africa with a “Medicines Act”)
○ Pharmaceutical companies react, sue, claim intellectual property rights
○ Had political leaders willing to take this on—Brazilians politicians saying to Global
Pharmaceutical Industry that they can take this on and will no longer put up with GPI
■ backup of political pressure on pharmaceutical companies
● Political economy of pharmaceuticalization
○ Brazilian gov had to negotiate access to first line ARVs with pharma companies
○ How did they do this? Why did pharma agree? What leverage did Brazil’s gov have
in these negotiations with drug companies
○ Brazil becomes global leader and model for other developing/poor countries (“south-
south” networking) at the level of the WHO, UNAIDS, etc
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Biehl article-pharmaceuticalization of aids treatment in brazil. Method: combines local-level ethnography with interviews with policy-makers and power- brokers in aids treatment. Interested both in the political economy of aids treatment and in the local networks of care and exclusion that follow the implementation of brazil"s arv treatment policy. 1996: first developing country to adopt universal access to arvs as a public health policy. 2005: brazil accounts for 15% of global aids patients receiving arv treatment (even though only 3% of global aids cases) Administered through sus - national health system. Problem: health system is institutionally weak; aids programs partially strengthen but also point to limitations in public system. Scaling up: expanding local-level health initiatives to country-level or internationally. Challenges: economic (resources/financing), administrative (need national level health system that reaches all parts of the population-urban and rural), political. Global expansion of aids treatment was pushed through global social activism. Global access to arvs as a social justice issue.
