Discourse, Power, and Policy: Constructing AIDS Treatment Access in South Africa

On World AIDS Day 2009, South African President Jacob Zuma was lauded as heralding 'the end of denialism' by the government's old foe, the Treatment Action Campaign. The President extended new treatment options, called for more and better quality HIV literacy, and demanded stronger moral guidance in the context of the AIDS crisis. This research complicates that claim that the end of denialism is upon the country and examines the persistent challenges to preventing and treating HIV in South Africa. Treatment access remains materially inaccessible for millions of South Africans and those seeking to prevent or treat HIV have severely constrained decision-making capacity as informed by both the political economy of treatment access and socio-cultural norms, all of which arise out of the history of Apartheid. Myriad discourses operate in South Africa in relation to HIV and AIDS, and while the dominant discourse at this time is that treatment is happening, this research highlights how this discourse collides with the neoliberal political economy and other narratives surrounding gendered norms, mistrust of Western biomedicine, cultural specificities, a paucity of traditional leadership on HIV, and how sharply conflicting understandings of HIV/AIDS challenge the uptake of and adherence to treatment. As these various discourses vie for dominance, not just health and well-being are debated, but the very meaning of modernity, progress, and South Africa's place within a globalizing world are at stake.