Contents

• Introduction

  A NEW WORLD OF HEALTH

  • The Right to a Nonprojected Future 3
  • Universal Access to Lifesaving Therapies 7
  • A Political Economy of Pharmaceuticals 10
  • Persistent Inequalities 14

  Lives

  • “Take me to my father’s house” (Edileusa) 20
  • “Today is another world” (Luis) 22
  • “If I only had thought then the way I think now” (Rose) 26
  • “Why will I think about the future?” (Nerivaldo) 30
  • “A child is what I wanted most in life” (Evangivaldo) 33
  • “To have HIV . . . is like not having money” (Valquirene) 37
  • “Too much medication” (Soraia) 40
  • “A beautiful place” (Tiquinho) 43
  • The Politics of Survival 47

• Chapter One

  PHARMACEUTICAL GOVERNANCE

  • Globalization and Statecraft 53
  • The Social Science of a Transforming Regime 55
  • AIDS, Democratization, and Human Rights 58
  • A Transnational Policy-Space 64
  • The Activist State 68
  • Intellectual Property Rights and World Trade 73
  • A Country’s Disease—Public-Private Partnerships 79
  • Decentralization and a Magic Bullet Approach 84
  • Public-Sector Science and the Production of Generic Drugs 87
  • Scaling-Up 93
  • The Pharmaceuticalization of Public Health 97

• Chapter Two

  CIRCUITS OF CARE

  • How Has AIDS Activism Changed? 105
  • From Passion to Politics 110
  • The AIDS Industry 115
  • Micro-Politics of Patienthood 120
  • Performing Citizenship 125
  • Grassroots Health Systems 130
  • A New National AIDS Program 135
  • On the Street: Violence, Charity, and Pleasure 140
  • In the Mainstream 155
  • Measures of Success, Undesirable Realities 160
  • The Undetectable Virus 164
  • “It is all about medicines now” 169
  • In Search of a Comprehensive Approach 172
  • “There is not just one death” 175

• Chapter Three

  A HIDDEN EPIDEMIC

  • The Limits of Surveillance 179
  • AIDS in Bahia 180
  • Economic Death 184
  • Pelourinho 190
  • “I set myself on fire” (Maria Madalena) 194
  • “They take care of me as if I were family” (Lazaro) 198
  • Technologies of Invisibility 202
  • A System of Nonintervention 204
  • Infectious Diseases Research 206
  • Medical Sovereignty, Local Bioethics 209
  • Triage 213
  • The Social Life of Death Certificates 217
  • AIDS Therapies and Homelessness 225
  • “Science makes people equal” 232
  • Brasília 236

• Chapter Four

  EXPERIMENTAL SUBJECTS

  • AIDS-like Symptoms 241
  • HIV Antibody Test 244
  • Certainty: Closing the Past 246
  • Uncertainty: The Window Period 246
  • A Population of Doubts 250
  • What Is Socially Visible Is an Imagined AIDS 253
  • Risk and Prevention Models 257
  • Libidinal Order 259
  • Science and Subjectivity 263
  • Dangerous Worlds of Intimacy 267
  • Technoneurosis 270
  • “They own their bodies and are responsible for their actions” 272
  • Clinical Trials 276

• Chapter Five

  PATIENT-CITIZENSHIP

  • “On the plane of immanence that leads us into a life” 283
  • A Place of No Government 286
  • Pastoral Power 296
  • Institutional Belonging and Treatment Adherence 303
  • New Prohibitions 308
  • “In Caasah we don’t just have AIDS—we have God” 312
  • Religion, Health, Wealth 318
  • Ambiguous Political Subjects 324
  • Resuming Sexual Life 327
  • Beyond Direct Observed Therapy 334

• Chapter Six

  WILL TO LIVE

  • Lifelong AIDS 339
  • Human Values 344
  • Medical Disparities 347
  • From Epidemic to Personalized Disease 349
  • Physically Well, Economically Dead 353
  • Drug Resistance and Rescue Treatments 355
  • “Medication is me” (Luis) 358
  • “I am mother and father” (Rose) 363
  • “It is the financial part of life that tortures me” (Evangivaldo) 368

• Conclusion

  GLOBAL PUBLIC HEALTH

  • Large-Scale Medical Change 375
  • “A little more reverence for life” 377
  • The Future of Treatment Rollouts 379
  • Pharmaceutical Philanthropy and Equity 383
  • Where Is the State? 388
  • A Vanishing Civil Society 393
  • Understanding the Nexus of AIDS, Poverty, and Politics 396
  • Local Economies of Salvation 399
  • The Unexpected and the Possible 404
• Acknowledgments 407
• Notes 411
• References 425
• Index 451