An ethnography of HIV/AIDS care transformation in Zambia

This dissertation adds to the literature on how institutions of care transform. It shows how differently positioned actors, including people with HIV, their friends and families, local health providers and officials, policy makers, local and international NGOs, bilateral, multilateral and transnational organisations, economy and technology interact to shape care practices for people with HIV and AIDS. I argue that it is the interactions and friction between different actors at the different times and spaces that shape both HIV/AIDS care practices and their evolution. The text highlights the friction between actors and their concepts and practices and how these interact with technology to create new forms and practices that are shaped by both the pragmatism and agency of local actors and knowledge of international agencies. To characterise HIV/AIDS care transformation, I provide a thick description of HIV counselling practice in all its main trajectories as currently practiced and attempt to provide a history and evolution of current policies and practices. I highlight the shifts in HIV/AIDS policy and practice as the epidemic matured from the pre-HIV test era through the Pre-HIV treatment era to the treatment era and beyond. I demonstrate the relationship between those shifts, the agency of different actors, the technology and age of the epidemic and show how friction between these actors has shaped HIV/AIDS care transformation in Zambia.