Reframing HIV treatment as prevention in eSwatini Transformations of a public health intervention in context

This dissertation provides an ethnographic account of the contextualization of a global health strategy, referred to as HIV ‘Treatment as Prevention’ (TasP), which advocates the early initiation of antiretroviral therapy by HIV-positive people as soon as possible upon diagnosis, to improve individual health outcomes and decrease HIV transmission in populations. As one of the anthropological researchers working within an implementation study evaluating TasP in the Kingdom of eSwatini (formerly Swaziland) between 2012 and 2018, Eva Vernooij examined how the intervention was shaped ‘in situ’ – through its implementation. Taking a critically applied medical anthropology approach, she highlights the local framings of biomedical knowledge by national-level policymakers, local health workers and community-based actors (people living with HIV and support group members), and shows how these framings shape and reshape what a global public health intervention comes to be. Studying the contextualization of TasP, and associated interventions, at three different levels (in policy-making, within the health system, and in study communities) the dissertation reveals what is at stake for differently positioned actors, including anthropologists, in their engagements with global health interventions. Couched in between anthropology and public health, the dissertation seeks to contribute new insights to medical anthropology, as well as public health research, about how contexts and interventions reciprocally shape each other, and how this can be investigated through the integration of ethnographic research within the rapidly growing field of implementation science in global health.