Sustaining Life. Theodore Powers

to locating transnational sociocultural process offers a useful tool for situating the sociopolitical dynamics of the South African HIV/AIDS epidemic. Particularly important is the continued role of the state in Tsing’s conceptualization of context. Rather than assume a state is withering away, her approach analyzes transnational influences on historically particular sociocultural circuits, enabling one to see how state institutions have transformed during the contemporary phase of globalization (Hibou 2004).

      Following Tsing, this book reincorporates the state in order to better understand the extended campaign for treatment access, as the ANC’s AIDS-dissident faction utilized state health institutions to limit public sector access to HIV/AIDS treatment. Furthermore, as HIV/AIDS treatment access unfolded unevenly in South Africa, with some cities and provinces moving ahead of others in providing public sector care, I engaged in multi-sited ethnographic research. This allowed me to follow the different actors, organizations, and institutions influencing HIV/AIDS politics and see how HIV/AIDS treatment access was manifested at different institutional levels.

       HIV/AIDS, Hot Spots, and Political Process in South Africa

      The primary challenge I faced starting fieldwork was how to follow individual HIV/AIDS activists while also studying larger politics surrounding HIV/AIDS. I learned very quickly that research participants’ everyday life activities did not neatly correspond to any discrete notion of politics or policy. The daily work of HIV/AIDS activists focused on addressing the difficulties faced by communities infected and affected by the epidemic, and access to treatment was one of many issues in their portfolio. Conversely, when I focused on the political controversy that surrounded a new national HIV/AIDS policy, as played out in newspapers and political speeches, it was often peripheral to the rich ethnographic material of everyday life. The methodological tension between studying HIV/AIDS politics and studying HIV/AIDS activism came to the forefront when selecting appropriate sites for fieldwork. How was I to choose the sites for data gathering that would be central to the politics of treatment access? Should I assume that policy would be created within state health institutions? What of the daily work of HIV/AIDS activists in the South African HIV/AIDS movement, such as Matamela? How could I analyze both sets of sociocultural dynamics within a single research project?

      I approached fieldwork with the intention of understanding how HIV/AIDS politics operated across institutional levels. As a result, I analyzed political activities involving different organizations and activists at several physical sites in South Africa. This included conducting participant observation among a range of institutions, from district coordinating bodies and community-based organizations in townships to a national meeting of the South African National AIDS Council (SANAC) and an array of ethnographic encounters in between. Accompanying research participants from one site to another played an important role in data gathering, and I followed HIV/AIDS activists to different meetings, conferences, protests, and policy consultations. I also kept pace with the political conflict over HIV/AIDS treatment access, following how people, organizations, and institutions were enmeshed in a broader sociopolitical process. The two frames of movement and context were inseparable; people moved, the political conflict shifted, and, all the while, communities infected and affected by the epidemic continued to suffer amid the material conditions produced by South African history.

      Multi-sited research initiatives offer a way to study sociocultural processes that accounts for movement, time, and space in the ethnographic analysis of social life (Burawoy 1991; Marcus 1995; Lowe 1996; Ferguson and Gupta 1997; Fischer 1999a, 1999b; Wolf 2001). For my project, I linked together multiple field sites by “following” the movement of research participants. I built on George Marcus’s work, which outlines several permutations of following, including two that I employed: following the people and following the conflict.⁵ Anthropologists analyzing policy have adapted Marcus’s concepts to “follow the policy” and “study through” the policy process (Shore and Wright 1997). “Following the policy” involves analyzing the web of interpersonal, organization, institutional, and political relations that are engaged in the policy process (Shore and Wright 2011). “Studying through” traces those interpersonal connections in order to “illuminate how different organizational and everyday worlds are intertwined across time and space” (Wedel et al. 2005). While these approaches offer a way to study the policy-oriented conflict over HIV/AIDS treatment, they did not allow me to connect HIV/AIDS activists’ everyday activities to broader social processes, such as the development of national HIV/AIDS policy.⁶

      A way to overcome the tension between movement and context grew out of my experiences moving alongside HIV/AIDS activists like Matamela. The pathways of different HIV/AIDS activists led me to intersections where HIV/AIDS treatment access was negotiated, and where I could combine the “following the policy” and “studying through” approaches. Field sites were determined by those who I followed: the HIV/AIDS activists, NGO representatives, and state administrators whose aggregated activities constituted South African HIV/AIDS politics. Following their pathways allowed me to identify field sites based on observed movements and connections rather than any predetermined notion of the field, policy, or the state. In short, it allowed me to identify particular sociospatial zones where the fight for treatment access was unfolding and the contours of local context were defined.

      Within these zones, HIV/AIDS activists and state administrators produced outcomes that affected HIV/AIDS treatment access. I conceptualize the interpersonal encounters I observed in this fieldwork as intersections of different pathways, laid out within a social field that is mediated by transnational influence.⁷ Following the pathways of people who had diverse institutional, organizational, and political affiliations enabled me to observe important variants of sociality within the larger field (Holston 1999). I observed a wide array of interactions and dynamics using this approach, with some involving small groups of people and others intense sociopolitical activity.

      I theorize these areas of concentrated sociopolitical activity related to the HIV/AIDS policy process as “hot spots.” In doing so, I build on the work of Hannah Brown and Ann Kelly (2014), who utilize the concept of hot spots to describe how infectious disease outbreaks grow out of a complex convergence of factors that create favorable conditions for transmission.⁸ In my study, localized political formations emerged at certain hot spots. Local actors and organizations transformed transnational forms of influence through their political activities, localizing the transnational dynamics of movement in a particular sociopolitical context (Powers 2017a). Where these hot spots emerged was dependent on the social and spatial concentration and interaction of actors, organizations, activities, and forms of influence. These hot spots produced “heat” via the concentration of political activity and the “friction” generated by the influence of transnational donors in the South African HIV/AIDS policy process (Tsing 2005). These areas where HIV/AIDS treatment access was negotiated were oriented around state health institutions but were not exclusive to them. Policy process is frequently conceptualized as unfolding within state institutions, which it quite often does. However, such a conceptualization may reify normative notions of the state and its institutions that may not be applicable in all societies, particularly those in the Global South, where state institutions and power dynamics were molded during the colonial era. Policy-making also happens along pathways, at intersections, and in hot spots.

      Over the past two decades, a growing focus on nongovernmental organizations (NGOs) has given rise to a series of debates among anthropologists that focus on research methods and conceptual approaches to studying the state. Proliferating alongside the expansion of neoliberal globalization, NGOs have been characterized as a means of extending state power (Fisher 1997), mediators and translators for transnational flows of various kinds (Lewis and Mosse 2006), the glue that holds global neoliberalism together (Schuller 2009), and a productive site for examining the messy interface between state and society (Bernal and Grewal 2014).

      However, NGOs can be defined differentially depending on the situation, transforming their shape relative to context, audience, or particular goals (Sharma 2006), leading to their characterization as a “productively unstable” site from which to study the contemporary age (Lewis and Schuller 2017).

      As the South African HIV/AIDS movement was populated by NGOs of various kinds, the question of how best to study NGOs is a point that requires reflection.