Science, Denial and Politics: “Boundary Work” in the Provision of AIDS Treatment in South Africa

Abstract Political debates over HIV/AIDS in South Africa have boundaries demarcated by science. South Africa probably has more than five million people living with HIV/AIDS—the highest number of any country in the world. It also hosts the world’s largest program for providing antiretrovirals (ARVs). Yet the national government is notorious for its lack of leadership on AIDS issues and for its president’s questioning of the link between HIV and AIDS, accusing scientists of racism and describing ARVs as poison. South Africa constitutes the most well-known successes and failures in AIDS treatment, but the relationship between them is in need of scrutiny. In this article, I will use primary data collected during a vertical study in the Western Cape Province to analyze the political boundaries that transverse the AIDS treatment discourse from national to provincial and clinic levels. This article argues that boundary work in the AIDS treatment discourse is still concerned with defining what counts as science. The national vs. regional political context helps in constructing the Western Cape as the one that embraces “science” while the rest of the country lags behind in the ARV roll-out. This boundary struggle between science and politics shapes debate and implementation of the country’s treatment program for people living with AIDS.