João Biehl

Deleuze and the Anthropology of Becoming

Philosopher Gilles Deleuze emphasizes the primacy of desire over power and the openness and flux of social fields. In this article, we place our ethnographic projects among the urban poor in Brazil and Bosnia‐Herzegovina in dialogue with Deleuze’s cartographic approach to subjectivity and his reflections on control and the transformative potential of becoming. As people scavenge for resources and care, they must deal with the encroachment of psychiatric diagnostics and treatments in broken public institutions and in altered forms of common sense. By reading our cases in light of Deleuze’s ideas, we uphold the rights of microanalysis, bringing into view the immanent fields that people, in all their ambiguity, invent and live by. Such fields of action and significance—leaking out on all sides—are mediated by power and knowledge, but they are also animated by claims to basic rights and desires. In making public a nuanced understanding of these fields—always at risk of disappearing—anthropologists still allow for larger structural and institutional processes to become visible and their true effect known. This fieldwork/philosophical dialogue highlights the limits of psychiatric models of symptoms and human agency and supplements applications of concepts such as biopolitics, structural violence, and social suffering in anthropology. Continually adjusting itself to the reality of contemporary lives and worlds, the anthropological venture has the potential of art: to invoke neglected human potentials and to expand the limits of understanding and imagination—a people yet to come.

Pharmaceuticalization: AIDS Treatment and Global Health Politics

This article examines the political economy of pharmaceuticals that lies behind global AIDS treatment initiatives, revealing the possibilities and inequalities that come with a magic bullet approach to health care. It tells how Brazil, against all odds, became the first developing country to universalize access to antiretroviral drugs—a breakthrough made possible by an unexpected alliance of activists, government reformers, development agencies, and the pharmaceutical industry. The article moves between a social analysis of the institutional practices shaping the Brazilian response to AIDS and the stories and lives of people affected by it. It draws from interviews with activists, policy makers, and corporate actors and from longitudinal ethnographic work among grassroots AIDS care services. Pharmaceutical innovations allow unlikely coalitions that both expose the inadequacies of reigning public health paradigms and act to reform, if to a limited extent, global values and mechanisms (of drug pricing and of types of medical and philanthropic interventions, for example). Treatment rollouts are matters of intense negotiation; their local realizations are shaped by contingency and uncertainty. Such realizations encode diverse economic and political interests, as well as the needs and desires of citizens. These therapeutic coalitions also expose the deficiencies of national and local infrastructures and consolidate novel state-civil society relations. A pharmaceutically-centered model of public health has emerged as a byproduct of AIDS treatment scale-up and the sustainability of the Brazilian AIDS policy has to be constantly renegotiated in light of global drug markets. A multitude of networks and variations in AIDS care have emerged on-the-ground, and the article explores why AIDS treatment has been so difficult to put into practice among poor Brazilians, who are often stigmatized as noncompliant or untreatable, becoming invisible to the public. Poor AIDS patients live in a state of flux, simultaneously acknowledging and disguising their condition while they participate in local economies of salvation. At both the macro and micro levels, we see a state of triage and a politics of survival crystallizing.

Judicialisation of the right to health in Brazil.

This article examines Brazils constitutional right to health and their pharmaceutical access. It states that Brazil must raise their funding for essential medicines and pursue strategies to ensure universal availability of medicines that the government has a legal responsibility to provide in order to reduce vulnerability to disease.

Technology and Affect: HIV/AIDS Testing in Brazil

Contemporary techno scientific and medical developments are restructuring social interactions and the very processes by which individual subjectivity is formed. This essay elaborates on the experiential and ethical impact of such transformations from the perspective of people who, in ordinary and unexpected ways, act science and technology out. We carried out ethnographic research in an HIV/AIDS Testing and Counseling Center (CTA) in northeastern Brazil, combining participant observation with epidemiological analyses and clinical survey. We found a high demand for free testing by low-risk clients, largely working and middle class, experiencing anxiety and complaining of AIDS-like symptoms. Most of the clients were ser-onegative and many returned for a second and third testing. We understand this to be a new techno-cultural phenomenon and call it imaginary AIDS. Throughout this essay, we describe CTAs routine practices, place these practices in historical, political, economic and cross-cultural perspective, and analyze the subjective data we collected from the clients of our pilot study. We explore how clinical epidemiological expertise and HIV testing technology are integrated into new forms of bio-politics aimed at specific marketable and disease-free populations, and on the affective absorption of bio-technical truth and the engendering of a technoneurosis in this testing center.

Drugs for All: The Future of Global AIDS Treatment

I am interested in the arts of government that accompany economic globalization and in the remaking of populations as market segments (specifically therapeutic markets). Using the Brazilian response to AIDS as an ethnographic baseline, I examine the systemic relations between pharmaceutical commerce and public health care and the value systems that underscore global AIDS treatment initiatives. The pharmaceuticalization of governance and citizenship, obviously efficacious in the treatment of AIDS, nonetheless crystallizes new inequalities.

Peopling Global Health

The field of Global Health brings together a vastly diverse array of actors working to address pressing health issues worldwide with unprecedented financial and technological resources and informed by various agendas. While Global Health initiatives are booming and displacing earlier framings of the field (such as tropical medicine or international health), critical analyses of the social, political, and economic processes associated with this expanding field — an “open source anarchy” on the ground — are still few and far between. In this essay, we contend that, among the powerful players of Global Health, the supposed beneficiaries of interventions are generally lost from view and appear as having little to say or nothing to contribute. We make the case for a more comprehensive and people-centered approach and demonstrate the crucial role of ethnography as an empirical lantern in Global Health. By shifting the emphasis from diseases to people and environments, and from trickle-down access to equality, we have the opportunity to set a humane agenda that both realistically confronts challenges and expands our vision of the future of global communities.

Tratamentos jurídicos: os mercados terapêuticos e a judicialização do direito à saúde

This study draw on the struggle of parents of children with mucopolysacchar idosis to access expensive drugs in the name of universal right to health. The work explores how, in Brazil, right-to-health litigation became an alternative pathway to access health care and shows that several public and private stakeholders dispute the judicialization of health. Biotechnology is, therefore, understood to remake human and social worlds as it opens up new spaces of ethical problematization, desire, and political belonging.This study draw on the struggle of parents of children with mucopolysacchar idosis to access expensive drugs in the name of universal right to health. The work explores how, in Brazil, right-to-health litigation became an alternative pathway to access health care and shows that several public and private stakeholders dispute the judicialization of health. Biotechnology is, therefore, understood to remake human and social worlds as it opens up new spaces of ethical problematization, desire, and political belonging.

How Can Urban Policies Improve Air Quality and Help Mitigate Global Climate Change: a Systematic Mapping Review.

Tackling climate change at the global level is central to a growing field of scientific research on topics such as environmental health, disease burden, and its resulting economic impacts. At the local level, cities constitute an important hub of atmospheric pollution due to the large amount of pollutants that they emit. As the world population shifts to urban centers, cities will increasingly concentrate more exposed populations. Yet, there is still significant progress to be made in understanding the contribution of urban pollutants other than CO2, such as vehicle emissions, to global climate change. It is therefore particularly important to study how local governments are managing urban air pollution. This paper presents an overview of local air pollution control policies and programs that aim to reduce air pollution levels in megacities. It also presents evidence measuring their efficacy. The paper argues that local air pollution policies are not only beneficial for cities but are also important for mitigating and adapting to global climate change. The results systematize several policy approaches used around the world and suggest the need for more in-depth cross-city studies with the potential to highlight best practices both locally and globally. Finally, it calls for the inclusion of a more human rights-based approach as a mean of guaranteeing of clean air for all and reducing factors that exacerbate climate change.

Antropologia no campo da saúde global

In this article, I explore the limits of magic-bullet approaches to global health problems and show how people-centered initiatives challenge economic and human rights orthodoxies and enlarge our sense of what is socially possible and desirable. I draw from my long-term ethnographic study of the Brazilian therapeutic response to HIV/AIDS and its repercussions through government, markets, health systems and personal lives. I also report on a new comparative project on the aftermath of large-scale pharmaceutical interventions in resource-poor settings. Attending to both larger processes and to human singularities, the article opens a critical window into the values and the real-life outcomes of contemporary pharmaceutical and humanitarian interventions. As I critique institutional evidence-making practices I also reconsider anthropology and medicines notions of responsibility and care.

Judicialization 2.0: Understanding right-to-health litigation in real time

ABSTRACT Over the past two decades, debate over the whys, the hows, and the effects of the ever-expanding phenomenon of right-to-health litigation (‘judicialization’) throughout Latin America have been marked by polarised arguments and limited information. In contrast to claims of judicialization as a positive or negative trend, less attention has been paid to ways to better understand the phenomenon in real time. In this article, we propose a new approach—Judicialization 2.0—that recognises judicialization as an integral part of democratic life. This approach seeks to expand access to information about litigation on access to medicines (and health care generally) in order to better characterise the complexity of the phenomenon and thus inform new research and more robust public discussions. Drawing from our multi-disciplinary perspectives and field experiences in highly judicialized contexts, we thus describe a new multi-source, multi-stakeholder mixed-method approach designed to capture the patterns and heterogeneity of judicialization and understand its medical and socio-political impact in real time, along with its counterfactuals. By facilitating greater data availability and open access, we can drive advancements towards transparent and participatory priority setting, as well as accountability mechanisms that promote quality universal health coverage.