Mobile Patients, Static Response: (Mis)managing well-being amidst South Africa's dual epidemic

Drawing from medical anthropology's approach to global health, this dissertation examines well-being among HIV- and TB-infected labor migrants in South Africa. Based on forty-four months of fieldwork from 2005 to 2013, it narrates households' struggles to make ends meet materially and morally in a context of unemployment, scarcity, and epidemic.;Attending to infected migrants' and their communities' local moral worlds, Mobile Patients, Static Response reveals how a public health system that demands that mobile patients living among multiple homes access care via a single, static medical home positions the biomedical aspects of well-being in conflict with its other elements. The resultant mismatch between mobile people and static services sets up biomedical and moral aspects of well-being as mutually exclusive and thereby makes well-being, it its holistic sense, unattainable.;The dissertation goes on to illustrate how in the specific case of antiretroviral therapy (ART) rollout in South Africa, this conflict has generated unintended consequences that have propelled the iatrogenic effect of drug resistance. The historical and ethnographic study of mobility and epidemic in South Africa demonstrates how an anthropological framing of care for mobile populations reveals the ways in which large-scale social, political, and economic forces entangled with the global public health apparatus can work against the promotion of both biomedical outcomes and more holistic well-being. Such an analysis opens up possibilities for rethinking care in policy and planning in a way that privileges the building of social worlds alongside the administration of biomedical therapeutics and celebrates what matters most to patients instead of defining their priorities based on globally circumscribed agendas.