Mind the gap: Access to ARV medication, rights and the politics of scale in South Africa

Abstract

Global access to anti-retroviral medication (ARVs) has increased exponentially in recent years. As a relatively recent phenomenon for the global South, much knowledge is being added, but analysis of ‘access’ to ARVs remains partial. The main research objective of this article is to gain a fuller picture of the range of forces constituting ‘access’ to ARVs by providing a local community case study from Hammanskraal, South Africa. A qualitative and relational approach situates specific points of ‘local’ access to ARVs within relations stretched over space. Spatial awareness enables us to consider the reinforcing effects of local geographies upon access to health care but also simultaneously sees this in relation to non-local geographies. The concept of scale is pivotal to creating linkages across space and reveals a number of ‘gaps’ in access that otherwise might not be shown. Elaborating on the meaning of “access” to treatment produces a more rounded picture of the context that people-living-with-AIDS encounter. A multi-scale and multi-disciplinary analysis of ‘access’ is therefore also highly informative in a related sense, namely, for closing the gap between human rights standards and actual implementation. A geographical imagination is useful not only to ‘mind’ but also to close the ‘gap’ in both senses.