Local pain, global prescriptions? Using scale to analyse the globalisation of the HIV/AIDS response

How can we best characterise the contexts that shape opportunities for members of HIV-affected communities to respond to the challenges of prevention, care and treatment, and to derive optimal benefit from associated interventions? Can the concepts of space and scale, and more particularly concepts such as ‘local’ and ‘global’, help us to develop actionable understandings of these contexts? What is the nature of HIV-mediated global interconnectedness, and how does it open up or close down opportunities for increased agency amongst the so-called beneficiaries of global funds and programmes? Billions of dollars of aid have been poured into HIV/AIDS responses in low and middle income countries, often with disappointing results. Thousands continue to be infected every day, with new infections out-pacing the scale-up of access to antiretroviral therapy (ART) in a ratio of 5:2 (WHO, 2008a). Furthermore, in evershifting political and economic climates, the sustainability even of current levels of ART provision is not assured. Millions of people continue to die from a preventable and treatable disease, and the epidemic continues to be a massive crisis, wreaking untold levels of suffering.