The problem of HIV internationally has many wide ranging impacts on people, communities and countries’ development. In the last decade antiretroviral (ARV) treatment has emerged as the major scientific-technical solution, albeit a costly one. Access to ARV treatment is of vital importance across Africa and around the world. Resources for HIV treatment, care and support are transferred globally on a massive scale. However, how such programmes operate ‘on the ground’ in different contexts is still unclear. This research contributes to understanding the experience of the people who access such treatment programmes in different contexts. This research focuses on this gap, exploring how treatment programmes are experienced, how the availability of treatment impacts both on people’s experience of being HIV+ and how the availability of treatment may also change perceptions of what it means to be HIV+, both individually and at a societal level. This research focuses on the lives and experiences, particularly the treatment experiences, of people living with HIV in peri-urban Gambia. Low prevalence countries such as The Gambia can provide a compelling example of the ways in which meanings and understandings of HIV are created.

Here, entering a field of health pluralism and fluid knowledge creation around HIV-infection, came large scale actors providing a high-profile ARV treatment programme through clinic-based medicine, and an effective de-pluralisation of the medical field in relation to HIV, inviting scrutiny of how such knowledge relations and differences are experienced. Although not anticipated at the outset of the research, in parallel the Gambia has become the locus of a major, politically-backed, ‘alternative’ AIDS treatment programme. This has thrown the personal and societal meanings of HIV into a new and sensitive context, compelling research attention into how knowledge, status and meanings around HIV are negotiated, and how people make choices amongst different treatment options.