My first visit to Mbarara’s Immune Wellness Clinic¹ was in July of 2003, when I spent a day there as part of a visiting research team from San Francisco, California. Located about four hours south of Kampala, Uganda’s capital city, the town of Mbarara is surrounded by rolling grassy hills that turn golden in the dry season. It is cattle and dairy country, and the main streets of the town center are dotted with shops selling fresh local milk by the ladle-full. The Wellness Clinic is located at the edge of town, on the grounds of the university teaching hospital...

As I entered the Oakwood Hotel in San Francisco’s Tenderloin District, I was greeted by the incongruous scents of body odor and Indian curry. The Oakwood was one of many single-room occupancy, or “SRO,” hotels populating San Francisco’s Skid Row neighborhood. Originally built around the turn of the century to house unmarried and migrant industrial workers, by the late twentieth century the hotels were occupied primarily by the elderly, poor, addicted, and mentally ill (Groth 1994). Some residents established long-term homes in these hotels, redecorating their tiny rooms to their taste and paying monthly rent out of their disability checks....

Viruses are peculiar organisms. Their structure consists of little more than a small package of genetic material (DNA or RNA) surrounded by a protein exterior called an envelope. Unlike plants or animals, viruses do not eat, drink, photosynthesize, or excrete. Unable to reproduce on their own, they are dependent upon the metabolic processes of the organisms they infect in order to replicate. Biologists have debated whether they actually meet the criteria to be categorized as living beings, describing them as organisms that “verge on life” (Villareal 2004, 103). At the same time, viruses are ubiquitous and—quite literally—a part...

“Africa is in vogue now,” Dr. Jason Beale told me in early 2005. “Three or four years ago, no one would mention it.” His comment was not intended to be flip. Rather, it was a joking acknowledgement of the way in which science is subject to its own form of trendiness that governs both interest in and funding of research projects. Beale is a warm and enthusiastic man, prone to mild exaggeration when trying to make a point, but earnest and persuasive nonetheless. He is both extremely ambitious and morally driven—a combination that has served him well in advancing...

The years between 2005 and 2009 were marked by massive changes at the Immune Wellness Clinic in Mbarara, wrought by the simultaneous scaling-up of free HIV treatment programs and the rapid growth of an international research presence. Patient enrollment at the clinic nearly doubled following the arrival of free antiretrovirals via PEPFAR and the Global Fund, and by 2009 there were over 7,000 patients receiving regular care, over 5,000 of whom were on ARVs. In addition, the clinic’s staff—not only doctors, but nurses, counselors, and laboratory workers—also grew, as did the space occupied by the clinic. This expansion...

While in Uganda in 2009, I ended up with an unexpected invitation to have dinner with a group of visiting undergraduate students from a prestigious university in the American Southeast. The students were participating in “The Kampala Project,” a one-month volunteer program sponsored by their school and based in the capital city. The theme of the 2009 Kampala Project trip was HIV/AIDS, and, not surprisingly, many of the participating students were on a pre-medical track. One student took a particular interest in me after hearing that I was a medical anthropologist and that my research involved interviewing HIV doctors in...

In 2011, the world marked the thirtieth anniversary of the June 5, 1981, CDC report documenting five unusual cases of pneumocystis pneumonia in young, previously healthy gay men in Los Angeles (CDC 1981). Traditionally, this report is viewed as the first official recognition of the disease that would come to be known as AIDS, and its publication has become a stand-in for the onset of the global epidemic. Other, less official forms of recognition came earlier—both in the United States, where gay men and their doctors started noticing inexplicable infections in the 1970s—and in central and east Africa,...