Biocarceral citizenship: Criminalizing through care in postapartheid South Africa

The story often told about HIV in South Africa is a celebratory one that foregrounds the relationship between seropositive citizens and health-care institutions. In the last 20 years, the government has invested heavily in rolling out life-sustaining antiretroviral medicines to all who need them, making HIV a firm ground upon which many residents claim protections from the state. This article explores the role of medicine in buttressing the carceral state. I propose biocarceral citizenship to characterize the way health-care entitlements produce new relationships to the criminal legal system, not through active state surveillance but by extending the responsibilization expected of patients to the penal sphere. Drawing from 22 months of ethnographic research carried out in clinics and courtrooms in the town of Thohoyandou between 2014 and 2018, I apply this concept to both those who have experienced rape, for whom reporting to the (carceral) state is a condition of accessing HIV prophylaxis, and to those who are charged with rape, for whom adherence to antiretroviral medicines is used as evidence of weaponizing sickness. In parallel ways, therapeutic responsibilization exposes both groups to state violence. The article takes HIV-related entitlements as a cipher for theorizing punishment beyond a critique of neoliberalism.