Internal Ecologies and the Limits of Local Biologies: A Political Ecology of Tuberculosis in the Time of AIDS

South Africa is known for its high rates of HIV and tuberculosis (TB), where HIV has provided fertile ground for the transmission of TB. Indeed, HIV–TB coinfection is widely understood as one of the, if not the, biggest health problems in the country. In practice, doctors and nurses understand that unusual cases of tuberculosis indicate HIV and they make diagnosis and treatment plans accordingly. International treatment standards and protocols inform this practice as doctors pay little attention to individual people and the political–economic, cultural, social, and environmental contexts in which they live. Political ecology, with its nested, place-based analysis, provides an excellent framework for understanding health in South Africa in the context of poverty; local understandings; and global policies, protocols, and priorities. To develop a political ecology of health, this article builds on the concept of local biologies, which understands health at the community scale as simultaneously biological, cultural, and social. Illustrated with the story of one HIV-negative woman's case of miliary TB, this article incorporates local biologies into a political ecology of health that mobilizes scales from the global to the “internal ecologies” of individual bodies. Centering its analysis on the place of the body, this article offers surprising insights into the HIV/AIDS epidemic. By examining the science of miliary tuberculosis alongside population-scale understandings of HIV–TB coinfection in a specific context, this article challenges the way we understand the health impacts of HIV/AIDS, suggesting that the epidemic has negative health implications even for those who are HIV negative.