An ethnography of antibiotics and antimicrobial resistance, in the lives of medicine providers, residents, and sex workers, in Harare, Zimbabwe.

A key global health challenge of our time is the rise of antimicrobial resistance (AMR). There is growing recognition that interventions to address AMR must transcend narrow behavioural approaches and address the ways in which antibiotics have come to stand in for more sustainable and equitable approaches to poverty, healthcare, and productivity. The quick-fix roles of antibiotics are particularly salient for the billion plus people globally living in impoverished urban areas of cities, many of whom live without adequate water and sanitation infrastructure, housing, and basic healthcare. Informality, a central characteristic of urban living, is an important part of the problem AMR poses for cities, yet to date, most scholarship and stewardship frameworks have been biased towards formal parts of health and economic systems. Addressing this gap, this thesis explores the ways antibiotics connect and hold together different aspects of informal urban living. I draw on ethnographic fieldwork in Mbare, the oldest township in Harare, Zimbabwe, and focus in particular on three important dimensions of informality in which antibiotics and AMR are caught up: (1) how residents navigate poor water and sanitation infrastructure through the use of antibiotics, (2) the role of informal market vendors in supplying antibiotics in the recesses of an under-resourced and frequently collapsing public healthcare sector, and (3) the role of antibiotics in the informal economy of sex work. A key connective theme throughout is that of the dynamics between municipal, national, and global modes of governmentality that explain both entrenched patterns of marginalisation and also why vulnerable individuals and groups are nonetheless increasingly being held accountable for mounting AMR. By tracing these processes as they impact lives and livelihoods in Harare, I expose pathways for stewardship that are more attuned to the realities of those relying on informality to survive on the peripheries of social and economic life.