Cette thèse a pour objet la description et l’analyse des marqueurs discursifs (MD) là, par exemple, ékyé et wèé en français parlé au Cameroun, variété de français régional qui s’inscrit dans le français parlé en Afrique subsaharienne. Elle propose une analyse centrée sur les échanges discursifs et prend en compte la pragmatique afin de montrer que la communication repose sur l’intersubjectivité langagière qu’on peut analyser au moyen de traces linguistiques comme les MD. Pour étudier ces phénomènes pragmatiques au demeurant très peu étudiés en français parlé au Cameroun, la recherche s’est organisée principalement autour des notions de flux discursif, d’implicite social et d’interaction afin de comprendre la structuration informationnelle et le contexte situationnel qui motivent l’apparition des MD là, par exemple, ékyé et wèé dans l’organisation du discours, tant dans la production que dans la réception. Le corpus se compose d’échanges radiophoniques d’une part et d’échanges internet d’autre part. La thèse est composée en deux parties. La première rend compte des aspects théoriques, même si nous l’illustrons parfois avec des extraits de notre corpus. La seconde est consacrée à l’analyse systématique des données (le fonctionnement des quatre MD là, par exemple, ékyé et wèé dans les discours radiophoniques et dans les écrits tirés d’internet). Cette analyse a permis de conclure à la difficulté de définir exactement ce qu’est un MD, et de relever l’existence de terminologies concurrentes, tant les théories qui décrivent et expliquent le fonctionnement des MD sont hétérogènes. Nous proposons une définition opérationnelle des MD pour l’analyse de notre corpus et nous plaidons pour une prise en compte des phénomènes oraux et liés à l’interaction dans les études sur le français régional en Afrique. / This thesis sets out to describe and to analyse the discourse markers (DMs) là, par exemple, ékyé and wèé in Cameroon French, a regional variety of French that is spoken in Subsharan Africa. It is a pragmatic study of oral discourses that highlights how communication is based on speech inter-subjectivity such as DMs, which constitute linguistic traces. In order to study these uninvestigated pragmatic phenomena in Cameroon spoken French, three notions were of prime necessity, namely: discursive continuity, social implicity and interaction. These notions help to shed light on the informational structure and on the situational context of the DMs là, par exemple, ékyé and wèé in discourse organization as well as in its production or in its reception. The data of this study was got from two sources: on the one hand, radio programmes, and on the other hand, scripts collected from the internet. The study comprises two parts: Part one focuses on the theoretical concerns, alongside some illustrations of excerpts from the data. The second part provides a systematic analysis of the data (the functioning of the four DMs là, par exemple, ékyé and wèé in radio programmes and in internet scripts). This analysis enabled the confirmation that not only is it difficult to clearly define what a DM is but that there are also several competing terms and explanations, as theories regarding studies on DMs are heterogeneous. We propose an operational definition of DMs for the analysis of the data and suggest that studies on regional French spoken in Africa should take into account oral phenomena related to interaction.

Introduction In sub-Saharan Africa, rapid urbanisation and per capita consumption of animal source foods are expected to accelerate in the short-medium term and to increase the movements of live animals and animal products in the region. In Cameroon, where the livelihood of most of the rural population depends on the agricultural and livestock sector, a wide range of endemic transboundary infectious diseases (TADs) affect livestock production and trade, and have direct detrimental effects on animal, human and environmental health. Livestock mobility represents a central economic activity in the livestock value chain of the country as well as a central strategy of seasonal adaptation to the ecosystem. Livestock movements, however, are also a central driver of infectious diseases dynamics and contacts between livestock populations are major risk factors for disease introduction and circulation. In countries where financial and technical resources are constrained, such as Cameroon, strategic interventions aiming at the surveillance and control of multiple infectious diseases simultaneously are essential for optimising their cost-effectiveness. The overall aim of this study was to apply a methodological framework to contribute to the understanding of cattle movements in Cameroon and of their implications for disease circulation. Methods This project used a variety of epidemiological and statistical methods to characterise cattle movements in the country across different scales. The collection of primary data and information targeted both the formal cattle trade system, across the country, and the informal seasonal transhumance, across the main livestock production areas. Between September 2014 and May 2015 diverse strategies were applied for collecting empirical data and various data sources from multiple Regions of the country were combined. Cattle trade in Cameroon mainly occurs via multiple trading points owned and managed either by the veterinary authorities or the municipalities. A total of 62 livestock markets, and the relevant offices of the Ministry of Livestock, Fisheries and Animal Products (MINEPIA), were targeted for collecting official data on cattle trade referring to a 12-month period ranging between September 2013 and August 2014. Additionally, a questionnaire-based survey with the various livestock markets stakeholders (herders, traders, butchers and veterinary officials) was carried out to collect a variety of information on the cattle market system. During this 9-month period of field work, data on cattle seasonal transhumance were simultaneously collected using a combination of GPS-tracking technology and questionnaire-based survey. Results Volumes of cattle trade, the type of traded animals and their commercial values varied over the year and across the Regions of the country included in this study. Nevertheless, the market supply of live cattle showed similar temporal trends over the year and across the Regions. Although for almost the entire study area the peak of traded animals in the market system was in December 2013, the trade volume was consistently higher during the rainy season (May to September). On the contrary, the reduction in the trade volume during the dry season was accompanied by an opposite trend in the cattle price, with their commercial value being higher during the dry season. Furthermore, a cattle price differential was highlighted between production Regions and high consumption Regions of the country. The highest volume of cattle trade was recorded in the Adamawa Region, which was the main source of cattle for the country while also receiving animals from neighbouring countries, such as Chad and Central African Republic. In contrast, major urban markets in the Littoral and Central Regions were the main receivers of cattle originating from almost all the other areas of the country. Interestingly, the North-West Region appeared to be more independent and isolated within the cattle trade network of Cameroon, particularly receiving few animals from other Regions. Importantly, there was little variation in the structural characteristics of the cattle trade network as well as in its properties across seasons, showing that, despite the seasonality in traded numbers, the network of cattle moving between markets in Cameroon is very stable. This consistent structure of the network over the year increases the robustness of strategic targeted interventions. We found that targeting the top 20% of the most connected markets would significantly reduce the network cohesiveness providing opportunities for strategic disease surveillance, communication and risk mitigation interventions. The centrality of the market within the trading network was also found to be positively associated with the price of live cattle, which tended to be heavily affected by phenotypic characteristics of the traded cattle. The seasonal cattle transhumance has been found as a common and widespread practice for herders attending the market system across whole the study area, highlighting the close relation between formal trading movements and informal pastoral movements across the country. Transhumant herds were observed to undertake migrations across multiple Regions for period exceeding 6 months and showing the potential for multiple types of interactions with domestic and wild animals. Discussion Multiple livestock infectious diseases were identified as being related to the cattle trade system. As neighbouring and non-neighbouring countries were found to be epidemiologically connected it is clear that national strategies for surveillance and control are likely to have limited effectiveness. Regional coordination for designing and implementing prevention and mitigation strategies against infectious diseases is essential to improve animal health also at national level. This study highlights the opportunity for strategic surveillance, control and communication interventions targeting key livestock markets and Regions of Cameroon. Live cattle price and centrality of markets, represented by their connectedness within the trading network, highlights the need to further investigate the links between economic factors and drivers of disease dynamics, such as livestock movements. The complexity of cattle movements in this context was further evidenced by the seasonal transhumance representing an established common mechanism for managing livestock, and closely interacting with the formal trading system as well as with other domestic and wild animal populations. Better data collection and analysis of livestock movements is required for improving the effectiveness of surveillance and control of infectious diseases. Although animal identification and registration systems would represent an ideal step for increasing traceability of cattle movements, enhancing animal health management and the overall competitiveness of the livestock industry, in the short-term a cost-effective intervention should aim at further developing the current data recording and management systems. Pastoralism, for long seen as an economic and environmental activity with little future, also needs to be acknowledged as a key component of the livestock production system in the country and to be considered accordingly in the management of infectious diseases.

Dans les villes moyennes de Garoua et Maroua, au Nord et à l’Extrême Nord du Cameroun, on dit des « chefs », soit des détenteurs de l’autorité à l’échelle d’une famille, d’un quartier, de la cité ou autrefois d’un royaume, qu’ils doivent être « comme des grands tas d’ordures ». Ce proverbe situe ainsi les relations de pouvoir et l’exercice de l’autorité dans un rapport particulier avec la gestion des déchets : le chef doit se montrer patient et hiératique comme un grand dépotoir, lorsqu’il reçoit toutes les insultes et les plaintes de ses sujets comme autant d’immondices ; mais, selon un registre ésotérique développé par les religions locales puis repris dans le cadre musulman, on attend aussi qu’il fasse preuve de la même puissance, magique notamment, que celle dégagée par une grande et ancienne accumulation de déchets. Les conceptions locales des excrétions corporelles, des objets déchus et des restes des activités du quotidien font en effet du contrôle et de la manipulation des déchets un élément majeur d’une « gouvernementalité » (Foucault) particulière. Celle-ci s’opère via des « techniques du corps » et des « techniques de soi » spécifiques autour du détachement entre soi, ses déchets corporels et ses possessions matérielles. L’analyse généalogique des discours et des pratiques de gestion individuelles et institutionnelles des déchets depuis la fondation des deux villes au XVIIIe siècle jusqu’au début du XXIe siècle, marqué par la privatisation de ce service public, permet alors de saisir comment les tas d’ordures dans ce contexte peuvent être considérés comme de véritables « dispositifs de pouvoir » et le contrôle des immondices comme un instrument puissant de gouvernement de soi et des autres. / In the middle-size cities of Garoua and Maroua in Northern Cameroon, it is said that “chiefs”, those having authority over a family, a town quarter, a city or, formally, a kingdom, should be « like great trash piles ». This proverb thus posits a privileged link between authority and the exercise of power, and the management of waste: a chief should adopt a patient and hieratic attitude towards the insults and complaints he receives from his subjects like so much filth; but also, in keeping with an esoteric understanding developed by local religions and taken up within an Islamic framework, he is expected to exhibit the magical and other powers that are held to arise from large and ancient heaps of rubbish. In the light of local conceptions relating to bodily excreta, refuse and the residues of daily activities, the control and handling of rubbish appears as an essential component of a distinctive “governmentality” (Foucault). The latter operates though specific “techniques of the body” and “techniques of the self” aimed at disentangling oneself from one’s bodily and material waste products. A genealogical analysis of the discourses and practices of individual and institutional waste management, since the founding of these two cities in the 18th century to the privatisation of this public service at the beginning of the 21st century, shows how, in this context, trash piles act as veritable “devices” of power, and the control of filth as a powerful instrument for governing the self and others.

Cette thèse examine la contribution économique des jeunes filles de Yaoundé (Cameroun) aux ressources de la famille de naissance. Phénomène très peu étudié dans le domaine des sciences sociales, l’objectif était d’en faire un objet de recherche à part entière. L’étude mobilise des entretiens semi-structurés auprès de 45 femmes (hébergées, chefs de ménage et mariées). Il ressort des résultats que le soutien économique de ces jeunes filles au profit de leur famille ne se fait pas spontanément. C’est la résultante d’un long processus intégrant les configurations sociales, familiales et individuelles particulières. Il apparaît également que contrairement aux idées véhiculées par les féministes, le bourreau des femmes n’est pas toujours l’homme mais la famille et principalement la femme.En effet, les femmes sur qui repose l’essentiel des dépenses familiales, sont placées dans la position ambivalente de devoir sacrifier l’autonomie future d’autres femmes, plus jeunes et plus vulnérables et qui parfois sont leurs propres filles, en leur déléguant les charges financières qui en principe leur incombent. Ainsi, ces jeunes filles sont des « aînées économiques » d’une part et des « cadettes sociales » d’autre part. Si notre étude présente la grande majorité de nos enquêtées comme des personnes jouant le rôle de « soutien économique » de famille, leur élan à soutenir financièrement les membres de leur famille de naissance cache de grandes blessures personnelles. En effet, ce rôle de soutien de famille a des retentissements négatifs sur leurs projets de vie, notamment leur déclassement sur le marché matrimonial, des difficultés à concevoir des enfants et leur incapacité à mettre des économies de côté qui pourraient leur être utiles dans leur vie future. / This thesis examines the financial contributions of young girls in Yaoundé (Cameroon) to their family resources. Little attention has been given to the phenomenon of young girls as breadwinner in research in the social sciences; thus, our objective through this work is to try to make it a subject of research in itself. Our study analyses semi-structured interviews with 45 women (hosted, heads of households, married). The results show that these young girls’ economic support to their family does not happen spontaneously. It is the result of a long process incorporating the specific social, family and individual configurations. It also appears that unlike the ideas conveyed by some feminists, the person exerting domination over women is not always the man but rather the entire family and mainly they are women.Women, who bear the bulk of the family's expenses, are placed in the ambivalent position of having to sacrifice the future autonomy of younger and more vulnerable women who are sometimes their own daughters. Parents thus delegate to children the financial burden that they are supposed to support. So these girls, whose economic responsibilities are considered as very important on the one hand, are socially considered as minors on the other hand.Although our study shows the vast majority of our respondents as individuals acting like breadwinners, their energy to support their families of birth results in great injuries. The role of breadwinner has negative repercussions on their life projects, namely, downgrading on the marriage market, difficulties in conceiving children and inability to put aside their own savings, that could be useful in their future life just to name a few.

Submitted by Daniele Santos (danielesantos.htl@gmail.com) on 2017-06-06T18:37:01Z No. of bitstreams: 1 Maters Thesis V3 Louis.pdf: 2979249 bytes, checksum: 4c0d335d9495ce5c9e68a50d36bd6bdc (MD5) / Approved for entry into archive by Janete de Oliveira Feitosa (janete.feitosa@fgv.br) on 2017-06-06T20:08:38Z (GMT) No. of bitstreams: 1 Maters Thesis V3 Louis.pdf: 2979249 bytes, checksum: 4c0d335d9495ce5c9e68a50d36bd6bdc (MD5) / Made available in DSpace on 2017-06-21T18:09:24Z (GMT). No. of bitstreams: 1 Maters Thesis V3 Louis.pdf: 2979249 bytes, checksum: 4c0d335d9495ce5c9e68a50d36bd6bdc (MD5) Previous issue date: 2017-05-02 / The culture of cocoa is one the main drivers of Cameroonian economy, bringing many promises in term of employment and revenues. The business organization around cocoa is developing, taking into consideration, the strategy of economic development deployed by the country, its image as the fifth producer of the world and the opportunity for Cameroon to answer the market increasing demand. We have developed in this paper the business organization around cocoa in Cameroon, the implication for people and administration, its potentialities in term of development and the rules to know when entering cocoa business in Cameroon. When we undertook to work on this topic for the master thesis, it was to connect both 'our project of developing cocoa business in Cameroon' and 'the analysis of local cocoa market and its connections to the international market'. Many sources of data have been analyzed including the information collected through the Internet, the Ministry of Agriculture in Cameroon, the Ministry of Trade, the provincial delegation of agriculture of Centre, cocoa buyers’ information such as Telcar, Sic-Cacao and the Cocoa Development Corporation with is the State corporate, developing cocoa seeds and training farmers. After reviewed the literature and meeting with people, we undertook the analysis of cocoa business organization. Interestingly, the results revealed the implication of local government and the effort they are putting together to reach their objective of positioning Cameroon by 2022 as the second producer of cocoa beans with more than 600.000 tons a year. Reaching such objective means develop business opportunities in term of production, increase export capacity to capture more value and develop local pre-transforming units.

À partir des années quatre-vingt, des groupes industriels internationaux entrent dans le capital de maisons d'édition du Nord. C'est le début de ce que l'on appellera la globalisation du livre. Face à la crainte de l'uniformisation des productions éditoriales, on observe l'émergence de réflexions et de projets autour de la bibliodiversité. C'est notamment dans cette dynamique que le marché du livre africain se structure en réseaux pour favoriser la diffusion, la distribution et la coédition de ses productions. Dès la fin des années quatre-vingt-dix, la recherche universitaire s'intéresse de plus en plus à l'arrière-plan des oeuvres littéraires africaines. Derrière chaque ouvrage se situent des institutions, des économies, des stratégies d'auteurs, etc., qu'il est important de prendre en considération. Ce travail s'intéresse d'abord à la relation de la production littéraire africaine avec le marché global du livre. Dans un second-temps, notre recherche étudie le cas du marché du livre camerounais et sa cohérence en tant que système éditorial participant à l'économie littéraire nationale, sous-régionale et internationale. / Since the eighties, international industrial firms enter North publishing houses' capital. This was the beginning of what is called book globalization. That process raises a standardization fear of published material; it also involves the emergence of thoughts and projects concerning bibliodiversity. In that context, African book's market has been structured in different kind of networks with the goal of sustaining its diffusion/distribution. On the end of the nineties, scholar researches increase their interest for African literature production's background. Behind each book, we find institutions, economies, authors' strategies, which are important to take in account. In this present work, we will consider the relations between African literary productions and Global book's market. Secondly, our work will focus on Cameroonian book's market as an editorial system, and will question its participation to the economy of literature at national, regional and international scales.

Magister Artium (Development Studies) - MA(DVS) / Remittances inflows have gradually become one of the major sources of external financial inflows to developing countries. As a result, research abounds on the developmental effects of remittances in the home countries of migrants. At the micro level, recipients of remittances are more likely to have better access to quality health care, education as well as start-up fund for their own businesses. On the other hand at the macro level, remittances inflows can help increase the credit worthiness of countries by enabling them to use future remittances inflows as collateral for loans. Additionally, remittances inflows as a source of foreign exchange can be used by countries to fund import bills. Although there has been a surge of scholarship on remittances, this scholarship seems to be concentrated on the economic study of migration instead of the macroeconomic aspects of remittances. Furthermore, comparative studies on these macroeconomic aspects of remittances especially on African countries are underresearched and remains at the backwaters of academic study. Using quantitative time series data, this research seeks to do a comparative study on the countercyclical nature of remittances in four selected West African countries (Cameroon, Cape Verde, Nigeria and Senegal). The research used descriptive trend analysis, autocorrelation and an ARMAX model analyse the research problem. After critical analysis on whether remittances are countercyclical or not using the 2009 global financial crisis as a reference year in these four countries, it was found that, remittance inflows to Cameroon, Cape Verde, Nigeria and Senegal were pro-cyclical in nature. Moreover, in analysing the relationship between remittances inflows and gross domestic product (economic growth) the research revealed that there was a positive relationship between remittances inflows and economic growth for the four countries (Cameroon, Cape Verde, Nigeria and Senegal) observed. One recommendation given from this study is that, there is the need for remittances inflows to be invested in productive activities. This is because even if remittances continue to increase, without its investment in productive sectors, it cannot have any meaningful impact on economic growth in these countries.

The aim of this research is to examine how Africa can become a socially sustainable society by the year 2030 using a strategic leadership approach with Cameroon as a case study. Using a generic and whole systems view, the study would examine the possibility of a transition from a socially un-sustainable society to sustainable society. The study analyses the current political, economic, social and environmental operations that undermines people’s ability to meet their basic needs. It also highlights some of the strengths and opportunities of the Cameroonian society that can help accelerate this transition. Threats and weaknesses are also identified and corrective measures are proposed. Agriculture and social capacity building amongst others stand out as prominent opportunities which could be use to further strategic progress towards sustainability. The study concludes that, with a well defined vision, it is possible for Cameroon to strategically progress towards a socially sustainable society.

A la limite entre le Cameroun et le Nigéria, la région du Faro est une zone d’extraordinaire diversité, tant du point de vue des populations que de la topographie. Pas moins de 13 groupes ethnolinguistiques y sont documentés, qui appartiennent à 3 grands ensembles linguistiques et se répartissent dans la plaine et les montagnes. Les données de la linguistique indiquent que les représentants des langues adamaoua seraient présents dans la plaine de la Bénoué et du Faro depuis environ quatre mille ans. Au niveau de l'ethnohistoire, on sait que les habitants des plaines sous soumis à l’autorité des Foulbé depuis deux siècles. Mais au delà de cette période, de nombreuses zones d'ombre demeurent. L’histoire des populations de cette partie du bassin de la Bénoué avant le 19ème siècle semblait donc hors d’atteinte, car la région du Faro restait vierge du point de vue archéologique. <p>Dans ce travail, j’apporte par le biais d'une approche historique et comparative des éléments susceptible d’expliquer, d’une part la complexité qui caractérise le peuplement du Faro et, d’autre part, la façon dont le peuplement de cette région a évolué au cours du dernier millénaire. Il est également question de faire progresser la réflexion méthodologique, en évaluant la façon dont les modèles obtenus par l’archéologie peuvent être confrontés avec ceux qui se basent sur les traditions orales, les éléments de la culture matérielle actuelle et la linguistique.<p>L’étude des traditions orales a permis de classer par ordre chronologique les éléments historiques importants et d’établir une histoire du peuplement durant ces derniers siècles. Elle confirme qu’il est possible de reconnaître des racines remontant au delà du 19ème siècle à la plupart des groupes qui peuplent encore la région aujourd’hui, ainsi que de nombreuses ruptures dans l’histoire du peuplement du Faro. Contrairement aux travaux antérieurs, la plus importante de ces fractures date du début du 19ème siècle, avec l’occupation des conquérants foulbé, qui ont provoqué l’insécurité généralisée, la division de la région en deux et les plus importantes déportations de populations des plaines vers les montagnes refuges.<p>L’approche archéologique a permis d’établir la première séquence chrono-culturelle du Faro au cours du dernier millénaire. Si la présence d’un peuplement ancien dans la plaine était envisagée, l’étude archéologique apporte la preuve que des communautés humaines vivent dans le Faro depuis environ 1000 ans. A partir du 15ème siècle, des modifications surviennent. Celles-ci se manifestent surtout par l’apparition d’une nouvelle poterie ornée au Blepharis sp. Lorsque l’on compare la carte de distribution des sites associés à cette céramique, au trajet suivi par les Bata, qui remontent le cours du Faro en implantant des villages et à l’aire d’extension des langues tchadiques au Faro, il semble plausible que de nouvelles populations occupent la région vers le milieu du dernier millénaire de notre ère. Pour le 19ème siècle bien documenté par les traditions orales, les données archéologiques viennent renforcer l’idée d’une profonde rupture durant cette période.<p>En abordant l’histoire du peuplement du Faro, il était nécessaire d’examiner le concept de l’ethnicité comme il est classiquement employé dans la région. D’une manière générale, l’étude conforte l’idée qu’il est très difficile d’aborder la profondeur historique des identités des groupes actuels.<p>La confrontation entre les faits des cultures vivantes et les résultats archéologiques a permis d’évaluer les potentialités de raisonnements historique et comparatif. On ne peut que constater, dans cet exemple concret, le grand intérêt qu’il y a à fonder la reconstitution du passé sur de multiples sources. <p> / Doctorat en Histoire, art et archéologie / info:eu-repo/semantics/nonPublished

Alors que l’accès aux traitements antirétroviraux se généralise dans les pays en développement, l’émergence de résistances virales, liées aux échecs thérapeutiques, constitue une menace sur un plan individuel et collectif. Au Cameroun, la prévention, la détection et la prise en charge des échecs thérapeutiques se heurtent à différentes contraintes. A travers une approche anthropologique, cette thèse explore le contexte et les déterminants des échecs thérapeutiques. Le défaut d’observance est la principale cause de leur survenue. Les équipes médicales et psychosociales font face à l’absence de guides et de procédures adaptées. Aussi l’annonce de l’échec est-elle souvent associée à une culpabilisation des patients, auxquels les soignants attribuent la seule responsabilité de l’échec. L’adaptation des structures est limitée. La prise en charge médicale et psychosociale est focalisée sur le démarrage du traitement et le changement de traitement, mais le suivi à long terme est inexistant. La perception, par les patients, des médicaments antirétroviraux, est perturbée par la survenue de l’échec. L’échec redéfinit les relations de pouvoir et de confiance entre les soignants et les patients. L’attitude des soignants oscille entre compassion et réprobation, alors que l’échec renforce la dépendance des patients. Cette thèse vise à contribuer aux réflexions anthropologiques sur les médicaments, le système de santé et les relations soignants-soignés mais aussi à contribuer à l’amélioration de la prise en charge des patients en échec, pour préserver l’efficacité des thérapies antirétrovirales, sur laquelle repose l’espoir, d’éradiquer un jour l’épidémie. / When antiretroviral treatment becomes widespread in countries in the Global South, the emergence of viral resistance related to treatment failures is a threat for individuals and the general public. In Cameroon, various constraints hinder the prevention, detection and case management of treatment failures. Through an anthropological approach, this dissertation explores the context and determinants of treatment failures. Nonadherence is the main cause of their onset. Medical and psychosocial teams must face a lack of suitable guidelines and procedures. Also, notification of the failure is often associated with placing blame on patients, on whom caregivers assign sole responsibility for the failure. Adaptation in facilities is limited. Medical and psychosocial care is focused on starting treatment and making changes in treatment, but long-term follow-up does not exist. Patients’ perceptions of antiretrovirals are hampered by failures. The failure redefines power relationships and trust between caregivers and patients. Caregivers’ attitudes vacillate between compassion and condemnation, while the failure reinforces the patients’ dependence. This dissertation aims to contribute to the anthropological discussion on medicines, the health system and the caregiver-patient relationship as well as to improve care for patients with treatment failure to ensure the continued effectiveness of antiretroviral therapies that underlie any hopes of one day eradicating the epidemic.