In no domain of global health has there been more talk of rights than in HIV/AIDS, yet little is known about how the right to HIV/AIDS care is mobilized at the clinic level. Drawing on interviews and field observations in the United States, South Africa, Thailand, and Uganda, we analyze the legal consciousness of caregivers in five HIV clinics. We identify three organizational factors—clinics' focus on the distribution rather than the adequacy of existing resources, the duties for caregivers that patients' rights create, and the dominant norms of exchange in healthcare—that help to explain the low penetration of formal rights talk into clinics despite its prevalence outside them. However, we also observe that within clinics, rights may accrue differently than public discourse about rights might lead us to expect. We find that patients often benefit from highly localized, tacit de facto rights that develop gradually over time with the support of state health infrastructure, clinic resources, and professional norms and commitments. These rights would be unlikely to stand up in a court of law but nevertheless have substantial impact on patients' access to care.

中文翻译：

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在宪法和诊所之间：正式和事实上的医疗保健权利

在全球卫生领域，没有比艾滋病毒/艾滋病更多的关于权利的讨论，但人们对如何在诊所一级动员艾滋病毒/艾滋病护理权知之甚少。通过在美国、南非、泰国和乌干达的访谈和实地观察，我们分析了五个艾滋病诊所的护理人员的法律意识。我们确定了三个组织因素——诊所关注分配而不是现有资源的充足性、患者权利创造的护理人员职责以及医疗保健中的主要交换规范——这有助于解释正式权利的低渗透率尽管在诊所之外很流行，但仍要与诊所交谈。然而，我们也观察到，在诊所内，权利的产生可能与关于权利的公共话语可能导致我们预期的不同。我们发现，在国家卫生基础设施、诊所资源以及专业规范和承诺的支持下，随着时间的推移逐渐发展，患者往往受益于高度本地化的、默认的事实上的 权利。这些权利不太可能在法庭上站得住脚，但仍会对患者获得护理产生重大影响。