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Paper short abstract

Drawing on research with Mapuche people living with HIV in Chile, this paper examines how patients navigate between biomedical and Indigenous healing. It focuses on the knowledge produced through lived experience and its role in how patients understand and decide about their care.

Paper long abstract

This paper examines the tensions and negotiations between biomedical and Indigenous medicine in Chile. It is based on research with Mapuche people living with HIV in Chile’s capital and in the region with the highest proportion of Indigenous population in the country. The paper explores the place of medical pluralism within care pathways, focusing on narratives of transmission, diagnosis, and treatment. Patients dynamically make sense of illness and navigate the practicalities of biomedicine and traditional Mapuche medicine—whether in terms of exclusion or complementation—according to their life trajectories, care pathways, and evaluations of practitioners’ legitimacy, shaped by encounters with biomedical doctors and machis (traditional Mapuche healers).

By considering how patients perceive themselves as morally, geographically, and ethnically close or distant from HIV, and how these perceptions shift following the biographical disruption of diagnosis, the paper examines how gender, sexuality, and physical proximity to Indigenous rural communities inform changing meaning-making and therapeutic decision-making in a context characterised by stigma. Drawing on previous and ongoing experiences, patients navigate between the differing openness of biomedical practitioners towards traditional healing and the diagnoses and claims of effectiveness made by machis. Ultimately, they evaluate therapies in relation to bodily effects and social risks.

Rather than viewing biomedical and Indigenous medical systems as being in conflict, this paper argues that, for Mapuche patients, medical pluralism constitutes a space in which they actively produce knowledge through lived experience, acknowledging biomedical hegemony while foregrounding patients’ dynamism in pursuing healing within the social worlds they inhabit.