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Merz S, Hunter B, Bisht R, Murray SF. 'Not in it for huge profits but because it's right': The contested moral economies of UK-India exports in health worker education and training. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:219-235. [PMID: 37578685 DOI: 10.1111/1467-9566.13700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023]
Abstract
While the growth of global markets in health-related services may have significant consequences for healthcare provisioning and training, it has received relatively little attention from the social sciences. This article examines UK-India, and specifically England-India, exports in health worker education and training as one such global market, drawing on sociological scholarship on moral economies to understand how trading in this field is constructed and legitimated by the individuals and organisations involved, what tensions evolve, and what is at stake in them. We employ a qualitative mixed methods approach using publicly available materials on existing UK-India collaborations and primary data from interviews with key stakeholders in India and the UK, including government departments, arms-length bodies, NHS Trusts, trade associations and private providers. Our analysis illustrates the key discursive strategies used to legitimate engagement in these markets, and the complex and contested moral economies unfolding between and across these stakeholders and contexts. Not least, we demonstrate the conflicting moral sentiments and the boundary work required to realise commodification. Situating cross-border trade in health worker education and training in a moral economy framework thus illuminates the social context and moral worlds in which this evolving trade is embedded.
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Affiliation(s)
- Sibille Merz
- Department of International Development, King's College London, London, UK
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Benjamin Hunter
- School of Global Studies, University of Sussex, Brighton, UK
| | - Ramila Bisht
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
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Moore EV, Hirsch JS, Nakyanjo N, Nakubulwa R, Morse-Karzen B, Daniel L, Spindler E, Nalugoda F, Santelli JS. The negative health spillover effects of universal primary education policy: Ethnographic evidence from Uganda. Glob Public Health 2023; 18:2221973. [PMID: 37305987 PMCID: PMC10357409 DOI: 10.1080/17441692.2023.2221973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/31/2023] [Indexed: 06/13/2023]
Abstract
Scholars of global health have embraced universal education as a structural intervention to prevent HIV. Yet the costs of school, including fees and other ancillary costs, create an economic burden for students and their families, indicating both the challenge of realising the potential of education for preventing HIV and the ways in which the desire for education may produce vulnerabilities to HIV for those struggling to afford it. To explore this paradox, this article draws from collaborative, team-based ethnographic research conducted from June to August 2019 in the Rakai district of Uganda. Respondents reported that education is the most significant cost burden faced by Ugandan families, sometimes amounting to as much as 66% of yearly household budgets per student. Respondents further understood paying for children's schooling as both a legal requirement and a valued social goal, and they pointed to men's labour migrations to high HIV-prevalence communities and women's participation in sex work as strategies to achieve that. Building from regional evidence showing young East African women participate in transactional, intergenerational sex to secure school fees for themselves, our findings point to the negative health spillover effects of Uganda's universal schooling policies for the whole family.
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Affiliation(s)
| | - Jennifer S Hirsch
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | | | | | - Lee Daniel
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Esther Spindler
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - John S Santelli
- Mailman School of Public Health, Columbia University, New York, NY, USA
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Nishi M. Care during ART scale-up: surviving the HIV epidemic in Ethiopia. BIOSOCIETIES 2022; 18:1-19. [PMID: 36211250 PMCID: PMC9527715 DOI: 10.1057/s41292-022-00283-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 11/21/2022]
Abstract
Over the last decades, there has been a worldwide rise of new technologies for controlling the HIV epidemic by expanding antiretroviral medicines. This article examines how the pharmaceutical-driven model of public health, which emerged as a byproduct of antiretroviral treatment (ART) scale-up in Ethiopia, interplayed with local forms of actions, engagements, and voices through which suffering inflicted by the epidemic was cared for. Through the eyes of an Ethiopian woman with HIV, this article illustrates how the increasing emphasis on ART facilitated the defunding of some community-based care practices. Moreover, it rendered the realities of precarious life with HIV invisible in the landscape of therapeutic citizenship. However, for Ethiopians, ART scale-up unfolded amid multiple forms of HIV care practices and relationships that endured stigma, alienation, and uncertainty before and after ART. The experience of surviving the HIV epidemic in Ethiopia provides a vital premise upon which claims of meaningful care are made, and ways to otherwise develop healthcare actions and engagements are sought.
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Affiliation(s)
- Makoto Nishi
- Hiroshima University, 1-7-1, Kagamiyama, Higashi-Hiroshima City, Hiroshima, 7398521 Japan
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4
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Managing disruption at a distance: Unequal experiences of people living with long-term conditions during the COVID-19 pandemic. Soc Sci Med 2022; 302:114963. [PMID: 35500314 PMCID: PMC8990438 DOI: 10.1016/j.socscimed.2022.114963] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/21/2022] [Accepted: 04/04/2022] [Indexed: 01/10/2023]
Abstract
The COVID-19 pandemic and 'lockdown' restrictions have affected people's health and wellbeing globally. Those who are clinically vulnerable to COVID-19 mortality due to living with long term conditions (LTCs) are at greater risk of negative impacts on their health and wellbeing, and of disruption in management of their LTCs. This study explores how people with LTCs managed their health and wellbeing under social distancing restrictions and self-isolation during the first wave of the COVID-19 pandemic, and examines why some people were more able to manage than others. Interviews were conducted between May and July 2020 with people (n = 44) living in North East England, who had one or more LTCs and were recruited via a social prescribing intervention. Data were analysed using a social constructivist thematic analysis. We present our analysis of the possibilities afforded to people to manage the impacts of lockdown on their health and wellbeing. We find that while some people deployed a range of capitals and/or etched out 'tactics' to make life 'habitable', others experienced 'zones of impossibility' requiring that they rely on contingent events or formal support. Our analysis highlights inequalities amongst people with LTCs, particularly regarding access to and deployment of important resources for health and wellbeing under COVID-19 social distancing restrictions, including outdoor space or greenspace, exercise and social connection. The study is novel in showing the mechanisms for coping with a significant period of disruption in the life-course whilst highlighting that although resilience was common in people with LTCs, this was sometimes at detrimental costs to themselves.
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Haram L. Negotiating Gender Justice in Tanzania. ETHNOS 2021. [DOI: 10.1080/00141844.2019.1696865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Liv Haram
- Department of Social Anthropology, Norwegian University of Science and Technology (NTNU), Dragvoll, Norway
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Wardlow H. “I am a dead woman”. FOCAAL 2021. [DOI: 10.3167/fcl.2021.900102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
HIV/AIDS can be understood as “an epidemic of signification” (Treichler 1987) not only about dangerous sexuality but also about dangerous relations of dependence. I begin by examining newspaper articles and nongovernmental organization reports to show how they pose alarmist questions about AIDS-related dependency, such as who will care for “AIDS orphans” and how will labor deficits be managed. I then turn to the Papua New Guinea context and focus on the experiences of women living with HIV who oft en narrate themselves as embodying state dependencies on foreign aid for their antiretroviral medications. In contrast, they typically resist their kin’s attempts to position them as wayward dependents who should be grateful for being given food and shelter.
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Tousignant N. Filtering Inequality: Screening and Knowledge in Senegal's Topography of Hepatitis B Care. Front Pharmacol 2021; 11:561428. [PMID: 33912027 PMCID: PMC8072661 DOI: 10.3389/fphar.2020.561428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/09/2020] [Indexed: 12/28/2022] Open
Abstract
Only a fraction of the estimated tenth or so of Senegalese who are chronically infected with hepatitis B virus (HBV) have been diagnosed. Of these, few have been assessed for their risk of progressing to potentially fatal liver disease (indicating need for treatment), and fewer still are taking antiviral drugs. A massive gap between those needing and getting treatment is widely acknowledged among experts. But given that HBV and its biomedical treatment options are largely invisible in bodies, health data, care practices, public messaging, or mass media, how can we observe, ethnographically, the effects of constraints on and inequalities in treatment? What are the stakes of access to drugs, when this access is not being sought out, claimed, or enacted? This article tackles these questions by examining how HBV is being enacted in Senegal, but not necessarily in relation to antiviral treatment. I first describe the emergence, over the past decade and a half, of an exclusionary topography of HBV diagnosis and treatment. I introduce the notion of “filtration” to describe the effects of this topography on the formation of potential “subjects of access.” The diagnostic therapies and expertise required to determine need for treatment are expensive, urban, and largely privatized. Moreover, knowledge about HBV and its possibilities of care circulates in narrow and sparsely distributed channels. Only a tiny minority of persons are effectively “filtered into” care, while issues of access remain largely outside of public debate. I then move onto small-scale efforts, led by rural primary health workers and community associations, to raise awareness of and expand screening for HBV. Those driving information and screening either do not reveal that effective drugs exist or locate these beyond the reach of most of their audiences or patients. Why then do they do it? I examine the logics and effects of their work to identify the forms of inclusion, care, efficacy, and explanation these open up. At the same time, I seek to discern the indirect effects of unequal access to knowledge and resources in the ambivalence, uncertainties, and contradictions that pervade these efforts to inform, diagnose, and advise.
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Hampshire K, Mwase-Vuma T, Alemu K, Abane A, Munthali A, Awoke T, Mariwah S, Chamdimba E, Owusu SA, Robson E, Castelli M, Shkedy Z, Shawa N, Abel J, Kasim A. Informal mhealth at scale in Africa: Opportunities and challenges. WORLD DEVELOPMENT 2021; 140:105257. [PMID: 33814676 PMCID: PMC7903241 DOI: 10.1016/j.worlddev.2020.105257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The extraordinary global growth of digital connectivity has generated optimism that mobile technologies can help overcome infrastructural barriers to development, with 'mobile health' (mhealth) being a key component of this. However, while 'formal' (top-down) mhealth programmes continue to face challenges of scalability and sustainability, we know relatively little about how health-workers are using their own mobile phones informally in their work. Using data from Ghana, Ethiopia and Malawi, we document the reach, nature and perceived impacts of community health-workers' (CHWs') 'informal mhealth' practices, and ask how equitably these are distributed. We implemented a mixed-methods study, combining surveys of CHWs across the three countries, using multi-stage proportional-to-size sampling (N = 2197 total), with qualitative research (interviews and focus groups with CHWs, clients and higher-level stake-holders). Survey data were weighted to produce nationally- or regionally-representative samples for multivariate analysis; comparative thematic analysis was used for qualitative data. Our findings confirm the limited reach of 'formal' compared with 'informal' mhealth: while only 15% of CHWs surveyed were using formal mhealth applications, over 97% reported regularly using a personal mobile phone for work-related purposes in a range of innovative ways. CHWs and clients expressed unequivocally enthusiastic views about the perceived impacts of this 'informal health' usage. However, they also identified very real practical challenges, financial burdens and other threats to personal wellbeing; these appear to be borne disproportionately by the lowest-paid cadre of health-workers, especially those serving rural areas. Unlike previous small-scale, qualitative studies, our work has shown that informal mhealth is already happening at scale, far outstripping its formal equivalent. Policy-makers need to engage seriously with this emergent health system, and to work closely with those on the ground to address sources of inequity, without undermining existing good practice.
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Affiliation(s)
- Kate Hampshire
- Department of Anthropology, Durham University, Durham DH1 3LE, UK
- Corresponding author.
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Aellah G. Understanding men, mood, and avoidable deaths from AIDS in Western Kenya. CULTURE, HEALTH & SEXUALITY 2020; 22:1398-1413. [PMID: 31944171 DOI: 10.1080/13691058.2019.1685131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/22/2019] [Indexed: 06/10/2023]
Abstract
A person diagnosed with HIV today might never experience AIDS, nor transmit HIV. Advances in treatment effectiveness and coverage has made the UN 2030 vision for the 'end of AIDS' thinkable. Yet drug adherence and resistance are continuing challenges, contributing to avoidable deaths in high burden African countries, especially among men. The mood of global policy rhetoric is hopeful, though cautious. The mood of people living with HIV struggling to adhere to life-saving medication is harder to capture, but vital to understand. This paper draws on ethnographic fieldwork with a high burden population in Kenya to explore specific socio-economic contexts that lead to a potent mixture of fatalism and ambition among men now in their thirties who came of age during the devastating 1990s AIDS crisis. It seeks to understand why some HIV-positive members of this bio-generation find it hard to take their life-saving medication consistently, gambling with their lives and the lives of others in pursuit of a life that counts. It argues that mood - here understood as a shared generational consciousness and collective affect created by experiencing specific historical moments - should be taken seriously as legitimate evidence in HIV programming decisions.
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Affiliation(s)
- Gemma Aellah
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Abstract
Anthropologists examining the relationship between physician and patient in Western biomedicine have observed an inherent power discrepancy between the physician, assumed to hold scientific knowledge, and the patient, the recipient of this knowledge. COVID-19 presents a unique challenge to that dynamic, as physicians, scientists and medical experts possess limited understanding of the pathophysiology, interventions and treatment of the disease. Drawing on my experience as a resident physician on the frontlines of the COVID-19 pandemic, I contend that the absence of knowledge surrounding COVID-19 fosters a new form of intimacy between physician and patient through greater emphasis on subjective patient experience, increased transparency between physician and patient, and an expanding physician role beyond management of the physical disease state.
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Affiliation(s)
- Kelly Colas
- Resident physician in internal medicine, Washington DC, USA
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Affiliation(s)
- TOM SCOTT‐SMITH
- Refugee Studies CentreUniversity of Oxford 3 Mansfield Road Oxford OX1 3TB United Kingdom
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Abstract
Since the turn of the millennium, conceptual and practice-oriented shifts in global
health have increasingly given emphasis to health indicator production over research and interventions
that emerge out of local social practices, environments and concerns. In this special
issue of Anthropology in Action, we ask whether such globalised contexts allow for, recognise
and sufficiently value the research contributions of our discipline. We question how global
health research, ostensibly inter- or multi-disciplinary, generates knowledge. We query ‘not-knowing’
practices that inform and shape global health evidence as influenced by funders’
and collaborators’ expectations. The articles published here provide analyses of historical and
ethnographic field experiences that show how sidelining anthropological contributions results
in poorer research outcomes for the public. Citing experiences in Latin America, Angola, Senegal,
Nigeria and the domain of global health evaluation, the authors consider anthropology’s
roles in global health.
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Abstract
In this article, I elaborate the concept of narrative navigation to analyze the subjective and intersubjective ways in which people struggle through experiences of illness by constructing multiple, ambiguous and non-linear narratives that may continuously change, as they reposition themselves within changing circumstances. Drawing on ethnographic material on HIV care in Aceh, Indonesia, I show how subjunctivity and open-endedness are crucial narrative ways in which people living with HIV, their relatives, medical doctors and support group workers adjust to possibilities and limitations of care over time, thereby continuously negotiating what good care may be. Unfolding within a changing Indonesian healthcare system, their narrative navigations reveal caregiving to be a complex and contradictory process, thereby problematizing boundaries between good care and neglect.
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Bosire E, Mendenhall E, Omondi GB, Ndetei D. When Diabetes Confronts HIV: Biological Sub-citizenship at a Public Hospital in Nairobi, Kenya. Med Anthropol Q 2018; 32:574-592. [PMID: 30117196 DOI: 10.1111/maq.12476] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/14/2018] [Accepted: 08/02/2018] [Indexed: 12/31/2022]
Abstract
This article investigates how international donor policies cultivate a form of biological sub-citizenship for those with diabetes in Kenya. We interviewed 100 patients at a public hospital clinic in Nairobi, half with a diabetes diagnosis. We focus on three vignettes that illustrate how our study participants differentially perceived and experienced living with and seeking treatment and care for diabetes compared to other conditions, with a special focus on HIV. We argue that biological sub-citizenship, where those with HIV have consistent and comprehensive free medical care and those with diabetes must pay out-of-pocket for testing and treatment, impedes diabetes testing and treatment. Once diagnosed, many are then systematically excluded from the health care system due to their own inability to pay. We argue that the systematic exclusion from international donor money creates a form of biological sub-citizenship based on neoliberal economic policies that undermine other public health protections, such as universal primary health care.
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Affiliation(s)
- Edna Bosire
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Emily Mendenhall
- Science, Technology, and International Affairs Program, Walsh School of Foreign Service, Georgetown University, Washington, DC, USA
| | | | - David Ndetei
- Africa Mental Health Foundation, Nairobi, Kenya.,Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Heckert C, Wright T, Hernandez E, De Anda V. Ethnographic reflections on communicative inequities, global health relationships, and two decades of HIV in the Bolivian press. Glob Public Health 2018; 14:1-11. [PMID: 30092700 DOI: 10.1080/17441692.2018.1508481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Abstract
This article draws on two decades of media representations of HIV, ethnographic research among people living with HIV, and an analysis of global health programms in Bolivia. In doing so, we chart the evolution of media representations in relation to the global health context and the implications of these representations for people living with HIV. Our overarching argument is that media discourses on HIV in Bolivia have consistently been produced in a context of an unequal balance of power between global health bodies and local actors. This power imbalance has enabled global health bodies operating in Bolivia to maintain authority in producing local narratives about HIV, even when these narratives do not adequately capture the particularities of the Bolivian context. The mismatch between dominant global health narratives that have infiltrated the Bolivian media and ethnographic realities can have deleterious effects on people living with HIV. We draw on the concept communicative inequities to highlight how global health bodies shape dominant media narratives and the ways these dominant narratives at times misrepresent ethnographic realities. Thus, a media analysis informed by ethnographic experiences offers a unique lens for interrogating the implications of global health interventions.
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Affiliation(s)
- Carina Heckert
- a Department of Sociology and Anthropology , University of Texas at El Paso , El Paso , TX , USA
| | | | - Estefanía Hernandez
- a Department of Sociology and Anthropology , University of Texas at El Paso , El Paso , TX , USA
| | - Victoria De Anda
- a Department of Sociology and Anthropology , University of Texas at El Paso , El Paso , TX , USA
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Bond V, Ngwenya F, Thomas A, Simuyaba M, Hoddinott G, Fidler S, Hayes R, Ayles H, Seeley J. Spinning plates: livelihood mobility, household responsibility and anti-retroviral treatment in an urban Zambian community during the HPTN 071 (PopART) study. J Int AIDS Soc 2018; 21 Suppl 4:e25117. [PMID: 30027643 PMCID: PMC6053474 DOI: 10.1002/jia2.25117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/09/2018] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Qualitative data are lacking on the impact of mobility among people living with HIV (PLHIV) and their decision-making around anti-retroviral treatment (ART). We describe challenges of juggling household responsibility, livelihood mobility and HIV management for six PLHIV in urban Zambia. METHODS Six PLHIV (three men and three women, aged 21 to 44) were recruited from different geographic zones in one urban community drawn from a qualitative cohort in a social science component of a cluster-randomized trial (HPTN071 PopART). Participants were on ART (n = 2), not on ART (n = 2) and had started and stopped ART (n = 2). At least two in-depth interviews and participant observations, and three drop-in household visits with each were carried out between February and August 2017. Themed and comparative analysis was conducted. RESULTS The six participants relied on the informal economy to meet basic household needs. Routine livelihood mobility, either within the community and to a nearby town centre, or further afield for longer periods of time, was essential to get by. Although aware of ART benefits, only one of the six participants managed to successfully access and sustain treatment. The other five struggled to find time to access ART alongside other priorities, routine mobility and when daily routines were more chaotic. Difficulty in accessing ART was exacerbated by local health facility factors (congestion, a culture of reprimanding PLHIV who miss appointments, sporadic rationed drug supply), stigma and more limited social capital. CONCLUSIONS Using a time-space framework illustrated how household responsibility, livelihood mobility and HIV management every day were like spinning plates, each liable to topple and demanding constant attention. If universal lifelong ART is to be delivered, the current service model needs to adjust the limited time that some PLHIV have to access ART because of household responsibilities and the need to earn a living moving around, often away from home. Practical strategies that could facilitate ART access in the context of livelihood mobility include challenging the practice of reprimand, improving drug supply, having ART services more widely distributed, mapped and available at night and weekends, and an effective centralized client health information system.
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Affiliation(s)
- Virginia Bond
- Zambart, School of MedicineUniversity of ZambiaLusakaZambia
- Department of Global Health and DevelopmentFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | | | - Angelique Thomas
- Desmond Tutu TB CentreStellenbosch UniversityTygerbergSouth Africa
| | | | - Graeme Hoddinott
- Desmond Tutu TB CentreStellenbosch UniversityTygerbergSouth Africa
| | - Sarah Fidler
- Department of MedicineImperial College LondonSt Mary's CampusLondonUK
| | - Richard Hayes
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Helen Ayles
- Zambart, School of MedicineUniversity of ZambiaLusakaZambia
- Department of Clinical ResearchLondon School of Hygiene and Tropical MedicineLondonUK
| | - Janet Seeley
- Department of Global Health and DevelopmentFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
- MRC/UVRI Uganda Research Unit on AIDSEntebbeUganda
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Qureshi A. AIDS Activism and ‘Civil Society’. AIDS IN PAKISTAN 2018. [DOI: 10.1007/978-981-10-6220-9_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Qureshi A. Introduction. AIDS IN PAKISTAN 2018. [DOI: 10.1007/978-981-10-6220-9_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Qureshi A. Conclusion. AIDS IN PAKISTAN 2018. [DOI: 10.1007/978-981-10-6220-9_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Cormier McSwiggin C. Moral Adherence: HIV Treatment, Undetectability, and Stigmatized Viral Loads among Haitians in South Florida. Med Anthropol 2017; 36:714-728. [PMID: 28777660 DOI: 10.1080/01459740.2017.1361946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In the United States, HIV is rendered a chronic condition, and viral transmission is minimized through strict adherence to pharmaceutical treatment. Treatment reduces viral loads to untraceable levels in the blood, a status known as "undetectable," as determined by laboratory testing. For Haitians living with HIV in South Florida, "undetectable" has become more than a viral status; it is a means to know and govern themselves as moral actors and to survey and stigmatize others who remain "detectable." The ethnographic evidence I present here suggests that Haitians adopt novel forms of subjectivity based on undetectability, producing identities entangled in biotechnical categorizations and dominant narratives of responsibility, morality, and health. Haitians' experiences with these processes reveal the persistence of HIV stigmatization and the centrality of biomedical morality in mediating perceptions of inclusion, value, and worth of people living with HIV.
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Benton A, Sangaramoorthy T, Kalofonos I. Temporality and Positive Living in the Age of HIV/AIDS--A Multi-Sited Ethnography. CURRENT ANTHROPOLOGY 2017; 58:454-476. [PMID: 29075043 DOI: 10.1086/692825] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Drawing on comparative ethnographic fieldwork conducted in urban Mozambique, United States, and Sierra Leone, the article is broadly concerned with the globalization of temporal logics and how specific ideologies of time and temporality accompany health interventions like those for HIV/AIDS. More specifically, we explore how HIV-positive individuals have been increasingly encouraged to pursue healthier and more fulfilling lives through a set of moral, physical, and social practices called "positive living" since the advent of antiretroviral therapies. We describe how positive living, a feature of HIV/AIDS programs throughout the world, has taken root across varied political, social and economic contexts and how temporal rationalities, which have largely been under-examined in the HIV/AIDS literature, shape communities' responses and interpretations of positive living. Our approach is ethnographic and comparative, with implications for how anthropologists might think about collaboration and its analytical possibilities.
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Affiliation(s)
- Adia Benton
- Department of Anthropology and Program of African Studies at Northwestern University (1810 Hinman Avenue, Evanston, llinois 60208, USA)
| | - Thurka Sangaramoorthy
- Department of Anthropology at the University of Maryland (1111 Woods Hall, 4302 Chapel Lane, College Park, Maryland 20742, USA)
| | - Ippolytos Kalofonos
- Department of Psychiatry and Behavioral Sciences and the International Institute at the University of California, Los Angeles (760 Westwood Plaza, Box #62, Los Angeles, California 90095, USA) and West Los Angeles Veterans Affairs Healthcare System (11301 Wilshire Boulevard, Los Angeles, California 90073, USA)
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Biruk C. Ethical Gifts?: An Analysis of Soap-for-data Transactions in Malawian Survey Research Worlds. Med Anthropol Q 2017; 31:365-384. [PMID: 28387005 DOI: 10.1111/maq.12374] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/09/2017] [Accepted: 02/17/2017] [Indexed: 12/27/2022]
Abstract
In 2008, thousands of Malawians received soap from an American research project as a gift for survey participation. Soap was deemed an ethical, non-coercive gift by researchers and ethics boards, but took on meanings that expressed recipients' grievances and aspirations. Research participants reframed soap and research benefits as "rights" they are entitled to, wages for "work," and a symbol of exploitation. Enlisting the perspectives of Malawi's ethics board, demographers, Malawian fieldworkers, and research participants, I describe how soap is spoken about and operates in research worlds. I suggest that neither a prescriptive nor a situated frame for ethics-with their investments in standardization and attention to context, respectively-provides answers about how to compensate Malawian research participants. The conclusion gestures toward a reparative framework for thinking ethics that is responsive not just to project-based parameters but also to the histories and political economy in which projects (and ethics) are situated.
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Mills E. Biopolitical precarity in the permeable body: the social lives of people, viruses and their medicines. CRITICAL PUBLIC HEALTH 2017. [DOI: 10.1080/09581596.2017.1282153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Elizabeth Mills
- Department of Anthropology, University of Sussex, Brighton, UK
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25
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de Klerk J, Moyer E. "A Body Like a Baby": Social Self-Care among Older People with Chronic HIV in Mombasa. Med Anthropol 2016; 36:305-318. [PMID: 27644708 DOI: 10.1080/01459740.2016.1235573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
As part of the chronic disease paradigm now widely used for HIV in sub-Saharan Africa, antiretroviral treatment programs emphasize self-care. In the informal settlements of Mombasa, Kenya, the management of stress-associated with economic precariousness-plays a significant role in self-care practices and ideologies. Based on ethnographic fieldwork, we examine how local narratives of stress and self-care intertwine with social responsibilities of older HIV-positive people. For older Mombassans, living with 'chronic' HIV means living with an unpredictable body, which affects how they are able to care for their kin. The physical reality of living with HIV thus shapes relational networks, making self-care a social practice. While, for some self-care entails managing the body so that its needs are hidden from loved ones, a kind of 'protective secrecy,' others enlist the support of their children and grandchildren in managing their body, and in that process subtly redefine generational expectations and responsibilities.
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Affiliation(s)
- Josien de Klerk
- a Faculty of Governance and Global Affairs , Leiden University College , The Hague , The Netherlands
| | - Eileen Moyer
- b Faculty of Social and Behavioural Sciences, Department of Anthropology , University of Amsterdam , Amsterdam , The Netherlands
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26
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Aellah G, Geissler PW. Seeking exposure: conversions of scientific knowledge in an African city. THE JOURNAL OF MODERN AFRICAN STUDIES 2016; 54:389-417. [PMID: 27990029 PMCID: PMC5144824 DOI: 10.1017/s0022278x16000240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Transnational medical research has become a common feature in many parts of Africa. This paper explores the contribution such activity makes to the social and economic lives of those involved, including both trial subjects and local staff. By considering the value of the 'exposure' that involvement brings to staff and research participants, we reflect on the conversion of scientific knowledge into practical knowledge and its value to sustaining precarious livelihoods in an economically fragile city. We consider the interplay between science and sociality and argue for a need to take seriously the circulation of scientific knowledge beyond the confines of expert spaces.
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Affiliation(s)
- Gemma Aellah
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom and The Royal Anthropological Institute, 50 Fitzroy Street, London W1T 5BT, United Kingdom
| | - P. Wenzel Geissler
- Department of Social Anthropology, University of Oslo, Norway and Department of Archaeology and Anthropology, University of Cambridge, Cambridge, United Kingdom
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Winchester MS, McGrath JW, Kaawa-Mafigiri D, Namutiibwa F, Ssendegye G, Nalwoga A, Kyarikunda E, Birungi J, Kisakye S, Ayebazibwe N, Walakira EJ, Rwabukwali C. Routines, Hope, and Antiretroviral Treatment among Men and Women in Uganda. Med Anthropol Q 2016; 31:237-256. [PMID: 27159357 DOI: 10.1111/maq.12301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 04/28/2016] [Accepted: 05/04/2016] [Indexed: 11/25/2022]
Abstract
Antiretroviral treatment programs, despite biomedical emphases, require social understanding and transformations to be successful. In this article, we draw from a qualitative study of HIV treatment seeking to examine the drug-taking routines and health-related subjectivities of men and women on antiretroviral treatment (ART) at two sites in Uganda. We show that while not all participants in ART programs understand clinical protocols in biomedical terms, they adopt treatment-taking strategies to integrate medication into daily practices and social spaces. In turn, these embedded practices and understandings shape long-term hopes and fears for living with HIV, including the possibility of a cure. More significant than new forms of citizenship or sociality, we suggest that quotidian dimensions of treatment normalization shape the long-term experience of medication and outlook for the future.
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Affiliation(s)
- Margaret S Winchester
- Department of Health Policy and Administration, Pennsylvania State University.,Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda and Case Western Reserve University
| | - Janet W McGrath
- Department of Anthropology, Case Western Reserve University.,Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda
| | - David Kaawa-Mafigiri
- Department of Anthropology, Case Western Reserve University.,Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda
| | - Florence Namutiibwa
- Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda.,Case Western Reserve University
| | - George Ssendegye
- Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda.,Case Western Reserve University
| | - Amina Nalwoga
- Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda.,Case Western Reserve University
| | - Emily Kyarikunda
- Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda.,Case Western Reserve University
| | - Judith Birungi
- Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda.,Case Western Reserve University
| | - Sheila Kisakye
- Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda.,Case Western Reserve University
| | - Nicholas Ayebazibwe
- Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda.,Case Western Reserve University
| | - Eddy J Walakira
- Department of Social Work and Social Administration, Makerere University, Kampala.,Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda
| | - Charles Rwabukwali
- Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda.,Department of Sociology and Anthropology, Makerere University, Kampala, Uganda
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Hampshire K, Porter G, Mariwah S, Munthali A, Robson E, Owusu SA, Abane A, Milner J. Who bears the cost of 'informal mhealth'? Health-workers' mobile phone practices and associated political-moral economies of care in Ghana and Malawi. Health Policy Plan 2016; 32:34-42. [PMID: 27476501 PMCID: PMC5886236 DOI: 10.1093/heapol/czw095] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 11/13/2022] Open
Abstract
Africa's recent communications 'revolution' has generated optimism that using mobile phones for health (mhealth) can help bridge healthcare gaps, particularly for rural, hard-to-reach populations. However, while scale-up of mhealth pilots remains limited, health-workers across the continent possess mobile phones. This article draws on interviews from Ghana and Malawi to ask whether/how health-workers are using their phones informally and with what consequences. Health-workers were found to use personal mobile phones for a wide range of purposes: obtaining help in emergencies; communicating with patients/colleagues; facilitating community-based care, patient monitoring and medication adherence; obtaining clinical advice/information and managing logistics. However, the costs were being borne by the health-workers themselves, particularly by those at the lower echelons, in rural communities, often on minimal stipends/salaries, who are required to 'care' even at substantial personal cost. Although there is significant potential for 'informal mhealth' to improve (rural) healthcare, there is a risk that the associated moral and political economies of care will reinforce existing socioeconomic and geographic inequalities.
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Affiliation(s)
- Kate Hampshire
- Department of Anthropology, Durham University, Durham DH1 3LE, UK
| | - Gina Porter
- Department of Anthropology, Durham University, Durham DH1 3LE, UK
| | - Simon Mariwah
- Department of Geography and Regional Planning, University of Cape Coast, Ghana
| | | | - Elsbeth Robson
- Department of Geography, Environment and Earth Sciences, University of Hull, UK
| | | | - Albert Abane
- Department of Geography and Regional Planning, University of Cape Coast, Ghana
| | - James Milner
- Centre for Social Research, University of Malawi.,Deceased author
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Mills E. "When the skies fight": HIV, violence and pathways of precarity in South Africa. REPRODUCTIVE HEALTH MATTERS 2016; 24:85-95. [PMID: 27578342 DOI: 10.1016/j.rhm.2016.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 04/15/2016] [Accepted: 04/21/2016] [Indexed: 11/19/2022] Open
Abstract
Based on multi-sited ethnographic fieldwork in South Africa, this article explores the skies that fight, the proverbial lightning strikes that bring HIV into women's lives and bodies. Departing from earlier studies on ARV programmes in and beyond South Africa, and broadening out to explore the chronic struggle for life in a context of entrenched socio-economic inequality, this article presents findings on women's embodiment of and strategic resistance to structural and interpersonal violence. These linked forms of violence are discussed in light of the concept of precarity. Across two sections, the findings trace the pathways through which precarity entered women's lives, drawing on verbal, visual and written accounts collected through participant observation, participatory photography and film, and journey mapping. In doing so, the ethnography articulates the intersection of structural and interpersonal violence in women's lives. It also reveals the extent to which women exert a 'constrained agency', on the one hand, to resist structural violence and reconfigure their political relationship with the state through health activism; and, on the other hand, to shift the gender dynamics that fuel interpersonal violence through a careful navigation of intimacy and independence.
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Affiliation(s)
- Elizabeth Mills
- Research Fellow, Institute of Development Studies at the University of Sussex, Brighton, UK
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Rai T, Lambert HS, Ward H. Migration as a risk and a livelihood strategy: HIV across the life course of migrant families in India. Glob Public Health 2016; 12:381-395. [PMID: 27002744 PMCID: PMC5327870 DOI: 10.1080/17441692.2016.1155635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Migrant workers are understood to be vulnerable to HIV. However, little is known about the experience of migration-based households following HIV infection. This qualitative study examined the migration-HIV relationship beyond the point of infection, looking at how it affects livelihood choices, household relationships and the economic viability of migrant families. We conducted semi-structured interviews with 33 HIV-positive migrant men and women recruited from an anti-retroviral therapy (ART) centre in north India. Following infection among the migrant men, contact with free, public-sector HIV services was often made late, after the development of debilitating symptoms, abandonment of migrant work and return to native villages. After enrolment at the ART centre participants’ health eventually stabilised but they now faced serious economic debt, an inflexible treatment regimen and reduced physical strength. Insecure migrant job markets, monthly drug collection and discriminatory employment policies impeded future migration plans. HIV-positive wives of migrants occupied an insecure position in the rural marital household that depended on their husbands’ health and presence of children. The migration-HIV relationship continued to shape the life course of migrant families beyond the point of infection, often exposing them again to the economic insecurity that migration had helped to overcome, threatening their long-term survival.
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Affiliation(s)
- Tanvi Rai
- a School of Public Health , Imperial College London , London , UK
| | - Helen S Lambert
- b School of Social and Community Medicine , University of Bristol , Bristol , UK
| | - Helen Ward
- a School of Public Health , Imperial College London , London , UK
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31
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Prince RJ. The Diseased Body and the Global Subject: The Circulation and Consumption of an Iconic AIDS Photograph in East Africa. VISUAL ANTHROPOLOGY 2016. [DOI: 10.1080/08949468.2016.1131517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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32
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Chronic Diseases in North-West Tanzania and Southern Uganda. Public Perceptions of Terminologies, Aetiologies, Symptoms and Preferred Management. PLoS One 2015; 10:e0142194. [PMID: 26555896 PMCID: PMC4640879 DOI: 10.1371/journal.pone.0142194] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 10/19/2015] [Indexed: 11/20/2022] Open
Abstract
Background Research has shown that health system utilization is low for chronic diseases (CDs) other than HIV. We describe the knowledge and perceptions of CDs identified from rural and urban communities in north-west Tanzania and southern Uganda. Methods Data were collected through a quantitative population survey, a quantitative health facility survey and focus group discussions (FGDs) and in-depth interviews (IDIs) in subgroups of population survey participants. The main focus of this paper is the findings from the FGDs and IDIs. Results We conducted 24 FGDs, involving approximately 180 adult participants and IDIs with 116 participants (≥18 years). CDs studied included: asthma/chronic obstructive lung disease (COPD), diabetes, epilepsy, hypertension, cardiac failure and HIV- related disease. The understanding of most chronic conditions involved a combination of biomedical information, gleaned from health facility visits, local people who had suffered from a complaint or knew others who had and beliefs drawn from information shared in the community. The biomedical contribution shows some understanding of the aetiology of a condition and the management of that condition. However, local beliefs for certain conditions (such as epilepsy) suggest that biomedical treatment may be futile and therefore work counter to biomedical prescriptions for management. Conclusion Current perceptions of selected CDs may represent a barrier that prevents people from adopting efficacious health and treatment seeking behaviours. Interventions to improve this situation must include efforts to improve the quality of existing health services, so that people can access relevant, reliable and trustworthy services.
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Hutchinson E, Reyburn H, Hamlyn E, Long K, Meta J, Mbakilwa H, Chandler C. Bringing the state into the clinic? Incorporating the rapid diagnostic test for malaria into routine practice in Tanzanian primary healthcare facilities. Glob Public Health 2015; 12:1077-1091. [PMID: 26457440 PMCID: PMC5526135 DOI: 10.1080/17441692.2015.1091025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The roles that rapid, point-of-care tests will play in healthcare in low-income settings are likely to expand over the coming years. Yet, very little is known about how they are incorporated into practice, and what it means to use and rely upon them. This paper focuses on the rapid diagnostic test for malaria (mRDT), examining its introduction into low-level public health facilities in Tanzania within an intervention to improve the targeting of costly malaria medication. We interviewed 26 health workers to explore how a participatory training programme, mobile phone messages, posters and leaflets shaped the use and interpretation of the test. Drawing on notions of biopolitics, this paper examines how technologies of the self and mechanisms of surveillance bolstered the role mRDT in clinical decision-making. It shows how the significance of the test interacted with local knowledge, the availability of other medication, and local understandings of good clinical practice. Our findings suggest that in a context in which care is reduced to the provision of medicines, strict adherence to mRDT results may be underpinned by increasing the use of other pharmaceuticals or may leave health workers with patients for whom they are unable to provide care.
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Affiliation(s)
- Eleanor Hutchinson
- a Department of Global Health and Development , London School of Hygiene and Tropical Medicine , London , UK
| | - Hugh Reyburn
- b Department of Disease Control and Vector Biology , London School of Hygiene and Tropical Medicine , London , UK
| | - Eleanor Hamlyn
- a Department of Global Health and Development , London School of Hygiene and Tropical Medicine , London , UK
| | - Katie Long
- a Department of Global Health and Development , London School of Hygiene and Tropical Medicine , London , UK
| | - Judith Meta
- c Joint Malaria Programme , Kilimanjaro Christian Medical Centre , Moshi , Tanzania
| | - Hilda Mbakilwa
- c Joint Malaria Programme , Kilimanjaro Christian Medical Centre , Moshi , Tanzania
| | - Clare Chandler
- a Department of Global Health and Development , London School of Hygiene and Tropical Medicine , London , UK
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Endeshaw M, Alemu S, Andrews N, Dessie A, Frey S, Rawlins S, Walson JL, Rao D. Involving religious leaders in HIV care and treatment at a university-affiliated hospital in Ethiopia: Application of formative inquiry. Glob Public Health 2015; 12:416-431. [PMID: 26256618 DOI: 10.1080/17441692.2015.1069868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In sub-Saharan Africa, religious views strongly influence how people relate to illness, health, and healing. Belief in the curative power of religion, including for HIV, persists in many communities. As such, many funding agencies and organisations working in the field of HIV have incorporated religious institutions into their programmes in various capacities. Yet, debate continues regarding the benefits and drawbacks of including sectarian organisations in the fight against HIV. In the current study, we sought to explore whether patients with HIV would be amenable to receiving HIV-related psychosocial support from religious leaders. We interviewed 48 Ethiopian Orthodox Church followers who presented for routine HIV care at Gondar University Hospital ART (antiretroviral treatment) clinic. Although almost half (46%) of participants self-identified as 'very religious', the majority of them (73%) had not disclosed their HIV status to a religious leader. Study participants highlighted multiple factors that could potentially affect their willingness to involve religious leaders in their HIV care. We discuss these findings in relation to religion and HIV in the African context. Our findings support the use of formative qualitative work prior to developing and implementing programmes that integrate faith and medical communities.
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Affiliation(s)
- Meheret Endeshaw
- a Department of Global Health , University of Washington , Seattle , WA , USA
| | - Shitaye Alemu
- b Internal Medicine , University of Gondar , Gondar , Ethiopia
| | - Nancy Andrews
- c Care Opportunities through Partnership in Ethiopia (SCOPE) , Seattle , WA , USA
| | - Abere Dessie
- b Internal Medicine , University of Gondar , Gondar , Ethiopia
| | - Sarah Frey
- a Department of Global Health , University of Washington , Seattle , WA , USA
| | - Sarah Rawlins
- d Harborview Medical Center , University of Washington , Seattle , WA , USA
| | - Judd L Walson
- a Department of Global Health , University of Washington , Seattle , WA , USA
| | - Deepa Rao
- a Department of Global Health , University of Washington , Seattle , WA , USA
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Abstract
During the past decade, donor funding for health interventions in Kenya and other African countries has risen sharply. Focused on high-profile diseases such as HIV/AIDS, these funds create islands of intervention in a sea of under-resourced public health services. This paper draws on ethnographic research conducted in HIV clinics and in a public hospital to examine how health workers experience and reflect upon the juxtaposition of ‘global’ medicine with ‘local’ medicine. We show that health workers face an uneven playing field. High-prestige jobs are available in HIV research and treatment, funded by donors, while other diseases and health issues receive less attention. Outside HIV clinics, patient's access to medicines and laboratory tests is expensive, and diagnostic equipment is unreliable. Clinicians must tailor their decisions about treatment to the available medical technologies, medicines and resources. How do health workers reflect on working in these environments and how do their experiences influence professional ambitions and commitments?
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Affiliation(s)
- Ruth J Prince
- a Department of Anthropology & Institute of Health and Society , University of Oslo , Oslo , Norway
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d'Alessandro E. Human activities and microbial geographies. An anthropological approach to the risk of infections in West African hospitals. Soc Sci Med 2015; 136-137:64-72. [PMID: 25988999 DOI: 10.1016/j.socscimed.2015.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In hospital care, management of the risk of infection represents a crucial issue. Nevertheless, this question remains a neglected area in anthropological research, especially in African countries. To shed new light on this question, we conducted an anthropological investigation in the infectious disease department of a hospital in Niger. Daily observation of the work of the hospital staff for a total period of 6 months was spread out over 2008 and 2009. During our prolonged stay, we also collected 64 in-depth interviews of health care workers and attendants in the department. This study method made it possible to describe many of the practices and discourses related to the issues of medical and personal care and hospital hygiene and to compare the practices observed to standard principles for preventing hospital-acquired infections. Our ethnographic attention to the behavior of the actors showed the absence of formal spatial segmentations between different activities. The care provided by the untrained relatives serving as personal attendants introduced territorial enclaves governed by home hygiene standards into the interior of technical spaces. At the same time, privatizing equipment and space for their diverse activities, the medical staff disrupted technical chains and generated the recurrent crossing of microbial geographies. These results allow us to offer two principal guidelines for improving the quality of care and the management of risks of infection in hospitals in West Africa: (1) the essential role of the attendants in the care provided to hospital inpatients must be officially taken into account, especially by including them in the organization of medical hygiene procedures; (2) the different overlapping technical activities and social activities in the work space must be limited by their geographic and architectural segmentation.
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Affiliation(s)
- Eugénie d'Alessandro
- Ecole des Hautes Etudes en Sciences Sociales, Centre Norbert Elias, La Vieille Charité, 13002, Marseille, France.
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BROWN HANNAH. Global health partnerships, governance, and sovereign responsibility in western Kenya. AMERICAN ETHNOLOGIST 2015. [DOI: 10.1111/amet.12134] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- HANNAH BROWN
- Anthropology Department; Durham University; Dawson Building, South Road Durham DH1 3LE United Kingdom
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38
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HIV and the remaking of hunger and nutrition in South Africa: Biopolitical specification after apartheid. BIOSOCIETIES 2015. [DOI: 10.1057/biosoc.2015.8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Qureshi A. AIDS Activism in Pakistan: Diminishing Funds, Evasive State. DEVELOPMENT AND CHANGE 2015. [DOI: 10.1111/dech.12151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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40
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HORTON SARAH. Identity loan: The moral economy of migrant document exchange in California's Central Valley. AMERICAN ETHNOLOGIST 2015. [DOI: 10.1111/amet.12115] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- SARAH HORTON
- Department of Anthropology; University of Colorado Denver; Campus Box 103, P.O. Box 173364 Denver CO 80217-3364
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Qureshi A. Uncivil society: the politics of HIV activism in Pakistan. JOURNAL OF THE ROYAL ANTHROPOLOGICAL INSTITUTE 2014. [DOI: 10.1111/1467-9655.12130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Maes K. "Volunteers are not paid because they are priceless": community health worker capacities and values in an AIDS treatment intervention in urban Ethiopia. Med Anthropol Q 2014; 29:97-115. [PMID: 25257547 DOI: 10.1111/maq.12136] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article analyzes community health workers' (CHW) capacities for empathic service within an AIDS treatment program in Addis Ababa. I show how CHWs' capacities to build relationships with stigmatized people, reconcile family disputes, and confront death draw on a constellation of values, desires, and emotions encouraged by CHWs' families and religious teachings. I then examine the ways in which the capacities of CHWs were valued by the institutions that deployed them. NGO and government officials recognized that empathic care was crucial to both saving and improving the quality of people's lives. These institutional actors also defended a policy of not financially remunerating CHWs, partly by constructing their capacities as so valuable that they become "priceless" and therefore only remunerable with immaterial satisfaction. Positive change within CHW programs requires ethnographic analysis of how CHWs exercise capacities for empathic care as well as consideration of how global health institutions value these capacities.
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Affiliation(s)
- Kenneth Maes
- Department of Anthropology, Oregon State University.
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43
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[Long-term impact of antiretroviral therapy in Africa: current knowledge]. ACTA ACUST UNITED AC 2014; 107:222-9. [PMID: 25204573 DOI: 10.1007/s13149-014-0392-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/08/2014] [Indexed: 10/24/2022]
Abstract
By the end of 2013, 11 million PLHIV were taking ARVs in Africa; application of the WHO recommendation to initiate treatment earlier (at CD4 count of 500 cells/mm3 or less) should further increase this number. Currently, twothirds of patients in Africa have been on treatment for less than five years, and less than 10% have received treatment for eight years or more. Given the historical perspective is in its early stages, the long-term impact of ARV therapy is still unclear. This article reviews the knowledge gained over the period marking the first ten years of implementation of the universal access strategy (2003-2013) in Africa, through a review of the literature documenting the long-term consequence of ARV treatment, focusing on medical care for adults with an emphasis on the patient-centered approach. The goal is to understand the interrelationships between biological and social factors and individual and collective aspects that affect the lives of PLHIV and determine the impacts of ARV treatment over the long term. The biomedical and social factors are addressed successively, based on the most significant results. Key knowledge on the long-term outcomes for PLHIVon ARV treatment offers vital information on the necessary conditions and adaptations for care systems needed to ensure the benefits of treatment endure over time.
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44
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Of shifting economies and making ends meet: the changing role of the accompagnant at the Fann Psychiatric Clinic in Dakar, Senegal. Cult Med Psychiatry 2014; 38:427-47. [PMID: 25034610 DOI: 10.1007/s11013-014-9386-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Since 1972, inpatients at the Fann Psychiatric Clinic have been required to have a family member or close friend--an accompagnant--stay with them for the duration of their hospitalization. In recent years, however, the role of the accompagnant has seen a dramatic transformation. This article considers the emergence of a new kind of accompagnant at Fann: the for-hire accompagnant mercenaire, who is unrelated to the patient and not employed by the clinic. Against the backdrop of Senegal's neoliberal turn and in light of the growing prominence of the biomedical approach at Fann, the author shows how the idealized accompagnant model of family caretaking has given way to this new form of commodified care. At the same time, however, the author argues that accompagnants mercenaires regularly draw upon and establish new sets of moral codes, obligations, debts, and expectations in their day-to-day interactions with patients, family members, and staff alike. By way of a careful ethnographic examination of the evolution of the accompagnant role at Fann, this article brings into focus a complex and multidimensional picture of the shifting economies--moral and political, as well as therapeutic--within the present-day clinic.
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Willen SS. Lightning Rods in the Local Moral Economy: Debating Unauthorized Migrants' Deservingness in Israel. INTERNATIONAL MIGRATION 2014. [DOI: 10.1111/imig.12173] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Sarah S. Willen
- Department of Anthropology; University of Connecticut; Storrs Connecticut
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46
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Abstract
This article explores the orientations of lay people in Kenya to science—specifically to biomedical knowledge about HIV—and their struggles to convert this knowledge into meaningful futures. In Kenya, the global response to the HIV-AIDS epidemic has resulted in a highly stratified landscape of intervention. Globally-funded treatment programs and clinical trials, focusing on HIV, channel transnational resources, expertise, and knowledge into specific sites—HIV clinics, NGOs, and research stations—inscribing these spaces as ‘global’ while leaving others decidedly ‘local.’ Rolled out in the form of ‘projects,’ these interventions offer resources and opportunities for a limited time only. Based on ethnographic fieldwork in the city of Kisumu, this article follows the circulation of biomedical knowledge through such projects and its conversion in ways beyond those imagined by policy-makers, as it meets the aspirations of city-dwellers and enters into local livelihoods. Mediated by nongovernmental organizations through workshops and certificates, this knowledge is both fragmentary and ephemeral. I explore the temporal and spatial implications of such knowledge for those who seek to attach themselves to it and shape their identities and futures in relation to it.
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Affiliation(s)
- Ruth J Prince
- a Centre of African Studies , University of Cambridge , Cambridge , United Kingdom
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Prince RJ. 'TARMACKING' IN THE MILLENNIUM CITY: SPATIAL AND TEMPORAL TRAJECTORIES OF EMPOWERMENT AND DEVELOPMENT IN KISUMU, KENYA. AFRICA : JOURNAL OF THE INTERNATIONAL INSTITUTE OF AFRICAN LANGUAGES AND CULTURES 2013; 83:582-605. [PMID: 26321763 PMCID: PMC4541551 DOI: 10.1017/s0001972013000478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Over the past fifteen years, the city of Kisumu in western Kenya has emerged as an epicentre of 'global health' interventions, organized by non-governmental and transnational groups. These interventions involve concrete, practical engagements with the city's populations, but also imaginations and desires, as they intersect with residents' expectations of development. This article follows the hopes, aspirations and trajectories of people who attach themselves as volunteers to these interventions, or who hope to do so through a process they describe as 'tarmacking'. In exploring how volunteers orient themselves to ideas of 'empowerment' that are promoted by NGOs and also have influence outside institutional settings, it examines the relations between the landscapes of intervention, the spatial-temporal horizons, and the geographies of responsibility emergent in the city. Through its association with 'moving ahead' and with development, empowerment implies movement towards some kind of future. While there is a widely shared sense among volunteers that they are going somewhere, just where that might be is not clearly articulated. Rather than attempt to pinpoint this destination, this article follows their trajectories in an attempt to grasp why and how it remains obscure.
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Geissler PW. STUCK IN RUINS, OR UP AND COMING? THE SHIFTING GEOGRAPHY OF URBAN PUBLIC HEALTH RESEARCH IN KISUMU, KENYA. AFRICA : JOURNAL OF THE INTERNATIONAL INSTITUTE OF AFRICAN LANGUAGES AND CULTURES 2013; 83:539-560. [PMID: 26321761 PMCID: PMC4541552 DOI: 10.1017/s0001972013000442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Since the Second World War, the Kenyan city of Kisumu has been an important site of medical research and public health interventions - on malaria and other vector-borne diseases, and lately on HIV and related infections. This article compares the work and lives of two generations of local workers in public health research, each central to science in the city at their time: staff of the Ministry of Health's Division of Vector Borne Disease (DVBD) in the decades after independence, and temporary employees of the Kenyan Medical Research Institute (KEMRI) in its collaboration with the US government's Centers for Disease Control and Prevention (CDC) in the early twenty-first century. Against the backdrop of changes to the city, which stagnated during the 1970s and 1980s, became an epicentre of the East African AIDS epidemic, and underwent an economic boom of sorts from the late 1990s - at least partly driven by HIV research and intervention programmes - the article examines the spaces and movements of health research workers, and their experience of the city in time. The now elderly DVBD workers' accounts are pervaded by memories of anticipated progress and the convergence of life and work in the civic wholes of nation and city; by chagrin about decay; and by nostalgia for lost hopes. Today's young KEMRI/CDC workers' short-term contracts, and the fragmented city they inhabit and study, make for less bounded and predictable spaces and temporalities. Their urban lives and work take shape between remainders and remembrances of past projects, the exhaustion of everyday struggles to make a living and a meaningful life, and the search for new forms of urban order and civic purpose.
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Kageha Igonya E, Moyer E. Putting sex on the table: sex, sexuality and masculinity among HIV-positive men in Nairobi, Kenya. CULTURE, HEALTH & SEXUALITY 2013; 15 Suppl 4:S567-S580. [PMID: 23971911 DOI: 10.1080/13691058.2013.815367] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Psychosocial support groups offer an important space for people living with HIV to pursue greater wellbeing as they learn how to accept and live with their HIV status. They are critical for the cultivation of responsible and adherent patients. Occasionally, support groups provide spaces where members are encouraged to discuss sexual struggles related to being HIV-positive, including sexual performance issues, sexual relationships, fertility desires and communicating with sexual partners. This paper examines an HIV-positive men's sex therapy support group at Kenyatta National Hospital in Nairobi, Kenya, where HIV-positive men access information about HIV and treatment, while getting tips on restoring sexual functioning and improving sexual gratification from medical experts, peer counsellors and fellow group members. In the group setting, members worked to rediscover and reconstruct masculinity under the guidance of a range of experts, while focusing on regaining or improving sexual prowess.
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Affiliation(s)
- Emmy Kageha Igonya
- a Amsterdam Institute for Social Science Research, University of Amsterdam , Amsterdam , The Netherlands
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50
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Madiega PA, Jones G, Prince RJ, Geissler PW. 'She's my sister-in-law, my visitor, my friend' -- challenges of staff identity in home follow-up in an HIV trial in Western Kenya. Dev World Bioeth 2013; 13:21-9. [PMID: 23521821 PMCID: PMC3674534 DOI: 10.1111/dewb.12019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Identities ascribed to research staff in face-to-face encounters with participants have been raised as key ethical challenge in transnational health research. ‘Misattributed’ identities that do not just deviate from researchers' self-image, but obscure unequivocal aspects of researcher identity – e.g. that they are researchers – are a case of such ethical problem. Yet, the reasonable expectation of unconcealed identity can conflict with another ethical premise: confidentiality; this poses challenges to staff visiting participants at home. We explore these around a case study of ‘follow-up’ staff, observed during an ethnographic study of a Kenyan HIV ‘trial community’, which included participant observation, conversations, and interviews with staff (n = 79) and participants (n = 89). We found that because of the need to maintain confidentiality and because of some suspicions towards researchers, research staff drew upon alternative identities – presenting themselves to non-participants as relatives or friends, rather than as researchers. Several staff experienced this as necessary but uncomfortable. Simultaneously, staff and participants forged close relations in line with their fictional identities, which however also posed challenges because they entailed personal responsibilities that were difficult to live up to, due to limited resources, and the trial's limited duration. Similar challenges may arise in transnational HIV treatment programmes and should be explored further in that context.
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