Hanne O. Mogensen

Tests for life chances: CD4 miracles and obstacles in Uganda

This article discusses the relationship between technologies, socialities and inequities based on case material from a recent study about the first generation of people living with ART – Antiretroviral Therapy – in Uganda. The authors discuss how the diagnostic technologies of HIV tests, ‘CD4 counts’, and weight measuring produce results and numbers that are appropriated by people living with HIV to reflect upon their lives, bodies and relationships and hence influence their socialities and subjectivities. It is argued that because treatment programmes and especially their associated technologies vary greatly in Uganda, the programmes themselves introduce inequity in the already unequal landscape of HIV patients. In debates about biomedical technology and about HIV/AIDS it has been suggested that new kinds of socialities emerge, which have been conceptualised as ‘therapeutic citizenship’ and ‘bio-sociality’. In the study on which the present article is based, clientship, friendship and kinship are kinds of sociality that play a much larger part in informants’ lives than do ‘therapeutic citizenship’ and ‘bio-sociality’. The authors attribute these findings, not only to the Ugandan setting, but to the method of doing extended case studies, which were not institution and programme based, but family and home based.

The ambivalence of stigma and the double-edged sword of HIV/AIDS intervention in Burkina Faso.

This article analyses the causes of HIV stigmatisation in Burkina Faso as perceived by people living with HIV/AIDS (PLHIV) and people working in AIDS-related Community Based Organisations (CBOs). Stigmatisation continues to be a pressing issue when dealing with HIV/AIDS in Sub-Saharan Africa. The article is based on direct observation of HIV-related practices within 20 CBOs in Burkina Faso, as well as semi-structured interviews or focus group discussions with 72 PLHIV and 90 professionals and volunteers working in CBOs. PLHIV were chosen by convenience sampling among the persons who accessed CBO services and were interviewed about their life quality and experience relating to HIV. Professionals and volunteers were interviewed about their strategies, their achievements, and the problems they encountered. The research was conducted in the course of three months fieldwork between September and November 2009. Our principal findings show, firstly, that moral or social stigmatisation does not in any simple way derive from fear, ignorance or inaccurate beliefs but that it is also established and continually reinforced by official campaigns addressing HIV/AIDS. Secondly, we show that stigmatisation is a socially complex and ambiguous process. Based on these empirical findings we conclude that HIV/AIDS need no longer be approached in AIDS intervention as a sexually acquired and fatal disease. When reliable access to antiretroviral drugs is in place, AIDS becomes a chronic condition with which one can live for many years, and this makes it easier to address HIV and moral or social stigmatisation by downplaying the current focus upon sexuality and morality.

Finding a Path through the Health Unit: Practical Experience of Ugandan Patients 1

ABSTRACT Finding ones way through a health facility is not necessarily an easy task for Ugandan patients. Our understanding of how people succeed in doing so, and of the obstacles they encounter on their way, is incomplete if we focus only on the cognitive level of the clinical encounter. Much research in public health and medical anthropology implicitly works with the notion that agency is located in the mind and that cognitive understanding is a precondition for practice. Based on material from eastern Uganda, this article explores the practical experience of Ugandan patients and their relatives and reflects upon the ways in which this notion of agency has often caused us to confuse the spectators point of view with the actors point of view. Thus, as Pierre Bourdieu has argued, we are made to look for answers to “questions that practice never asks because it has no need to ask them.”

Antiretroviral therapy: unmet need and associated socio-demographic characteristics among HIV-positive women in Haiphong, Vietnam.

Abstract In Vietnam, ARV access has been scaled up since 2005 in high HIV prevalence areas in order to meet increasing demands for HIV treatment. This paper aims to estimate ARV unmet need and its associated socio-demographic characteristics among HIV-positive women in Haiphong, Vietnam. A cross-sectional study using structured questionnaires and CD4 cell count was conducted with 353 HIV-positive women recruited from groups of people living with HIV/AIDS (PLWHA), by snowball technique through member of PLWHA groups and the local AIDS management system (Provincial AIDS Center (PAC)). The percentage of HIV-positive women having an unmet ARV need was estimated to be 40%, particularly high among women who were not registered at PAC. Having an unmet ARV need was associated with not participating in PLWHA groups (OR 6.5; 2.4–17.2) and being younger than 30 years old (OR 2.9; 1.1–7.3).

Factors associated with the failure to seek HIV care and treatment among HIV-positive women in a northern province of Vietnam

This cross-sectional survey examines the utilization of HIV care and treatment services after HIV diagnosis among women in Vietnam and describes factors that may be associated with failure in seeking services. From May 2007 to November 2007, we conducted structured interviews with 353 HIV-positive women living a Haiphong, a northern province of Vietnam. The women were recruited through a network of people living with HIV/AIDS (HPN+) by means of snowball sampling and through the local, governmental HIV registration system (Provincial AIDS Centre [PAC]). Approximately 26.3% of the study participants had never attended HIV care and treatment services. Failure in seeking the services was associated with not being registered in the PAC (odds ratio [OR]: 3.0; 95% confidence interval [CI]: 1.4-6.4), not having a known HIV-positive family member (OR: 3.2; 95% CI: 1.2-8.3), not having disclosed HIV status (OR: 4.0; 95% CI: 2.0-8.1), and factors associated with the testing situation, whereby women who were tested by chance had a 4.0 times increased OR (95% CI: 1.4-11.7) and women who were tested in relation to antenatal care or delivery had 3.0 times increased OR (95% CI: 1.1-8.5) for failure to seek HIV care compared to women who had been tested because their husbands/partners were sick or had died. We suggest that the posttest counseling and referral system for HIV care and treatment need to be improved. An alternative system for picking up those not wishing to attend the official system might help to approach these needy women.

Pursuing Treatment and Moral Worth: HIV-Infected Women in a Northern Province of Vietnam Living With Antiretroviral Therapy

&NA; There is a need to understand how social and cultural expectations of being a woman shape the challenges women face when trying to access antiretroviral therapy (ART) and to continue the treatment over time. Based on a 7‐month prospective study of 15 HIV‐infected women, the particular challenges met by these women in northern Vietnam are discussed in this article. We argued that, by taking ART to maintain their health and to fulfill their responsibilities to family and community, the women managed to reclaim the “moral worth” they had lost as a result of having HIV infection. At the same time, certain social and economic contingencies related to ART made it difficult for the women to uphold this moral position. The study demonstrated the importance of understanding the meanings and implications of ART in specific social contexts to understand how social support structures could be established to ensure treatment continuation.

Vietnamese Women's Struggle to Access Antiretroviral Drugs in a Context of Free Treatment

This qualitative study aims to explore how HIV positive women living in a northern province of Vietnam experience seeking antiretroviral (ARV) treatment in the public health system, and how they address obstacles encountered along the way. Despite the fact that antiretroviral drugs were freely provided, they were not always accessible for women in need. A variety of factors at the population and health system level interacted in ways that often made access to ARV drugs a complicated and time-consuming process. We have suggested changes that could be made at the health system level that may help facilitate womens ability to access treatment.

Introduktion: Humanistisk psykiatri - udforskning af et krydsfelt

Dette nummer af Tidsskrift for Forskning i Sygdom og Samfund praesenterer en raekke forskningsprojekter inden for det, man kan kalde humanistisk psykiatriforskning, dvs. kvalitativ forskning i sindslidelse og behandling med humanistisk afsaet. Der findes en storre tradition for humanistisk psykiatriforskning i USA og England med repraesentanter som Arthur Kleinman (bl.a. 1988; 1995), Byron Good (bl.a. 1997), Sue Estoff (bl.a. 1985) og Roland Littlewood (Littlewood og Liepsedge 1997; Littlewood og Dein 2000), men i en nordisk sammenhaeng er forskningsfeltet kun i sin vorden. I 2004 modtes flere af os i forbindelse med et seminar pa Syddansk Universitet, som lektor Helle Johannesen havde taget initiativ til. Her skabtes de forste tiltag til at samle de forskere, som arbejder med omradet i dansk regi i et netvaerk. Dette nummer er den forste mere samlede praesentation af feltet. Ud over repraesentanter for den danske forskning har vi ogsa inviteret en norsk forsker, hvis forskning ligger i trad med de ovrige bidrag.