Abstract
The health of people living with HIV (PLWH) and the sustained success of antiretroviral therapy (ART) programmes depends on PLWH’s motivation and ability to self-manage the condition over the long term, including adherence to drugs on a daily basis. PLWH’s self-management of HIV and their wellbeing are likely to be interrelated. Successful self-management sustains wellbeing, and wellbeing is likely to motivate continued self-management. Detailed research is lacking on PLWH’s self-management processes on ART in resource-limited settings. This paper presents findings from a study of PLWH’s self-management and wellbeing in Wakiso District, Uganda. Thirty-eight PLWH (20 women, 18 men) were purposefully selected at ART facilities run by the government and by The AIDS Support Organisation in and around Entebbe. Two in-depth interviews were completed with each participant over three or four visits. Many were struggling economically, however the recovery of health and hope on ART had enhanced wellbeing and motivated self-management. The majority were managing their condition well across three broad domains of self-management. First, they had mobilised resources, notably through good relationships with health workers. Advice and counselling had helped them to reconceptualise their condition and situation more positively and see hope for the future, motivating their work to self-manage. Many had also developed a new network of support through contacts they had developed at the ART clinic. Second, they had acquired knowledge and skills to manage their health, a useful framework to manage their condition and to live their life. Third, participants were psychologically adjusting to their condition and their new ‘self’: they saw HIV as a normal disease, were coping with stigma and had regained self-esteem, and were finding meaning in life. Our study demonstrates the centrality of social relationships and other non-medical aspects of wellbeing for self-management which ART programmes might explore further and encourage.
Highlights
In Uganda people living with HIV (PLWH) on antiretroviral therapy (ART) with access to good treatment support can have the same life expectancy as the general population [1]
We briefly summarise the socio-economic circumstances of the 38 participants because meeting minimum needs is a foundation of wellbeing [24]: if minimum consumption needs cannot be achieved for example, this is likely to undermine self-management and subjective wellbeing
Our findings complement other research showing enhanced wellbeing among PLWH on ART in resource-limited settings [9,14,26,27,28]
Summary
In Uganda people living with HIV (PLWH) on antiretroviral therapy (ART) with access to good treatment support can have the same life expectancy as the general population [1]. The health of PLWH and the sustained success of ART programmes depend on the health care available and on PLWH’s motivation and ability to self-manage the condition, including daily adherence to drugs. There is a growing body of evidence about ART adherence and its influences in resource-limited settings [4,5,6,7], there is still relatively limited research on the range of PLWH’s self-management processes on ART in resource-limited settings [2,8,9]. Analysis extends beyond adherence to examine a range of social, psychological and practical self-management processes, which in turn are closely related to and influence PLWH’s wellbeing
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