The Framing and Fashioning of Therapeutic Citizenship Among People Living With HIV Taking Antiretroviral Therapy in Uganda.

Steve Russell,Stella Namukwaya,Flavia Zalwango,Janet Seeley

doi:10.1177/1049732315597654

Abstract

In this article, we examine how people living with HIV (PLWH) were able to reconceptualize or “reframe” their understanding of HIV and enhance their capacity to self-manage the condition. Two in-depth interviews were held with 38 PLWH (20 women, 18 men) selected from three government and nongovernment antiretroviral therapy (ART) delivery sites in Wakiso District, and the narratives analyzed. ART providers played an important role in shaping participants’ HIV self-management processes. Health workers helped PLWH realize that they could control their condition, provided useful concepts and language for emotional coping, and gave advice about practical self-management tasks, although this could not always be put into practice. ART providers in this setting were spaces for the development of a collective identity and a particular form of therapeutic citizenship that encouraged self-management, including adherence to ART. Positive framing institutions are important for many PLWH in resource-limited settings and the success of ART programs.

Highlights

Rationale and ObjectivesHIV diagnosis can cause profound disruption to people’s lives and identity
We analyze the role of HIV treatment providers in the lives of people living with HIV (PLWH) in Uganda who are on antiretroviral therapy (ART)
We focus on how PLWH’s interactions with government providers, and The AIDS Support Organization (TASO), influenced their self-management of HIV

Summary

Introduction

Rationale and ObjectivesHIV diagnosis can cause profound disruption to people’s lives and identity. We focus on how PLWH’s interactions with government providers, and The AIDS Support Organization (TASO), influenced their self-management of HIV. These organizations can shape how PLWH understand and cope with the condition, helping them to “reconceptualize” or “reframe” interpretations of the illness and how to selfmanage HIV as a long-term condition (Abel, Rew, Gortner, & Delville, 2004; Watkins-Hayes, Pittman-Gay, & Beaman, 2012). Many PLWH in Sub-Saharan Africa have been taking ART for several years, so on-going support from health providers to promote long-term self-management and adherence remains important (Beard, Feeley, & Rosen, 2009; Mbonye, Nakamanya, et al, 2013)

Objectives

Methods

Results

Conclusion