The Socio-Political Economy of Antiretroviral Treatment as HIV Prevention

Class, Deena M. (2012) The Socio-Political Economy of Antiretroviral Treatment as HIV Prevention. PhD thesis, University of Trento.

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This doctoral thesis seeks to explore the socio-political economy of antiretroviral treatment (ART) as an HIV prevention strategy in sub-Saharan Africa (SSA) and, specifically, in Mozambique. We begin with a look at the social construction of HIV in SSA as a ‘sexually transmitted disease’ despite its very low transmission efficiency through heterosexual sex. This inordinate focus on sexual transmission in SSA to the exclusion of other routes of transmission (i.e.: blood-borne transmission) not only allows new infections to continue to occur in areas that do not receive attention, but also has both fed and been fed by a political and social climate that paints an extraordinarily negative picture of those who are infected with HIV. Alternatives to the ineffective and misguided sexual behavior prevention paradigm are introduced to conclude Chapter 1. Chapter 2 then explores, in depth, the most efficacious form of HIV prevention currently in existence: antiretroviral treatment (ART) for infected persons. ART for an infected partner is 96% effective at preventing transmission of HIV to an uninfected partner. Due to this startlingly high efficacy and recent increases in coverage, we may be preventing more new cases of HIV annually through ART than through the use of condoms and abstinence combined in Mozambique. The financial implications of a paradigmatic shift to explicitly considering ART as a prevention strategy are discussed, particularly as they relate to PEPFAR's very specific regulations for the allocation of funds. As PEPFAR funding constitutes over 95% of Mozambique's HIV-specific funding, these regulations and earmarks have created deep path dependence and whittled away at national and local ownership of policy. The third chapter of this thesis then focuses on Mozambique's severe human resources for health constraints and current efforts in health systems strengthening. These strategies include task shifting and human resources scale-up, issues which, while being general to the health system, are also inordinately important for continued ART scale-up. The fourth and final chapter contains the case study in Maputo, Mozambique. This qualitative study attempts to examine the effects of the sexual behavior prevention paradigm on people living with HIV and receiving ART. As these patients are our best hope for halting the HIV epidemic, it will be important for us to view our decades-old prevention messages from their point of view and understand how these messages may also affect their adherence as well as their willingness to be tested initially and to enroll in treatment. The interviews were carried out with patients, guardians of pediatric patients and clinicians at two health facilities in Maputo. Analysis of these interviews supports the hypothesis that traditional prevention messages found in public health campaigns, the media and in health facilities themselves, may be creating and exacerbating stigma that discourages people living with HIV to be tested and treated.

Item Type:Doctoral Thesis (PhD)
Doctoral School:Local Development and Global Dynamics (within the School in Social Sciences, till the a.y. 2010-11)
PhD Cycle:XXIV
Subjects:Area 14 - Scienze politiche e sociali > SPS/13 STORIA E ISTITUZIONI DELL'AFRICA
Area 14 - Scienze politiche e sociali > SPS/11 SOCIOLOGIA DEI FENOMENI POLITICI
Uncontrolled Keywords:HIV, ART, ART as prevention, Africa, Mozambique, Maputo, nosocomial transmission, PEPFAR, stigma, sexual behavior, human resources for health, scale-up, Global Fund, HIV treatment, global health, mother-to-child transmission
Repository Staff approval on:22 Jun 2012 11:48

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