Doctoral Degrees (Geography and Environmental Studies)

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Browsing Doctoral Degrees (Geography and Environmental Studies) by Subject "AIDS (Disease) -- Treatment"

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    Linking love and health: Social narratives of sex, intimacy, and love in the context of universal testing and treatment of HIV
    (2021-03) Viljoen, Lario; Reynolds, Lindsey Jeanne; Thesis (PhD)--Stellenbosch University, 2021.; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Sociology and Social Anthropology.
    ENGLISH ABSTRACT: Since the 1990s, HIV prevention efforts have evolved from a primary focus on sexual behavioural change to an increasing focus on treatment-based prevention modalities as scientific evidence about the preventive benefits of antiretroviral treatment (ART) has accumulated. As these new prevention technologies have been tested and implemented worldwide, new knowledge gaps have emerged about how the availability of HIV treatment as prevention (TasP) would fit into sexual experiences and shape relationship dynamics in high HIV burden contexts. In this thesis I aim to understand how women in South Africa experience sex, intimacy, and health in the context of a changing HIV prevention landscape. As women are disproportionately affected by the disease, the study of their sexual experiences and relationship dynamics in the context of treatment-based prevention is especially urgent. Furthermore, the dynamics of intimacy, care, and emotional connections in relation to sex in Africa remain underexplored. Historically, research on sex in Africa has positioned women as either fetishised or diseased, and the rise of the HIV epidemic did little to redirect this problematic narrative. I challenge these narratives and explore women’s conceptualisations of sex, focusing on how intimacy and emotional connections are prioritised. The study is nested in the HPTN 071 (PopART) HIV prevention trial, a community-randomised trial conducted in South Africa and Zambia from 2012-2018 that aimed to test the effectiveness of TasP at population-level through a strategy called universal test and treat (UTT). We conducted a qualitative cohort study with 89 households (n = ⁓300 participants, including 180 women) over 18-24 months to describe individual and community experiences of the trial. I analysed data from the cohort to explore women’s narratives of their sexual experiences. Working across theoretical constructs (scripting theory, performance theory, responsibilisation) and empirical findings, the central emerging theme relates to the ongoing tensions between idealised or expected conceptions of women’s sexual lives and their experienced realities. This is evident in the discord between women’s perception of HIV risk (assigned to ‘transgressive’ others) and how their own intimate relationships are described (trust, fidelity, respect, risk-free). Through focusing on idealised notions of romantic sex, HIV risk is dismissed, and idealised relationship values upheld, even when partners fail to live up to these expectations. An HIV diagnosis, or the possibility of HIV risk, is positioned as challenging to women’s conceptualisations of intimate relationships (safe, trustworthy) and to their conceptualisations of self (as morally ‘good’ women). As an early study of the effects of UTT on women’s sexual lives, the findings show that readily available HIV testing and treatment has not yet shaped the sexual narratives of women in South Africa. Despite fears related to behavioural disinhibition (where people engage in more risky sex), I did not find demonstrable differences in women’s narratives around their sexual experiences in places where treatment-based prevention strategies were implemented. These findings suggest that public health programmes must be responsive to women’s changing experiences and perceptions of their own HIV risk and consider presenting TasP as a partnered solution.