Spinning plates : livelihood mobility, household responsibility and anti-retroviral treatment in an urban Zambian community during the HPTN 071 (PopART) study
Date
2018
Journal Title
Journal ISSN
Volume Title
Publisher
Wiley Open Access
Abstract
Introduction: Qualitative data are lacking on the impact of mobility among people living with HIV (PLHIV) and their decisionmaking
around anti-retroviral treatment (ART). We describe challenges of juggling household responsibility, livelihood mobility
and HIV management for six PLHIV in urban Zambia.
Methods: Six PLHIV (three men and three women, aged 21 to 44) were recruited from different geographic zones in one
urban community drawn from a qualitative cohort in a social science component of a cluster-randomized trial (HPTN071
PopART). Participants were on ART (n = 2), not on ART (n = 2) and had started and stopped ART (n = 2). At least two
in-depth interviews and participant observations, and three drop-in household visits with each were carried out between
February and August 2017. Themed and comparative analysis was conducted.
Results: The six participants relied on the informal economy to meet basic household needs. Routine livelihood mobility, either
within the community and to a nearby town centre, or further afield for longer periods of time, was essential to get by.
Although aware of ART benefits, only one of the six participants managed to successfully access and sustain treatment. The
other five struggled to find time to access ART alongside other priorities, routine mobility and when daily routines were more
chaotic. Difficulty in accessing ART was exacerbated by local health facility factors (congestion, a culture of reprimanding
PLHIV who miss appointments, sporadic rationed drug supply), stigma and more limited social capital.
Conclusions: Using a time-space framework illustrated how household responsibility, livelihood mobility and HIV management
every day were like spinning plates, each liable to topple and demanding constant attention. If universal lifelong ART is to be
delivered, the current service model needs to adjust the limited time that some PLHIV have to access ART because of household
responsibilities and the need to earn a living moving around, often away from home. Practical strategies that could facilitate
ART access in the context of livelihood mobility include challenging the practice of reprimand, improving drug supply,
having ART services more widely distributed, mapped and available at night and weekends, and an effective centralized client
health information system.
Description
CITATION:Bond, V., et al. 2018. Spinning plates : livelihood mobility, household responsibility and anti-retroviral treatment in an urban Zambian community during the HPTN 071 (PopART) study. Journal of the International AIDS Society, 21(54):e25117, doi:10.1002/jia2.25117.
The original publication is available at https://onlinelibrary.wiley.com
The original publication is available at https://onlinelibrary.wiley.com
Keywords
Livelihood mobility, Antiretroviral agents -- Acccessibility -- Zambia, HIV-positive persons, Mobility of HIV-positive persons -- Zambia, PopART, HPTN 071
Citation
Bond, V., et al. 2018. Spinning plates : livelihood mobility, household responsibility and anti-retroviral treatment in an urban Zambian community during the HPTN 071 (PopART) study. Journal of the International AIDS Society, 21(54):e25117, doi:10.1002/jia2.25117