Spinning plates : livelihood mobility, household responsibility and anti-retroviral treatment in an urban Zambian community during the HPTN 071 (PopART) study

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dc.contributor.authorBond, Virginiaen_ZA
dc.contributor.authorNgwenya, Fredricken_ZA
dc.contributor.authorThomas, Angeliqueen_ZA
dc.contributor.authorSimuyaba, Melvinen_ZA
dc.contributor.authorHoddinott, Graemeen_ZA
dc.contributor.authorFidler, Sarahen_ZA
dc.contributor.authorHayes, Richarden_ZA
dc.contributor.authorAyles, Helenen_ZA
dc.contributor.authorSeeley, Janeten_ZA
dc.date.accessioned2020-04-25T13:24:25Z
dc.date.available2020-04-25T13:24:25Z
dc.date.issued2018
dc.descriptionCITATION: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.
dc.descriptionThe original publication is available at https://onlinelibrary.wiley.com
dc.description.abstractIntroduction: 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.en_ZA
dc.description.urihttps://onlinelibrary.wiley.com/doi/10.1002/jia2.25117
dc.description.versionPublisher's version
dc.format.extent13 pages
dc.identifier.citationBond, 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
dc.identifier.issn1758-2652 (online)
dc.identifier.otherdoi:10.1002/jia2.25117
dc.identifier.urihttp://hdl.handle.net/10019.1/107729
dc.language.isoen_ZAen_ZA
dc.publisherWiley Open Access
dc.rights.holderAuthors retain copyright
dc.subjectLivelihood mobilityen_ZA
dc.subjectAntiretroviral agents -- Acccessibility -- Zambiaen_ZA
dc.subjectHIV-positive personsen_ZA
dc.subjectMobility of HIV-positive persons -- Zambiaen_ZA
dc.subjectPopARTen_ZA
dc.subjectHPTN 071en_ZA
dc.titleSpinning plates : livelihood mobility, household responsibility and anti-retroviral treatment in an urban Zambian community during the HPTN 071 (PopART) studyen_ZA
dc.typeArticleen_ZA
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