Between state and sickness: The social experience of HIV/AIDS illness management and treatment in Grahamstown, South Africa

• Main Author: Jones, Chaunetta
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2014
• Subjects: African Studies; Archaeology; Public health; South African Studies
• ISBN: 9781321283037; 1321283032

This dissertation examines the health and antiretroviral treatment-seeking behaviors among people living with HIV/AIDS in Grahamstown, South Africa. I conducted fourteen months of ethnographic fieldwork from 2008-2009, and use the concept of illness management as a complementary framework to medical anthropological health-seeking models to trace the social experiences of disease among those infected with and affected by HIV/AIDS. My research reveals that entrenched economic inequalities and structural barriers to healthcare, largely a result of apartheid-era policies and delayed HIV/AIDS decision-making at the national level, often force people living with HIV/AIDS to choose between their economic or health security. In communities with extremely high unemployment, like Grahamstown, people living with HIV/AIDS increasingly rely on government disability grants as their sole source of income. My ethnographic findings uncovered a complex dilemma, in which people engage in a range of treatment-seeking practices, including manipulating antiretroviral treatment adherence, to keep their CD4 counts at or below the threshold to remain eligible for a grant. Failed or modified treatment adherence may lead to the development and spread of drug resistant strains of the virus, potentially creating significant individual and public health concerns. Further, using rich life history and illness narratives, I demonstrate how state-prescribed health care models, based largely on standardized, biomedical categories, often belie the ways in which health-seeking processes are highly fluid and nuanced within everyday lived experiences. Future state-prescribed HIV/AIDS treatment programs should remain cognizant of patient treatment and prevention strategies, and develop holistic initiatives that address both health and economic security, particularly in resource-limited communities. This research contributes to medical anthropological scholarship on inequality and health, ethnographic studies on HIV/AIDS in southern Africa, and anthropological analyses of how socio-political and economic forces shape health and treatment-seeking practices.