Disclosure of HIV status occurs for a variety of reasons and in various contexts, such as to sexual partners to enable safer sexual choices, to health-care workers to access treatment and care services and to family and community members to gain various forms of support. The reasons for disclosure or non-disclosure are shaped by the relationships, needs and circumstances of people living with HIV (PLHIV) at the time of disclosure. The purpose of this study was to investigate and describe the act and experience of disclosure in order to understand how these experiences of disclosure impact on the lives of PLHIV on antiretroviral (ARV) treatment and influence adherence to treatment. Using a qualitative research design, I conducted an ethnographic study at and through the referral clinic at the Tygerberg Hospital in Cape Town, South Africa. Ninety-three adult patients (75 women) participated in the study, 32 of whom were visited at home to conduct semi-structured in-depth interviews, and 61 of them participated in a cross-sectional study at the referral clinic using researcher-administered questionnaires. A general inductive approach was used to analyse the data. Participants in both arms of the study disclosed mainly to family members, then partners and then to friends and other persons; only five had not disclosed to anyone at all. In deciding to disclose or not, the author began to see how patients negotiated their disclosure. From weighing up other people's reactions, to being concerned about the effect of their disclosure on their disclosure targets, to concealing one's status to evade untoward negative reactions towards themselves. Further, negotiating one's disclosure is not only about to whom or how to disclose, it also means finding good opportunities to disclose or conceiving ways of hiding one's status and/or medication from others in order to enhance access and adherence to their ARV treatment. Perceived rather than actual stigma played an important role in decisions not to disclose. Nonetheless, HIV remains a highly stigmatising disease. The author suggests that both the gains in support and the evasion of negative reactions from the disclosure will continue to drive negotiation of disclosure of one's status in order for patients to access and remain adherent to their treatment. Thus, areas of disclosure and concealment as they influence one's adherence to treatment need to be investigated further to facilitate adherence to treatment.Keywords: stigma, discrimination, social, household, family, partners RésuméLe partage du statut VIH a lieu pour diverses raisons et dans des contextes divers: avec les partenaires sexuels pour permettre des choix à moindre risque, avec les agents de santé pour accéder aux traitements et aux services de soins, et avec des membres de la famille et de la communauté pour obtenir diverses formes de soutien. Les motifs du partage ou du non-partage sont façonnés par les relations, les besoins et les circonstances des personnes vivant avec le VIH (PVVIH) au moment où elle...
There is a growing body of anthropological work analysing humanitarian organizations (see Fassin, 2010). Life in Crisis: The Ethical Journey of Doctors Without Borders, by Peter Redfield, is aligned with this body of work. Drawing on Marcus's (1995) construct of multisited ethnography to study the international nongovernmental organization (NGO) Médecins Sans Frontières (MSF), or Doctors Without Borders, Redfield pursues the organization across various field sites and office locations. Life in Crisis chronicles the journey of MSF since its formation as an offshoot of the Red Cross Movement in France, to its engagement with saving lives in crisis and emergency situations, to its work with chronic diseases and longer-term humanitarian work in the field. Life in Crisis lays bare MSF's ethical confrontations: defining whom to save, deciding when to wrap up and leave the field site, and determining what constitutes a crisis or an emergency. Life in Crisis is divided into three parts. In part one, 'Terms of Agreement', Redfield examines how MSF defines its involvement in the field missions that it undertakes. Chapter 1, 'A Time of Crisis', illustrates how MSF defines a crisis and its rationale for engaging in particular missions. The award of
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