Access for all: contextualising HIV treatment as prevention in Swaziland

Abstract

This article explores how notions of the individual and population are evoked in two ongoing HIV treatment as prevention (TasP) implementation studies in Swaziland. By contrasting policy discourses with lived kinship experiences of people living with HIV, we seek to understand how TasP unfolds in the Swazi context. Data collection consisted of eight focus group discussions with people living with HIV who were members of support groups to examine their perspectives about TasP. In addition, 18 key informant interviews were conducted with study team members, national-level policy-makers and NGO representatives involved in the design of health communication messages about TasP in Swaziland. Thematic analysis was used to identify recurrent themes in transcripts and field notes. Policy-makers and people living with HIV actively resisted framing HIV treatment as a prevention technology but promoted it as (earlier) access to treatment for all. TasP was not conceptualised in terms of individual or societal benefits, which are characteristic of international public health debates; rather its locally situated meanings were embedded in kinship experiences, concerns about taking responsibility for one's own health and others, local biomedical knowledge about drug resistance, and secrecy. The findings from this study suggest that more attention is needed to understand how the global discourse of TasP becomes shaped in practice in different cultural contexts. ARTICLE HISTORY

Good Health and Moral Responsibility: Key Concepts Underlying the Interpretation of Treatment as Prevention in South Africa and Zambia Before Rolling Out Universal HIV Testing and Treatment

“…This boost was deemed necessary when PLHIV had a low CD4 count and/or were seriously ill. Reinfection is commonly understood as PLHIV preventing themselves from being infected with a different strain of HIV by abstaining from sex, consistently using condoms, or by having sex with the same long-term partner. Studies in Kenya 6 and Swaziland 7 also documented the latter concerns about reinfection among health workers and PLHIV. Zambian HIV specialists in one community said they discouraged PLHIV having multiple sexual partners partly because of the risk of reinfection.…”

“…Resistance to the term was expressed by national policy makers and study implementers in Swaziland, partly on the basis of clarity and given that they were already moving toward offering this as the best standard of care. 7 …”

Comparative assessment of five trials of universal HIV testing and treatment in sub‐Saharan Africa

“…The average follow-up refers to the average time a study participant was observed in the context of the trial. strategies by the general population [29,[53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69]. Overall, the analysis of the various themes addressed within these five trials will contribute to understanding the impact of UTT strategies in various contexts as well as inform the generalization of such a strategy to new contexts.…”

Global Health

“…They might also work in the other direction to bring knowledge gained through long-term, grounded engagement with everyday life to spaces of global expertise so as to improve health experts' practices of design and dissemination. They might also do both (Vernooij et al 2016;Manderson 1998;Hardin 2018).…”