‘I am also a human being!’ Antiretroviral treatment in local moral worlds

Abstract

The experiences and practices of antiretroviral drug consumers in Tanzania are shaped by economic scarcity, limited state-provided social welfare, and fragile kinship-based solidarity. Embedding antiretroviral therapy (ART) in patients’ ‘local moral worlds’ brings further existential dimensions to the fore that articulate closely with the priority the treatment acquires in their lives. An exemplary case study of a middle-aged HIV-positive man suggests that dignity, social recognition, and belonging may be of central interest and temporarily overshadow patients’ concern for mere survival. A stronger focus on patients’ moral concerns contributes to a better understanding of the complex dynamics that prevent HIV-positive people from becoming the ‘pharmaceutical selves’ that are promoted during treatment enrolment. Moreover, it is indispensable to account for the lived experiences of patients struggling with what too readily has been termed a ‘chronic disease’.

Keywords:

• HIV/AIDS
• Tanzania
• ART
• morality
• subjectivity
• medical anthropology

Acknowledgements

The Fritz-Thyssen-Stiftung, the National Institute of Medical Research and Tanzania Commission for Science and Technology provided funding and ethical approval. The author thanks Hansjörg Dilger, Claire Beaudevin, the Arbeitskreis Medical Anthropology at the Freie Universität Berlin, and the editors and reviewers for their insightful suggestions. Finally, he expresses his great indebtedness to the people living with HIV in Tanga.

The paper was presented at the conference ‘Medical Anthropology in Europe’ funded by the Wellcome Trust and Royal Anthropological Institute.

Conflict of interest: none.

Notes

1. All names in this paper are pseudonyms.