Synergistic vulnerabilities: Antiretroviral treatment among women in Uganda

Abstract

Despite being an early success story in the reduction of HIV infection rates, Uganda faces myriad challenges in the recent era of accelerated antiretroviral treatment (ARV) scale-up. For those able to access treatment, ongoing vulnerabilities of poverty and violence compound treatment-related costs and concerns. This paper explores experiences of one particularly vulnerable population – women on ARVs who have also experienced intimate partner violence (IPV). Data were collected over 12 months in Uganda. They include ethnographic interviews (n = 40) drawn from a larger sample of women on ARV and semi-structured interviews with policy-makers and service providers (n = 42), examining the intersection of experiences and responses to treatment from multiple perspectives. Women's narratives show that due to treatment, immediate health concerns take on secondary importance, while other forms of vulnerability, including IPV and poverty, can continue to shape treatment experiences and the decision to stay in violent relationships. Providers likewise face difficulties in overburdened clinics, though they recognise women's concerns and the importance of considering other forms of vulnerability in treatment. This analysis makes the case for integrating treatment with other types of social services and demonstrates the importance of understanding the ways in which synergistic and compounding vulnerabilities confound treatment scale-up efforts.

Keywords:

• medical anthropology
• Uganda
• HIV treatment
• intimate partner violence

Acknowledgements

I thank the study participants, staff at Joint Clinic Research Centre and Mbarara University of Science and Technology ISS Clinic for their assistance and research assistants Kisakye Sheila and Namanya Judith. I am grateful to Janet McGrath, Toby Reiner, Brian King and anonymous reviewers for comments on earlier versions of this paper.

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Funding

This study was funded by the National Science Foundation [grant number DDIG#0823287], with additional support from the Zdanis Fellowship at Case Western Reserve University.