“We Smoke the Same Pipe”: Religion and Community Home-Based Care for PLWH in Rural Swaziland

ABSTRACT

We draw on a study of a church-run community home-based care organization in Swaziland to explore how individuals living with HIV perceived caregivers’ impact on well-being. Our primary concern was to examine how religion, as a heuristic practice of Christian-based caregiving, was felt to be consequential in a direly underserved region. Part of a larger medical anthropological project, we conducted semi-structured interviews with 79 community home-based care clients, of whom half (53%) said they would have died, some from suicide, without its services. We utilized a critical phenomenological approach to interpret semantic and latent themes, and explicated these themes within a ‘healthworld’ framework. Participants were resolute that caregivers be Christian, less for ideological positioning than for perceived ontological sameness and ascribed traits: “telling the truth” about treatment, confidentiality, and an ethos of unconditional love that restored clients’ desire to live and adhere to treatment. Findings are intended to help theorize phenomenological meanings of care, morality, health, and sickness, and to interrogate authoritative biomedically based rationalities that underwrite most HIV-related global health policy.

KEYWORDS:

• Africa
• ART/ARV
• biomedicine
• HIV/AIDS
• phenomenology

Acknowledgments

The Institutional Review Board of Baruch College, City University of New York approved the research protocol. Ethical research processes, including informed consent, were rigorously implemented. The authors declare no conflict of interest. The authors are grateful to the women and men of Shiselweni Home-based Care for their participation in the study; Casey Golomski for his invaluable contributions to the research process, from inception to analysis; and draft manuscript reviewers whose feedback was instrumental.

Funding

This study was funded with a grant from the Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal.

Notes

1. The Dutch Reformed Church (DRC) in South Africa was founded by Dutch missionaries in South Africa in the late seventeenth century. In 1945, the DRC established a missionary outpost in Swaziland that, over time, became indigenized as the Swaziland Reformed Church. The Swazi denomination has more than 2000 members regularly meeting in homes and church buildings.

Additional information

Funding

This study was funded with a grant from the Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal.

Notes on contributors

Robin Root

Robin Root, MPH, PhD is professor of Anthropology, Department of Sociology & Anthropology, Baruch College, City University of New York, and a medical anthropologist who has explored social aspects of HIV/AIDS in Swaziland since 2005.

Arnau Van Wyngaard

Arnau Van Wyngaard, PhD, has been a missionary pastor in Swaziland for the past 30 years and published extensively on theologies of HIV/AIDS. He is a research associate, Department of Science of Religion and Missiology, University of Pretoria, and CEO of Shiselweni Home-Based Care.

Alan Whiteside

Alan Whiteside, OBE, DEcon, was brought up in Swaziland and has been engaged in economic analysis and HIV research for over 30 years. He is the founder and former director of Health Economics and HIV/AIDS Research, University of KwaZulu-Natal, and CIGI Chair in Global Health Policy, Balsillie School of International Affairs, Canada.