Life projects and therapeutic itineraries: marriage, fertility, and antiretroviral therapy in Nigeria.
OBJECTIVE
To examine and understand the marital and fertility aspirations and behaviours of individuals receiving antiretroviral therapy (ART) in Nigeria and evaluate the effects on sexual behaviour, disclosure, and adherence.


METHODS
The study used ethnographic methods of participant observation and in-depth interviews of individuals receiving ART through a government-supported programme in southeastern Nigeria.


RESULTS
Interviews and observations of individuals on treatment demonstrate that marriage and childbearing are paramount desires for people whose health is restored by ART. The concept of life projects is introduced and combined with the established idea of therapeutic itineraries to show how participation in and adherence to treatment, disclosure of HIV status, and decisions about sexual behaviour cannot be understood in purely biomedical terms. Marital and reproductive aspirations routinely impinge on and often trump clinical and public health priorities. Emblematic case studies are provided to illustrate the social dynamics that motivate and explain behaviour seemingly inimical to individual and public health.


CONCLUSIONS
Effective antiretroviral programme design and therapy management will require acknowledging and often enabling rather than discouraging the marital and reproductive goals of individuals if issues of disclosure, adherence, and prevention are to be realistically addressed.
Smith
Daniel Jordan
DJ
Department of Anthropology, Brown University, Providence, Rhode Island 02912, USA. daniel_j_smith@brown.edu
Mbakwem
Benjamin C
BC
D000884:Anthropology, Cultural; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology; D005260:Female; D005298:Fertility; D006040:Goals; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology / Q000523:psychology*; D006801:Humans; D008297:Male; D008393:Marriage; D009549:Nigeria; D012725:Sexual Behavior; D014342:Truth Disclosure
D019380:Anti-HIV Agents