title: Challenging the paradigm: anthropological perspectives on HIV as a chronic disease.
abstract: Recently HIV has been framed as a 'manageable' chronic disease in contexts in which access to effective care is reliable. The chronic disease paradigm emphasizes self-care, biomedical disease management, social normalization, and uncertainty. Data from a longitudinal study of patients (N = 949) in HIV care at two sites in Uganda, collected through semistructured interviews and ethnographic data, permit examination of the salience of this model in a high burden, low resource context struggling to achieve the promise of a manageable HIV epidemic. Our data highlight the complexity of the emerging social reality of long-term survival with HIV. Participants struggle to manage stigma as well as to meet the costs involved in care seeking. In these settings, economic vulnerability leads to daily struggles for food and basic services. Reconceptualizing the chronic disease model to accommodate a 'social space,' recognizing this new social reality will better capture the experience of long-term survival with HIV.
authors.affiliation: a Department of Anthropology , Case Western Reserve University , Cleveland , Ohio , USA.
authors.forename: Janet W
authors.initials: JW
authors.lastname: McGrath
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Winchester
authors.forename: David
authors.initials: D
authors.lastname: Kaawa-Mafigiri
authors.forename: Eddy
authors.initials: E
authors.lastname: Walakira
authors.forename: Florence
authors.initials: F
authors.lastname: Namutiibwa
authors.forename: Judith
authors.initials: J
authors.lastname: Birungi
authors.forename: George
authors.initials: G
authors.lastname: Ssendegye
authors.forename: Amina
authors.initials: A
authors.lastname: Nalwoga
authors.forename: Emily
authors.initials: E
authors.lastname: Kyarikunda
authors.forename: Sheila
authors.initials: S
authors.lastname: Kisakye
authors.forename: Nicolas
authors.initials: N
authors.lastname: Ayebazibwe
authors.forename: Charles B
authors.initials: CB
authors.lastname: Rwabukwali
mesh_terms: D000328:Adult; D060432:Anthropology, Medical; D002908:Chronic Disease; D005260:Female; D015658:HIV Infections; D006801:Humans; D008297:Male; D014454:Uganda; D055815:Young Adult
keywords: HIV/AIDS; Uganda; antiretroviral treatment; chronic disease; identity work