title: Finding Meaning: HIV Self-Management and Wellbeing among People Taking Antiretroviral Therapy in Uganda.
abstract: The health of people living with HIV (PLWH) and the sustained success of antiretroviral therapy (ART) programmes depends on PLWH's motivation and ability to self-manage the condition over the long term, including adherence to drugs on a daily basis. PLWH's self-management of HIV and their wellbeing are likely to be interrelated. Successful self-management sustains wellbeing, and wellbeing is likely to motivate continued self-management. Detailed research is lacking on PLWH's self-management processes on ART in resource-limited settings. This paper presents findings from a study of PLWH's self-management and wellbeing in Wakiso District, Uganda. Thirty-eight PLWH (20 women, 18 men) were purposefully selected at ART facilities run by the government and by The AIDS Support Organisation in and around Entebbe. Two in-depth interviews were completed with each participant over three or four visits. Many were struggling economically, however the recovery of health and hope on ART had enhanced wellbeing and motivated self-management. The majority were managing their condition well across three broad domains of self-management. First, they had mobilised resources, notably through good relationships with health workers. Advice and counselling had helped them to reconceptualise their condition and situation more positively and see hope for the future, motivating their work to self-manage. Many had also developed a new network of support through contacts they had developed at the ART clinic. Second, they had acquired knowledge and skills to manage their health, a useful framework to manage their condition and to live their life. Third, participants were psychologically adjusting to their condition and their new 'self': they saw HIV as a normal disease, were coping with stigma and had regained self-esteem, and were finding meaning in life. Our study demonstrates the centrality of social relationships and other non-medical aspects of wellbeing for self-management which ART programmes might explore further and encourage.
authors.affiliation: School of International Development, University of East Anglia, Norwich Research Park, Norwich, United Kingdom.
authors.forename: Steve
authors.initials: S
authors.lastname: Russell
authors.affiliation: External Research Associate, School of International Development, University of East Anglia, Norwich, United Kingdom.
authors.forename: Faith
authors.initials: F
authors.lastname: Martin
authors.affiliation: Medical Research Council / Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: Flavia
authors.initials: F
authors.lastname: Zalwango
authors.affiliation: Medical Research Council / Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: Stella
authors.initials: S
authors.lastname: Namukwaya
authors.affiliation: Medical Research Council / Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: Ruth
authors.initials: R
authors.lastname: Nalugya
authors.affiliation: Medical Research Council / Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: Richard
authors.initials: R
authors.lastname: Muhumuza
authors.affiliation: Medical Research Council / Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Katongole
authors.affiliation: Medical Research Council / Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda.|London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Janet
authors.initials: J
authors.lastname: Seeley
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010549:Personal Satisfaction; D036301:Qualitative Research; D012648:Self Care / Q000523:psychology*; D012649:Self Concept; D057545:Social Stigma; D012944:Social Support; D014454:Uganda
chemical_list: D044966:Anti-Retroviral Agents