title: Access for all: contextualising HIV treatment as prevention in Swaziland.
abstract: This article explores how notions of the individual and population are evoked in two ongoing HIV treatment as prevention (TasP) implementation studies in Swaziland. By contrasting policy discourses with lived kinship experiences of people living with HIV, we seek to understand how TasP unfolds in the Swazi context. Data collection consisted of eight focus group discussions with people living with HIV who were members of support groups to examine their perspectives about TasP. In addition, 18 key informant interviews were conducted with study team members, national-level policy-makers and NGO representatives involved in the design of health communication messages about TasP in Swaziland. Thematic analysis was used to identify recurrent themes in transcripts and field notes. Policy-makers and people living with HIV actively resisted framing HIV treatment as a prevention technology but promoted it as (earlier) access to treatment for all. TasP was not conceptualised in terms of individual or societal benefits, which are characteristic of international public health debates; rather its locally situated meanings were embedded in kinship experiences, concerns about taking responsibility for one's own health and others, local biomedical knowledge about drug resistance, and secrecy. The findings from this study suggest that more attention is needed to understand how the global discourse of TasP becomes shaped in practice in different cultural contexts.
authors.affiliation: a Department of Anthropology , Amsterdam Institute for Social Science Research, University of Amsterdam , Amsterdam , The Netherlands.
authors.forename: Eva
authors.initials: E
authors.lastname: Vernooij
authors.affiliation: b Swaziland National Network of People Living with HIV and AIDS , Mbabane , Swaziland.
authors.forename: Mandhla
authors.initials: M
authors.lastname: Mehlo
authors.affiliation: a Department of Anthropology , Amsterdam Institute for Social Science Research, University of Amsterdam , Amsterdam , The Netherlands.
authors.forename: Anita
authors.initials: A
authors.lastname: Hardon
authors.affiliation: a Department of Anthropology , Amsterdam Institute for Social Science Research, University of Amsterdam , Amsterdam , The Netherlands.|c Department of Public Health and Primary Care , Leiden University Medical Centre , Leiden , The Netherlands.|d The Children's Institute, School of Child and Adolescent Health , University of Cape Town , Rondebosch , South Africa.
authors.forename: Ria
authors.initials: R
authors.lastname: Reis
mesh_terms: D000293:Adolescent; D000328:Adult; D013541:Eswatini; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology / Q000628:therapy; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D065129:Pre-Exposure Prophylaxis / Q000458:organization & administration*; D011634:Public Health; D036301:Qualitative Research; D012941:Social Responsibility; D055815:Young Adult
keywords: Swaziland; Treatment-as-prevention; expectations; implementation research; localisation