Abstract
At the end of 2017, an estimated 36.9 million people were living with HIV (PLHIV) worldwide of which an estimated 21.7 million were accessing ART. Medical research is clear about the positive impact of ART on reducing morbidity and mortality amongst PLHIV. However, less is known about the broader implications and effects of ART on PLHIV. This study aimed to close this gap and provide a comprehensive understanding of the well-being of PLHIV on ART, and their households, in Lusaka, Zambia. It did this by moving beyond restrictive socio-economic approaches and restrictively medical understandings of health by focussing on the well-being of PLHIV on ART.
Well-being was conceptualised to contain three elements: the material (what a person has), the relational (what they can do with what they have), and the affective/cognitive (how they feel about what they have and can do with what they have). Also, much attention was given to the temporal context, in which PLHIV on ART exist. This study considered well-being not as an outcome but as a state of being in the present that builds on the past and is aimed at the future.
The study employed a fully mixed concurrent equal status design to study the broader impacts of ART on PLHIV. Using both quantitative and qualitative methods allowed for a comprehensive exploration of the concept of well-being in which both the objective circumstances of people’s lives as well as their subjective evaluations of these were incorporated. This resulted in a broad understanding of the well-being of PLHIV while simultaneously providing a more detailed and descriptive understanding of their experiences.
This study showed that PLHIV on ART were found to have lower socio-economic levels than their HIV negative counterparts. In essence, this means that while ART may have circumvented some of the negative impacts of HIV, it has not (yet) done so entirely. The results of this study are positive with regards to the potential mitigating impact that ART can have. It concludes that the combination of the strength of household safety nets and the timing of the initiation of ART play a significant role in determining what impact ART can have.
D.Litt. et Phil. (Sociology)