'Lost to follow up': rethinking delayed and interrupted HIV treatment among married Swazi women
'Lost to follow up': rethinking delayed and interrupted HIV treatment among married Swazi women
复制标题
DOI：
10.1093/heapol/czw117
复制
发表时间：
2017-03-01
影响因子：
3.2
通讯作者：
Moyer, Eileen
中科院分区：
文献类型：
--
作者：
Dlamini-Simelane, Thandeka T. T.;Moyer, Eileen
通过各种运动和战略，在艾滋病毒高流行率国家，有更多妇女接受艾滋病毒检测。尽管在斯威士兰等撒哈拉以南非洲国家的政府诊所可以随时获得治疗，但妇女一直报告难以获得治疗。从斯威士兰所谓的泄漏级联的一个更大的研究中选择两个单独的案例研究，我们说明了漫长的旅程已婚妇女进行启动治疗。我们展示了妇女如何机动战术诊断后，突出的因素，影响他们的决定有关启动治疗，并详细参与决策过程中的演员。我们的研究表明，阻碍获得服务的结构性因素持续存在，包括经济制约因素、性别不平等和重男轻女的社会规范。被称为“失访”的患者在许多情况下积极寻求治疗的背景下，包括生物医学卫生系统，但也远远超出了它。我们认为，“失访”一词掩盖了复杂的社会导航所需的妇女发起和保持获得治疗。此外，我们建议，通过考虑延迟治疗倡议的结构和社会方面，可以更好地解决监测和跟踪艾滋病毒感染者的许多后勤挑战。
Through various campaigns and strategies, more women are being tested for HIV in countries with a high prevalence of the virus. Despite the ready availability of treatment at government clinics in sub-Saharan African countries like Swaziland, women consistently report difficulty in maintaining access to treatment. Drawing on two individual case studies selected from a larger study of the so-called leaky cascade in Swaziland, we illustrate the protracted journeys married women undertake to initiate treatment. We demonstrate how women manoeuvre tactically after diagnosis, highlight factors that influence their decisions related to initiating treatment, and detail the actors involved in the decision-making process. Our research shows the persistence of structural factors that inhibit access, including economic constraints, gender inequality and patriarchal social norms. Patients referred as 'lost to follow up' are in many cases actively pursuing treatment within a context that includes the biomedical health system, but also extends well beyond it. We argue that the phrase 'lost to follow up' conceals the complex social navigation required by women to initiate and maintain access to treatment. Further, we suggest that many of the logistical challenges of monitoring and tracking people with HIV can be better addressed by taking into account the structural and social aspects of delayed treatment initiative.