Adherence as therapeutic citizenship:: impact of the history of access to antiretroviral drugs on adherence to treatment
Adherence as therapeutic citizenship:: impact of the history of access to antiretroviral drugs on adherence to treatment
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DOI：
10.1097/01.aids.0000298100.48990.58
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发表时间：
2007-10-01
期刊：
影响因子：
3.8
通讯作者：
Tiendrebeogo, Issoufou
中科院分区：
文献类型：
--
作者：
Nguyen, Vinh-Kim;Ako, Cyriaque Yapo;Tiendrebeogo, Issoufou
非洲抗逆转录病毒药物的使用量急剧增加，因此更加注重坚持治疗，迄今为止，这种情况即使不比北方的情况好上级，也与之相当。人们对这种例外情况的原因知之甚少。在本文中，我们研究坚持在布基纳法索，科特迪瓦和马里获得治疗的历史和人种背景。生活在没有社会保障和最低限度的医疗保健的地方，被诊断为艾滋病毒感染者面临着疾病、死亡、排斥和绝望的威胁，不得不在相互冲突的义务、互惠和价值观网络中进行谈判。艾滋病毒和艾滋病方案重视解决社会和生物脆弱性的努力。相反，基于亲属关系的社会关系可能以其他方式重视个人。这些相互冲突的道德经济在艾滋病毒感染者的世界中往往相互交织。艾滋病毒感染状况可以用来要求公共或非政府组织方案提供资源。这可能会干扰社交网络，而社交网络是最稳定的物质和情感支持来源。自助和增强能力的技巧为艾滋病毒感染者提供了有效的工具，使他们成为有效的倡导者。因此，在使用抗逆转录病毒疗法的最初几年，获得治疗的机会受到教派做法和社会分类形式的影响。我们引入“治疗公民”一词来描述艾滋病毒感染者如何将适当的ART作为一套权利和责任来谈判这些有时相互冲突的道德经济。示范性的坚持应该通过治疗公民的透镜来看待。(c)2007年威科健康|利平科特·威廉姆斯和威尔金斯。
A dramatic increase in the use of antiretroviral drugs in Africa has increased focus on adherence to treatment, which has so far been equivalent if not superior to that in northern contexts. The reasons for this exceptional adherence are poorly understood. In this paper, we examine adherence in the historical and ethnographic context of access to treatment in Burkina Faso, Cote d'lvoire and Mali. Living where there is no social security and minimal, if any, medical care, individuals diagnosed with HIV are faced with the threat of illness, death, ostracism and destitution, and were obliged to negotiate conflicting networks of obligation, reciprocity, and value. HIV and AIDS programmes value efforts to address social, and indeed biological, vulnerability. In contrast, kinship-based social relationships may value individuals in other ways. These conflicting moral economies often intersect in the worlds of people living with HIV. HIV status can be used to claim resources from the public or non-governmental organization programmes. This may interfere with social networks that are the most stable source of material and emotional support. Self-help and empowerment techniques provided effective tools for people living with HIV to fashion themselves into effective advocates. In the early years of the use of antiretroviral therapy (ART), access to treatment was thus mediated by confessional practices and forms of social triage. We introduce the term 'therapeutic citizenship' to describe the way in which people living with HIV appropriate ART as a set of rights and responsibilities to negotiate these at times conflicting moral economies. Exemplary adherence should be viewed through the lens of therapeutic citizenship. (c) 2007 Wolters Kluwer Health | Lippincott Williams & Wilkins.