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ARV Exceptionalism

ARV Exceptionalism. Living with ART: The First Generation Dr. Susan Reynolds Whyte. Policy exceptionalism. AIDS exceptionalism ( De Cock et al. 1998, 2002) >>special measures eg confidentiality and counseling

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ARV Exceptionalism

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  1. ARV Exceptionalism Living with ART: The First Generation Dr. Susan Reynolds Whyte

  2. Policy exceptionalism • AIDS exceptionalism (De Cock et al. 1998, 2002) >>special measures eg confidentiality and counseling • ARV exceptionalism>>vertical programming and supply, restricted access, adherence, control

  3. Popular exceptionalism • AIDS is a secret disease, but confiding about it is virtuous • ARVs are not like other meds, more valuable, not ordinary commodities for anyone • Not used presumptively for variety of problems • Keeping the precious objects at home

  4. Contrast with other meds • Easy access to most meds in shops • Lack of consistency in treatment for long-term illnesses (epilepsy, diabetes, cardiovascular conditions) • Contrast is experienced in daily life for clients of programmes that do not give meds for Ois • Some even get ARVs and septrin from different sources

  5. Formalization • These meds are like ‘ebigwasi’- sacred, bring blessings, singular • They are part of a (ritual) framework • These meds have rules

  6. Belonging and clientship • ARVs are embedded in programmes — unlike most other meds • Requirements of programmes vary (social trials) • The nature and extent of clientship differs • Buying meds >> individual consumers • Free programmes demand commitment • Large anonymous urban facilities vs personal rural ones; standard vs research

  7. Care and/or control • Drugs must be checked: weekly or monthly • Supplies given for limited periods which ties people to treatment source • Flexibility at discretion of health worker

  8. Initiation into ARVs • Trial by septrin: as way of checking adherence and getting used to taking drugs daily • Studying ARVs

  9. Treatment partners • Encouraged by most programmes, required by many • Formalization of relationships: an appointed HH member or relative • A name is written on a form

  10. In practice • Write pro forma name • De facto treatment supporters among family and neighbours • Routinization>>when does daily medication become a habit?

  11. Disclosure and meds • Openness: allows others to encourage • Secrecy: hide meds, take privately • Passing: take openly but don’t say why or what meds

  12. Concluding questions • What are specific social relations of ARVs: membership in programme; relation to doctor/clinical officer, counselor; relation to fellow HIV+; relations to family, etc ? • What are social relations through which other medicines (e.g. for OIs) are accessed? • What lessons can be learned for treatment of other conditions? • How exceptional should ARVs be and for how long?

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