Amsterdam 2015
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| Abstract #2169 - Poster 2 | ||||
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Session: 59.21: Poster 2 (Poster) on Tuesday in Chaired by Authors: Presenting Author: Ms Caroline Masquillier - University of Antwerp, Belgium |
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| Additional Authors: | ||||
| Aim: In the context of severe human resource shortages in HIV care, task-shifting and more particularly community mobilization is increasingly cited as a potential way to durably provide support to chronic HIV patients. However, the socio-ecological theory clearly stipulates that – in all social interventions – the interrelatedness and interdependency between individuals and their immediate social context in which they live should be taken into account. To date, however, community-based interventions to support chronic HIV patients have largely ignored the social context in which they are implemented. Research is thus required to investigate such community-based support within its contextual reality. As people living with HIV/AIDS (PLHWA) seldom live in isolation from their household, the aim of this study is to address this research gap by answering the following research question: how do household dynamics hamper or facilitate the impact of community based treatment adherence support programs on PLWHA? | ||||
| Method / Issue: During the participatory observations, 48 community based treatment adherence support sessions in patient’s houses were observed in a township on the outskirts of Cape Town, South Africa. Furthermore, 32 in-depth interviews were conducted, as well as 4 focus group discussions with 36 community health workers (CHWs). The field notes, the transcripts of the interviews and focus group discussions were analysed using Nvivo 10. | ||||
| Results / Comments: Despite the fact that the CHWs try to present themselves as not being openly associated with HIV/AIDS services, results show that the presence of a CHW is often seen as a marker of the disease. Besides the clear benefit of bringing care closer to the community, community-based adherence support thus also contains challenges for both the patient and the CHW. On the one hand, it challenges the patient’s hybrid identity management and his or her attempt to regulate the interference of the household in the disease management. On the other hand, it influences the manner in which the CHW can perform his or her job. Depending on the HIV/AIDS competence of the patient’s household, the patient and CHW might employ various strategies to conceal the actual purpose of the visits. Moreover, the degree of HIV/AIDS competence present in the household influences the advantages experienced by the patient and his or her household members. While it is easier to perform treatment adherence support visits in more HIV/AIDS competent households, this support might only offer limited added value for patients living in such a health-enabling social environment in comparison to patients living in a household which displays less characteristics of HIV/AIDS competence. In such a household context, the CHW cannot only play an important role in supporting the patients on treatment, but also in trying to involve the household in the disease management: when the patient – as a gatekeeper – allows, the CHW can guide the household on the road to HIV/AIDS competence. | ||||
| Discussion: Pre-existing social dynamics in the social environment of the patient, such as the HIV/AIDS competence of the household, should be taken into account when designing community based-treatment adherence programs, aiming to provide long-term quality care, treatment and support in a context of human resource shortages. | ||||
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