Centers

AIDS, Inequalities and the Gendered Spectrum of Care (Planning Grant)

Principal Investigators:  Jennifer S. Hirsch & Daniel Jordan Smith

Funded by the National Institute of Child Health and Human Development
Grant Number  1 R01 HD057792-01A2

Project Description

Objective:  The Love, Marriage and HIV Project Team has initiated an NIH-funded collaboration to develop a competitive proposal to conduct comparative ethnographic research on the experiences of individuals living with HIV in diverse international fieldsites, with a particular focus on Sub-Saharan Africa.  This project will examine the gendered social contexts that shape people’s engagement with AIDS-related care.

Background and Significance:   Unprecedented resources have been committed to AIDS treatment worldwide over the past decade, with profound benefits for individuals and families in terms of health, longevity, and economic productivity. The project under development would generate critical policy-relevant information about the obstacles to men’s and women’s participation in the spectrum of AIDS care—information that is essential to increase testing and treatment adherence.  A great deal is known about individual and clinical determinants of adherence, and a growing literature has begun to identify structural barriers to adherence that emphasizes the impact of social support and social capital.  In the proposed project, we plan to build on that important work by analyzing men’s and women’s social relations of obligation and care.  In other words, we will examine both the “support” men and women receive from others, and just as importantly, their ties of obligation to others, demonstrating how these relations of reciprocity can both motivate and deter care-seeking behavior.   By examining  these types of social relations in each fieldsite, by comparing how these relations might differ within each setting depending on economic position, marital status, and other contextual factors, and by contrasting the ways that these social relationships are organized across geographic settings, we will produce recommendations at the clinic, community, and wider social levels for programs and policies that take maximum advantage of the health promoting aspects of social relations, while mitigating the ways in which people’s social relations can serve as barriers to caring for themselves.

Methods:  Three country sites collectively representing the African regional context of the HIV epidemic have been preliminarily selected for study: Kwazulu Natal, South Africa, Ubakala, Nigeria, and Bulubandi, Uganda.  In each site, researchers plan to employ ethnographic methods to examine the social context that impacts engagement with the spectrum of AIDS-related care.  Ethnographic interviews and extended case studies will be conducted in combination with participant observation, which will allow researchers to learn not just what people say they do, but also to witness what they actually do in “real life” and to systematically observe the institutional and community contexts that shape people’s behaviors.  For each field site, ethnographic data will be analyzed to relate relationship- and macro-level factors to specific attitudes and behaviors. The ethnographic findings will also be pooled to conduct an analysis of key themes and findings across sites.

Implications:   An ethnographic approach will allow us to draw policy-relevant conclusions about the reasons individuals opt out of HIV-testing and AIDS-related treatment, drop out or adhere sporadically once they are enrolled in therapy, and frequently behave in ways that appear inimical to their own and others’ health.