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ARV Exceptionalism

Explore the unique social, ritualistic, and relational aspects of Antiretroviral Drugs (ARVs) treatment, contrasting them with other medications. Delve into the complexities of ARV exceptionalism and its impact on individuals and communities.

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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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