HIV prevalence and inequalities

Coercions, exclusions, voluntary participation and inclusion 

MARPs in Uganda a local NGO, embarked on synthesizing reports from all its activities and uses standard knowledge development methods. Under the program “structural barriers to ART adherence in the Global South,” one of the the themes is the 40 year paradox of HIV Prevention moving hand in hand with inequalities across places. Scholars point out the role of social, political, economical and cultural status in affecting planned HIV Prevention and in turn optimal ARV adherence. Some social factors include: stigma, food purchases, subsistence, rent, transport expenditures, registration, user fees at health facilities, managing opportunistic infections and lost wages due to long waiting times. In some cases, long waiting hours could be clinical in nature. Adverse side effects and poor adherence practices, may lead to drug resistance and need to switch from first line ART which is cheaper to second line ART which is 10-15 times more expensive and undermines ART adherence in many global South countries. For progress work to be effective, it has to follow the UNAIDS 2020 Goal. But, this may not be possible because of the harshness of poverty.  An HIV burden cartogram of national territories distorted by the HIV Prevalence figures can provide an insight into these inequalities.  Extreme poverty is linked to poor or no access to ARVs in many places. Spatial variability and place-dependence of processes across multiple intersecting spatial scales, brings into focus the nature-society relationships. Place-specific political struggles redefine the life of an HIV+ve person to control life, preserving resources at a local or anecdotal level. Indigenous cultural, historical and geographical  prevention practices are exemplified in livelihoods, civil society and rights, systems of gender, race/ethnicity and one’s HIV status. Two forms of structures arise. There are those that are  considered universal, legitimized as standard but in being “noble” they disempower and devalue those living with HIV. This construction of powerful knowledge has contributed to a harsh and marginalized life experienced by those living with HIV depicting them as ones who ceased to lead productive lives. This in turn sets in place a reluctance to invest in life preserving entities targeting those living with HIV. The much needed services at  local grass-root levels include: regular counseling and guidance opportunities, post-test clubs where those living with HIV can meet to share experiences, transport means, land use, nutrition support and training community health care peers in proxy skills (nature-society relationships). These are the HIV-related inequalities which if unmet drive happiness or satisfaction down. There is a relationship between satisfaction and adherence.