Treatment through empowerment? : exploring the dynamics of ‘responsibility’ in antiretroviral therapy (ART) in two clinics in the Cape Winelands

Myburgh, Hanlie (2013-03)

Thesis (MA)--Stellenbosch University, 2013.

Thesis

ENGLISH ABSTRACT: This study investigates how the new technology of treatment, i.e. antiretroviral therapy (ART), is incorporated into public health care institutions. The success of this technology ideally relies on the notion of the ‘responsibilised’ patient as one who, simply put, consistently maintains the level of ARV-adherence necessary to suppress the viral load and to avoid drug resistance. The stringent management and continual monitoring of treatment adherence necessary to achieve these outcomes lie beyond the direct control of the health care institution. Given that the institution sees its patients irregularly, a patient’s divergence from treatment guidelines is established only after the fact. The institution takes on a supporting role while it is the patient who, on a day-to-day, dose-by-dose basis manages and monitors themselves, making ART a seemingly individual endeavour and responsibility. This shift in responsibility is compatible with the ‘new contract’ between provider and client, necessitated by ART. Even so, the institution attempts to manipulate the day-to-day behaviours of the patient to conform to those required in order to achieve treatment outcomes. This thesis examines how these different aspects of ART play out within two clinics in the Cape Winelands, and more specifically, the institutional intricacies of managing a disease which requires treatment that is not directly observed.

AFRIKAANSE OPSOMMING: Die studie ondersoek hoe die nuwe tegnologie van behandeling, antiretrovirale behandeling (ARB), in publieke gesondheidsorgklinieke geïntegreer word. Die sukses van hierdie tegnologie hang af van die nosie van die ‘verantwoordelike’ pasiënt wat, eenvoudig gestel, die nodige vlak ARV-gebruik handhaaf om die virale lading te onderdruk en weerstand te voorkom. Die streng kontrole oor die toewyding tot behandeling wat nodig is om hierdie uitkomstes te bereik, lê buite die direkte beheer van die gesondheidsorgkliniek. Aangesien die kliniek sy pasiënte slegs periodiek sien, word ʼn pasiënt se afwyking van behandelingsriglyne eers later gemeet. In hierdie opsig neem die kliniek 'n ondersteunende rol in, terwyl dit die pasiënte is wat op 'n daaglikse, dosis-tot-dosis basis hulself moet handhaaf en monitor. Dit maak ARB 'n oënskynlike individuele onderneming en verantwoordelikheid. Hierdie skuif in verantwoordelikheid is in lyn met die nuwe kontrak tussen die gesondheidsorgdiens en die kliënt, wat deur ARB genoodsaak word. In ieder geval probeer die institusie om die daaglikse gedrag van die pasiënt te manipuleer om te pas by die riglyne wat deur die uitkomstes genoodsaak word. Hierdie tesis ondersoek hoe hierdie verskillende aspekte van ARB binne twee klinieke in die Kaapse Wynland uitspeel, en meer spesifiek, die institusionele bestuur van 'n siekte waarvoor behandeling nie direk geobserveer kan word nie.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/79969
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