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

[摘要] ENGLISH ABSTRACT: This study investigates how the new technology of treatment, i.e. antiretroviral therapy (ART), isincorporated into public health care institutions. The success of this technology ideally relies on the notionof the 'responsibilised' patient as one who, simply put, consistently maintains the level of ARV-adherencenecessary to suppress the viral load and to avoid drug resistance. The stringent management and continualmonitoring of treatment adherence necessary to achieve these outcomes lie beyond the direct control ofthe health care institution. Given that the institution sees its patients irregularly, a patient's divergencefrom treatment guidelines is established only after the fact. The institution takes on a supporting role whileit is the patient who, on a day-to-day, dose-by-dose basis manages and monitors themselves, making ARTa 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 tomanipulate the day-to-day behaviours of the patient to conform to those required in order to achievetreatment outcomes. This thesis examines how these different aspects of ART play out within two clinicsin the Cape Winelands, and more specifically, the institutional intricacies of managing a disease whichrequires treatment that is not directly observed.

[发布机构] Stellenbosch University