Becoming Healthy Again: Reproductive Intentions and ARVs in Uganda

Project summary

Becoming healthy again: Reproductive Intentions among HIV positive women and men with increased access to anti-Retrovirals in Uganda. Reproductive decision-making is strongly influenced by cultural norms, such as the value of children in a particular society and the specific roles of men and women. In Africa, as elsewhere, the desire of men and women to have children is strong: to achieve social status, to have offspring to support you when you get old and to continue the lineage. Due to the antiretroviral treatment the HIV/AIDS related mortality and morbidity is expected to be reduced, and HIV positive individuals are expected to have prolonged life expectancy as well as improved quality of life and productivity. The study will explore how the embeddedness of social relationships and the constraints of culture curb the possible range of options concerning reproduction. Few studies have been carried out to explore reproductive intentions among HIV positive and very few have explored reproductive intentions among HIV positive receiving antiretroviral treatment in the south. Globalisation has made ARV treatment more accessible, but what effect does an increased access to ARV treatment have on the lives of HIV positive individuals? Inspired by recent theories of ‘therapeutic citizenship’ and HIV positive people’s reproductive intentions seen as a ‘counterpublic’ sphere or discourse, this ethnographic study proposes to examine HIV positive’s reproductive decision making in Uganda. As Uganda during the past 3 years has extended access to anti-retroviral treatment, the country offers an exceptional site for exploring this.

Outputs

With increased access to antiretroviral treatment, a growing number of HIV positives are able to live longer and healthier lives and to pursue motherhood aspirations. Medical staff at HIV/AIDS programmes is advising HIV positive women to aviod or postpone pregnancy until their CD4 count has reached an acceptable level and to discuss their pregnancy intentions with the staff.

In this thesis I examine the role of motherhood and belonging for HIV positive women. Based on a one-year anthropological fieldwork in and aorund the town Gulu in Northern Uganda, the analysis concentrates on respectability, moralities, therapeutic paths and life projects. The thesis takes as its starting point a description of a number of different HIV positive women, their reproductive aspirations and strategies and their striving to become a respectable women.

Through a description of the social relations in which women live, I have linked personal action, aspirations and longings for identity processes and forces of patronage and economy. I have situated (high) fertility within these relations and I argue that marriage and mothering are vital for living a good life, becoming the "right" person, enjoying happiness and generating respectability in Northern Uganda.

The thesis is an empirical contribution to a deeper understanding of HIV positive ARV receivers' health practices and experiences with marriage and motherhood. Theoretically, the thesis contributes to anthropological discussions of therapeutic