"Knowing My Status" and the PMTCT Program: Preservation of Life Strategies Post HIV Diagnosis

Abstract

In this thesis, I focus on the health-seeking experiences of women diagnosed with HIV in a prevention of mother-to-child transmission (PMTCT) program in Lilongwe, Malawi. Based on ethnographic research, which included participant observation, in-depth interviews, and focus groups with women participating in the program, I explore women's motivations for HIV testing, capacity to engage in health interventions, and the meaning they give to life with HIV. While the PMTCT program is delivered at a local site, it is produced at a local-global intersection where local actors and international processes converge. I utilize critical approaches to medical anthropology to examine the global political and economic context of local life and the PMTCT program. The program is one where lives are at stake; where women learn of their HIV status, available medical interventions, and work to prolong their lives. Women engage in this program because nurses communicate messages of hope in the face of HIV. These messages are the new benefits of HIV in countries with growing opportunities for therapeutic intervention. This thesis contributes to an emerging health/social science literature that seeks to develop successful HIV interventions by focusing on patients ' experiences of HIV and HIV therapies newly available in Africa. Yet, as reported in this study, women experience barriers to the purported benefits because of the dominant health-delivery paradigm. Specifically, its verticality; human resources, counseling, and education limitations; and structural constraints that prevent women's full participation in the program. Successful PMTCT programs will need a more comprehensive approach to health and disease treatment, to provide more than just techno-medical solutions. Successful therapeutic interventions need to not only provide drugs, but also address other barriers to health maintenance.