Accepted Paper:

Decentralised AIDS care in Mozambique: stigma as a detriment to patient retention in care  

Author:

Bent Steenberg Olsen (Roskilde University)

Paper short abstract:

How and why ordinary Mozambican HIV/AIDS patients are influenced by a shift in the modality of the governance of AIDS treatment through an aggravation of AIDS stigma in local communities.

Paper long abstract:

The dawn of Mozambique's AIDS treatment era came as late as 2002, at which point in time the provision of antiretroviral drugs (ARVs) through national sub-Saharan health sectors was thought of as largely unfeasible. Quasi-autonomous medical organisations thus pioneered in the field of AIDS treatment through so-called Day Hospitals caring solely for the HIV+. In 2008, however, shifts occurred in global health discourse and major international actors are now warm proponents of an on-going health care reform: a decentralisation of AIDS treatment services in which AIDS care is integrated within public health sectors, thus out-phasing medical NGOs previously charged with this task. A decentralisation of AIDS care services, it is assumed, will have several beneficial effects for AIDS patients, chiefly due to a closer proximity of these services to local communities. Contrariwise, however, new ethnographic data from extensive fieldwork following this process in Mozambican AIDS treatment facilities paradoxically suggest that these policies are in fact producing the exact opposite of their alleged beneficial effects due to an inadvertent aggravation of AIDS stigma through public exposure and increased visibility of the HIV+ in local communities. From the point of view of ordinary patients, present paper analyses the significance of an aggravation of AIDS stigma for three specific programme components. I argue that despite the intentions of policymakers, decentralisation and AIDS stigma result in increased transport costs for patients; in decreased patient retention in care; in unpredictable and uncertain patterns of patient uptake; and, consequently, in increased rates of treatment abandonment.

Panel P013
Governing AIDS through aid to civil society: power, responsibilization and resistance