Paper short abstract:

This paper examines political, economic, and social synergies among chronic conditions that require attention by international stakeholders in research and healthcare delivery by an examining two case studies of women with Type 2 diabetes who are HIV-infected (Kenya) and HIV-affected (South Africa).

Paper long abstract:

There is growing suspicion among researchers and practitioners that Type 2 diabetes and HIV/AIDS are converging among low-income populations in Sub-Saharan Africa. This paper critically examines two narrative case studies drawn from anthropological research in urban Kenya and South Africa of women with diabetes who are HIV-infected and HIV-affected. The first narrative introduces Ester, a middle-aged woman with diabetes and HIV residing in Nairobi, Kenya, who faces complex medical and social problems. Ester describes how she has achieved compliance and control of her HIV via anti-retroviral treatment provided by the President's Emergency Plan for AIDS Relief (PEPFAR). Yet, because international aid does not target non-communicable diseases (NCDs), out-of-pocket payments for diabetes testing and medicines and high cost of healthy foods impede diabetes management. The second narrative introduces Sibongile, a middle-aged woman with diabetes residing in Soweto, South Africa, whose role as caretaker for her AIDS orphaned grandchildren poses economic and social challenges for diabetes care. Sibongile's narrative also introduces an emergent "chronic illness" stigma, imbuing sociomedical links between HIV/AIDS and diabetes. These narratives illustrate how international donor stipulations, such as funds dedicated exclusively for HIV/AIDS, and public messages about what it means to be sick in the context of high HIV prevalence can fail to meet medical and social needs of people with chronic illness. Thus, the political, economic, and social synergies among these chronic conditions require more attention by international stakeholders in healthcare delivery and research in order to cultivate effective interventions for a changing epidemiological landscape.