Antiretroviral Therapy in Walvis Bay, Namibia

Callaghan, M; (2015) Antiretroviral Therapy in Walvis Bay, Namibia. PhD thesis, University of Toronto.

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Highly Active Antiretroviral therapy (HAART) is a successful means of treating infection with the Human Immunodeficiency Virus (HIV). Namibia was among the first countries in sub-Saharan Africa to achieve universal access to HAART for HIV-positive citizens through the public sector. In this thesis, I explore treatment outcomes in Walvis Bay, a busy port city at Namibia’s coast. I find that gender is the most important factor shaping HAART, with women reporting for testing and treatment in greater numbers than men, sooner in the course of their illness, and enjoying lower mortality after treatment initiation. There are no compelling biological explanations for this distribution; I postulate a series of socio-cultural and political-ecological factors driving outcomes in Walvis Bay. In particular, changing gender roles and different points of entry into care are important at the individual level. I describe a ‘toxic masculinity’ that, however fragile, actively interferes with testing, treatment, and health-seeking behavior. Female identity, conversely, emerges as altogether more stable and more suited to the clinical and social demands of HAART. More broadly, actions are shaped by large-scale processes of urbanization and globalization, and especially the effects these have on labour, subsistence, and culture change. I conclude by suggesting modifications to the rollout program that may help to distribute the benefits of HAART more equitably through the treatment population. This research has important implications for other countries in sub-Saharan Africa as they gradually move toward universal access to HAART. More generally, it may presage future challenges of globalization and infectious disease.

Item Type: Thesis
Thesis Type: Doctoral
Thesis Name: PhD
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development


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