Illness Experiences of People Living with HIV in Kenya: A Case Study of Kisumu County
Author: Owino, George Evans Odero, firstname.lastname@example.org
Department: Public Health Medicine
University: Universität Bielefeld, Germany
Supervisor: Dr. Reinhard Bornemann and Prof. Dr. Alexander Krämer
Year of completion: 2015
Language of dissertation: English
, reactions to diagnosis
, acceptance of status
, coping with HIV
Areas of Research:
More than thirty years after its onset, the HIV pandemic continues to be a huge public health problem. By the end of 2013, there were an estimated 35 million people living with HIV (PLHIV) globally; 70% of whom resided in sub-Saharan Africa with Kenya accounting for about 1.6 million. Despite highly active antiretroviral therapy (HAART) enhancing their life-expectancy, PLHIV still struggle with stigma, discrimination and livelihood insecurity. The purpose of this study was to describe how PLHIV in Kisumu County, Kenya made sense of their diagnosis and the coping strategies they adopted.
The study was guided by the symbolic interactionist and the illness trajectory theories, both embedded in the interpretative tradition. The hermeneutic phenomenological design guided data collection, coding and analysis. Data comprised of 49 in-depth interviews, (30 females and 19 males), eight (8) focus group discussions (FGDs) and six (6) key informant interviews. Data was digitally recorded, personally transcribed, and deductively and inductively coded and analysed using MAXQDA. Ethical approval was granted by Kenyatta University and Jaramogi Oginga Odinga Teaching and Referral Hospital ethical review committees.
PLHIV knew their status during personal illness, spouse’s death or illness, antenatal care, or public health campaigns. Most of them immediately accepted their status and adopted positive living, although nearly all expressed fear, shock, pain or sadness. Reconciliation was considered an integral part of adaptive coping to the diagnosis and was mediated by psychosocial support, quest for long life, perceived high HIV prevalence and children’s present and future well-being. Social relationships either remained stable, became problematic, improved or were restructured. The capacity to fulfill social obligations was either retained, regained, or diminished. The sense of self was perceived as being stable, disrupted, or restored. Coping strategies included reception of psychosocial support, practicing faith and religious beliefs, maintaining social engagement, adherence to medication and clinical appointments, livelihood enhancement, and adoption of safe sexual behaviours.
The participants were diagnosed HIV positive under a variety of circumstances, adopted diverse psychosocial reactions and devised pragmatic strategies to make sense of and cope with their status. However, their coping efforts were hampered by stigma, discrimination and livelihood insecurity. In sum, PLHIV are able to cope and adapt well to the disruptions, contradictions and difficulties of living with HIV. However, for such coping to be adaptable, PLHIV need the psychosocial, emotional and material support of their families, communities, health providers and government. It is recommended that the design and implementation of policy and programmatic interventions should involve all stakeholders, including PLHIV. Other recommendations include provision of HIV-related information and education to the communities, review of the health education curriculum and assurance of a sustainable access to appropriate health services including anti-retroviral therapy (ART).