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Time-space constraints to HIV treatment engagement among women who use heroin in Dar es Salaam, Tanzania: A time geography perspective

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  • Saleem, Haneefa T.
  • Likindikoki, Samuel
  • Silberg, Claire
  • Mbwambo, Jessie
  • Latkin, Carl

Abstract

Timely initiation and sustained adherence to antiretroviral therapy (ART) are essential to improving the health outcomes of people living with HIV and preventing onward HIV transmission. However, women who use heroin often face challenges to initiating and adhering to ART. In this paper we identify spatial, temporal, and social factors that affect HIV treatment engagement among women who use heroin, drawing from a time geography framework. We conducted in-depth interviews with 30 heroin-using women living with HIV in Dar es Salaam, Tanzania between January and March 2019. We found that unstable housing, high mobility, HIV-related stigma, and unpredictable daily paths due to heroin use and involvement in sex work spatially and temporally constrained women who use heroin from incorporating HIV treatment behaviors into daily routines. Some women, however, were able to overcome these time-space constraints to HIV treatment engagement through social support and social role performance. Time geography, including concepts of time-space constraints and daily paths, is a useful framework for identifying barriers to ART engagement. Structural, relational, and individual interventions aimed at eliminating time-space constraints hold the potential to improve HIV treatment engagement among particularly vulnerable and mobile populations.

Suggested Citation

  • Saleem, Haneefa T. & Likindikoki, Samuel & Silberg, Claire & Mbwambo, Jessie & Latkin, Carl, 2021. "Time-space constraints to HIV treatment engagement among women who use heroin in Dar es Salaam, Tanzania: A time geography perspective," Social Science & Medicine, Elsevier, vol. 268(C).
    • Handle: RePEc:eee:socmed:v:268:y:2021:i:c:s0277953620305980
    DOI: 10.1016/j.socscimed.2020.113379
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    References listed on IDEAS

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    1. Aidala, A.A. & Wilson, M.G. & Shubert, V. & Gogolishvili, D. & Globerman, J. & Rueda, S. & Bozack, A.K. & Caban, M. & Rourke, S.B., 2016. "Housing status, medical care, and health outcomes among people living with HIV/AIDS: A systematic review," American Journal of Public Health, American Public Health Association, vol. 106(1), pages 1-23.
    2. Davey, Calum & Cowan, Frances & Hargreaves, James, 2018. "The effect of mobility on HIV-related healthcare access and use for female sex workers: A systematic review," Social Science & Medicine, Elsevier, vol. 211(C), pages 261-273.
    3. Gesler, Wilbert M., 1992. "Therapeutic landscapes: Medical issues in light of the new cultural geography," Social Science & Medicine, Elsevier, vol. 34(7), pages 735-746, April.
    4. Takahashi, Lois M. & Wiebe, Douglas & Rodriguez, Rigoberto, 2001. "Navigating the time-space context of HIV and AIDS: : daily routines and access to care," Social Science & Medicine, Elsevier, vol. 53(7), pages 845-863, October.
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