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Tobacco use and cessation in the context of ART adherence: Insights from a qualitative study in HIV clinics in Uganda

Author

Listed:
  • Thirlway, Frances
  • Nyamurungi, Kellen Namusisi
  • Matovu, Joseph K.B.
  • Miti, Andrew Kibuuka
  • Mdege, Noreen Dadirai

Abstract

Sub-Saharan Africa carries a disproportionate burden of human immunodeficiency virus (HIV). Tobacco use amongst people living with HIV is higher than in the general population even though it increases the risk of life-threatening opportunistic infections including tuberculosis (TB). Research on tobacco use and cessation amongst people living with HIV in Africa is sparse and it is not clear what interventions might achieve lasting cessation. We carried out qualitative interviews in Uganda in 2019 with 12 current and 13 former tobacco users (19 men and 6 women) receiving antiretroviral therapy (ART) in four contrasting locations. We also interviewed 13 HIV clinic staff. We found that tobacco use and cessation were tied into the wider moral framework of ART adherence, but that the therapeutic citizenship fashioned by ART regimes was experienced more as social control than empowerment. Patients were advised to stop using tobacco; those who did not concealed this from health workers, who associated both tobacco and alcohol use with ART adherence failure. Most of those who quit tobacco did so following the biographical disruption of serious TB rather than HIV diagnosis or ART treatment, but social support from family and friends was key to sustained cessation. We put forward a model of barriers and facilitators to smoking cessation and ART adherence based on engagement with either ‘reputation’ or ‘respectability’. Reputation involved pressure to enjoy tobacco with friends whereas family-oriented respectability demanded cessation, but those excluded by isolation or precarity escaped anxiety and depression by smoking and drinking with their peers.

Suggested Citation

  • Thirlway, Frances & Nyamurungi, Kellen Namusisi & Matovu, Joseph K.B. & Miti, Andrew Kibuuka & Mdege, Noreen Dadirai, 2021. "Tobacco use and cessation in the context of ART adherence: Insights from a qualitative study in HIV clinics in Uganda," Social Science & Medicine, Elsevier, vol. 273(C).
  • Handle: RePEc:eee:socmed:v:273:y:2021:i:c:s0277953621000915
    DOI: 10.1016/j.socscimed.2021.113759
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    References listed on IDEAS

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    1. Cole, Steven M. & Tembo, Gelson, 2011. "The effect of food insecurity on mental health: Panel evidence from rural Zambia," Social Science & Medicine, Elsevier, vol. 73(7), pages 1071-1079.
    2. Panter-Brick, Catherine & Eggerman, Mark, 2018. "The field of medical anthropology in Social Science & Medicine," Social Science & Medicine, Elsevier, vol. 196(C), pages 233-239.
    3. Fassin, Didier, 2013. "A case for critical ethnography," Social Science & Medicine, Elsevier, vol. 99(C), pages 119-126.
    4. Dancause, Kelsey Needham & Akol, Helen A. & Gray, Sandra J., 2010. "Beer is the cattle of women: Sorghum beer commercialization and dietary intake of agropastoral families in Karamoja, Uganda," Social Science & Medicine, Elsevier, vol. 70(8), pages 1123-1130, April.
    5. Tsai, Alexander C. & Bangsberg, David R. & Frongillo, Edward A. & Hunt, Peter W. & Muzoora, Conrad & Martin, Jeffrey N. & Weiser, Sheri D., 2012. "Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda," Social Science & Medicine, Elsevier, vol. 74(12), pages 2012-2019.
    6. Barbeau, E.M. & Krieger, N. & Soobader, M.-J., 2004. "Working Class Matters: Socioeconomic Disadvantage, Race/Ethnicity, Gender, and Smoking in NHIS 2000," American Journal of Public Health, American Public Health Association, vol. 94(2), pages 269-278.
    7. Russell, Steven & Seeley, Janet, 2010. "The transition to living with HIV as a chronic condition in rural Uganda: Working to create order and control when on antiretroviral therapy," Social Science & Medicine, Elsevier, vol. 70(3), pages 375-382, February.
    8. Ezzy, Douglas, 2000. "Illness narratives: time, hope and HIV," Social Science & Medicine, Elsevier, vol. 50(5), pages 605-617, March.
    9. Siu, Godfrey E. & Seeley, Janet & Wight, Daniel, 2013. "Dividuality, masculine respectability and reputation: How masculinity affects men's uptake of HIV treatment in rural eastern Uganda," Social Science & Medicine, Elsevier, vol. 89(C), pages 45-52.
    10. Steve Russell & Faith Martin & Flavia Zalwango & Stella Namukwaya & Ruth Nalugya & Richard Muhumuza & Joseph Katongole & Janet Seeley, 2016. "Finding Meaning: HIV Self-Management and Wellbeing among People Taking Antiretroviral Therapy in Uganda," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-16, January.
    11. Harling, Guy & Ehrlich, Rodney & Myer, Landon, 2008. "The social epidemiology of tuberculosis in South Africa: A multilevel analysis," Social Science & Medicine, Elsevier, vol. 66(2), pages 492-505, January.
    12. de Kok, B.C. & Widdicombe, S. & Pilnick, A. & Laurier, E., 2018. "Doing patient-centredness versus achieving public health targets: A critical review of interactional dilemmas in ART adherence support," Social Science & Medicine, Elsevier, vol. 205(C), pages 17-25.
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