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Managing uncertainty around HIV/AIDS in an urban setting: Private medical providers and their patients in Pune, India

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  • Kielmann, Karina
  • Deshmukh, Deepali
  • Deshpande, Sucheta
  • Datye, Vinita
  • Porter, John
  • Rangan, Sheela

Abstract

Changing epidemiological patterns and the advent of new rapid diagnostic technologies and therapies have created considerable uncertainty for providers working in HIV. In India, the demand for HIV care is increasingly being met by private practitioners (PPs), yet little is known about how they deal with the challenges of managing HIV patients. To explore HIV management practices in the private medical sector, a survey was conducted with 215Â PPs in Pune, India, followed by in-depth interviews focusing on the social context of practice among a sub-set of 27Â PPs. Drawing primarily on interview data, this paper illustrates a number of uncertainties that underlie the reported actions of providers in a competitive medical market. PPs perceive HIV as a 'new' and challenging disease for which they lack adequate knowledge and skills. Combined with the perceived high cost and complexity of antiretroviral treatment, preconceptions about HIV patients' social, financial and mental capacity lead to highly individualistic management practices. While these fall short of clinical 'best practice' guidelines, they reflect adaptive responses to the wider uncertainties surrounding HIV care in urban India. By highlighting contextual issues in PPs' management of HIV patients, the paper suggests the need to explicitly acknowledge the social, moral and economic bases of uncertainty beyond the clinical setting.

Suggested Citation

  • Kielmann, Karina & Deshmukh, Deepali & Deshpande, Sucheta & Datye, Vinita & Porter, John & Rangan, Sheela, 2005. "Managing uncertainty around HIV/AIDS in an urban setting: Private medical providers and their patients in Pune, India," Social Science & Medicine, Elsevier, vol. 61(7), pages 1540-1550, October.
  • Handle: RePEc:eee:socmed:v:61:y:2005:i:7:p:1540-1550
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    1. Finn, Mark & Sarangi, Srikant, 2008. "Quality of life as a mode of governance: NGO talk of HIV 'positive' health in India," Social Science & Medicine, Elsevier, vol. 66(7), pages 1568-1578, April.
    2. Sheikh, Kabir & Porter, John, 2010. "Discursive gaps in the implementation of public health policy guidelines in India: The case of HIV testing," Social Science & Medicine, Elsevier, vol. 71(11), pages 2005-2013, December.
    3. George, Asha & Iyer, Aditi, 2013. "Unfree markets: Socially embedded informal health providers in northern Karnataka, India," Social Science & Medicine, Elsevier, vol. 96(C), pages 297-304.
    4. Cross, Jamie & MacGregor, Hayley Nan, 2010. "Knowledge, legitimacy and economic practice in informal markets for medicine: A critical review of research," Social Science & Medicine, Elsevier, vol. 71(9), pages 1593-1600, November.

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