Social capital and resilience among people living on antiretroviral therapy in resource-poor Uganda

BackgroundDespite the national roll-out of free HIV medicines in Uganda and other sub-Saharan African countries, many HIV positive patients on antiretroviral therapy (ART) are at risk of non-adherence due to poverty and other structural and health system related constraints. However, several patients exhibit resilience by attaining and sustaining high levels of adherence amid adversity. Social capital, defined as resources embedded within social networks, is key in facilitating resilience but the mechanism through which it operates remains understudied. This article provides insights into mechanisms through which social capital enables patients on ART in a resource-poor setting to overcome risk and sustain adherence to treatment.MethodologyThe article draws from an ethnographic study of 50 adult male and female HIV patients enrolled at two treatment sites in Uganda, 15 of whom were followed-up for an extended period of six months for narrative interviews and observation. The patients were selected purposively on the basis of socio-demographic and treatment related criteria.FindingsSocial capital protects patients on ART against the risk of non-adherence in three ways. 1) It facilitates access to scarce resources; 2) encourages HIV patients to continue on treatment; and 3) averts risk for non-adherence.ConclusionsSocial capital is a key resource that can be harnessed to promote resilience among HIV patients in a resource-limited setting amid individual, structural and health system related barriers to ART adherence. Invigoration and maintenance of collectivist norms may however be necessary if its protective benefits are to be fully realized.

研究背景：尽管乌干达及其他撒哈拉以南非洲国家已在全国范围内推广免费HIV药物，但许多接受抗反转录病毒治疗（antiretroviral therapy，简称ART）的HIV感染者仍因贫困、结构性因素及卫生系统相关限制因素面临治疗不依从的风险。不过，部分患者在逆境中仍能达到并维持高水平的治疗依从性，展现出治疗复原力。社会资本（social capital）定义为嵌入于社会网络中的资源，是促进复原力的关键因素，但其发挥作用的机制仍有待深入研究。本文旨在探讨资源匮乏环境下，社会资本如何帮助接受ART治疗的患者规避风险并维持治疗依从性的相关机制。
研究方法：本文基于一项民族志研究（ethnographic study），研究对象为乌干达两家诊疗点入组的50名成年HIV感染者（含男性与女性），其中15名患者接受了为期6个月的长期随访，开展叙事访谈与观察。研究对象依据社会人口学特征及治疗相关标准进行目的性选取。
研究结果：社会资本可通过三种途径降低接受ART治疗患者的治疗不依从风险：其一，促进稀缺资源的获取；其二，鼓励HIV感染者坚持治疗；其三，规避治疗不依从风险。
研究结论：在资源匮乏环境中，面对个体层面、结构性因素及卫生系统相关的ART治疗依从性障碍，社会资本是可被加以利用以提升HIV感染者治疗复原力的关键资源。但若要充分发挥其保护效用，则需强化并维系集体主义规范。