HIV Center for Clinical and Behavioral Studies, Columbia University and the New York State Psychiatric Institute, 1051 Riverside Drive, Unit 15, New York, NY 10032, United States.
Soc Sci Med. 2017 Oct;190:75-82. doi: 10.1016/j.socscimed.2017.08.017. Epub 2017 Aug 18.
Access and adherence to antiretroviral therapy (ART) are essential to HIV treatment success and epidemic control. This article is about how HIV-positive Muslims and providers balance ART with religious tenets and obligations. I conducted 17 months of multi-site ethnographic research between 2007 and 2010, including participant-observation in an urban HIV clinic in Kano, Nigeria and a support group for people living with HIV, as well as in-depth interviews with 30 HIV-positive men and 30 key informants with caregiving, clinical, or policy roles related to HIV/AIDS. Patients migrated from Islamic prophetic medicine to ART when it became more widely available in the mid-2000s through the U.S. PEPFAR program. At the same time, a conceptual shift occurred away from considering HIV immediately curable through spiritual and herbal-based Islamic prophetic medicine toward considering HIV as a chronic infection that requires adherence to daily pill regimens. Hope for a complete cure and encouragement from some Islamic prophetic healers resulted in some patients forgoing ART. Patients and providers adapted biomedical treatment guidelines to minimize disruption to religious practices also considered essential to Muslims' wellbeing, irrespective of HIV status. Providers discouraged patients on second-line ART from fasting because such patients had fewer treatment options and, often, poorer health. However, patients' medication adherence was affected by the desire to fulfill fasting obligations and to avoid questions from family and friends unaware of their HIV-positive status. This study is one of few ethnographic accounts of HIV treatment in a Muslim-majority society and contributes to understanding the significance of religion for HIV treatment in northern Nigeria. It has implications for public health programming and clinical approaches to HIV treatment in medically pluralistic Muslim societies.
获得并坚持接受抗逆转录病毒疗法（ART）是艾滋病毒治疗成功和控制疫情的关键。本文探讨了艾滋病毒阳性穆斯林和医护人员如何在 ART 与宗教教义和义务之间取得平衡。我于 2007 年至 2010 年期间进行了为期 17 个月的多地点人种学研究，包括在尼日利亚卡诺市的一家城市艾滋病毒诊所和一个艾滋病毒感染者支持小组进行参与式观察，以及对 30 名艾滋病毒阳性男性和 30 名具有与艾滋病毒/艾滋病相关的护理、临床或政策角色的关键知情人进行深入访谈。在 2000 年代中期，随着美国 PEPFAR 计划的开展，ART 变得更加广泛可用，患者开始从伊斯兰教先知医学转向接受 ART。与此同时，人们的观念发生了转变，不再认为通过基于精神和草药的伊斯兰教先知医学可以立即治愈艾滋病毒，而是认为艾滋病毒是一种需要坚持每日服用药物的慢性感染。一些伊斯兰教先知治疗师承诺可以完全治愈艾滋病毒，这给一些患者带来了希望，导致他们放弃了接受 ART。患者和医护人员对生物医学治疗指南进行了调整，以尽量减少对被视为穆斯林健康至关重要的宗教实践的干扰，而不论其艾滋病毒状况如何。医护人员劝阻正在接受二线 ART 的患者禁食，因为这些患者的治疗选择较少，而且往往健康状况较差。然而，患者的药物依从性受到遵守禁食义务的愿望和避免家庭和朋友询问他们艾滋病毒阳性状况的影响。本研究是少数关于在穆斯林占多数的社会中进行艾滋病毒治疗的人种学报告之一，有助于理解宗教对尼日利亚北部艾滋病毒治疗的重要性。它对公共卫生规划和在医学多元化的穆斯林社会中进行艾滋病毒治疗的临床方法具有启示意义。
