Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine , London, UK.
Research Department, Medecins Sans Frontieres , Nhlangano, Swaziland.
Med Anthropol. 2020 Nov-Dec;39(8):675-688. doi: 10.1080/01459740.2020.1720981. Epub 2020 Feb 20.
Treat-all recommends prompt treatment initiation for those diagnosed HIV positive, requiring adaptations to individuals' behavior and practice. Drawing on data from a longitudinal qualitative study in Eswatini, we examine the choice to initiate treatment when asymptomatic, the dissonance between the biomedical logic surrounding Treat-all and individuals' conceptions of treatment necessity, and the navigation over time of ongoing engagement with care. We reflect on the perspectives of healthcare workers, responsible for implementing Treat-all and holding a duty of care for their patients. We explore how the potentially differing needs and priorities of individuals and the public health agenda are navigated and reconciled. Rationalities regarding treatment-taking extend beyond the biomedical realm, requiring adjustments to sense of self and identity, and decision-making that is situated and socially embedded. Sense of choice and ownership for this process is important for individuals' engagement with treatment and care.
Treat-all 建议对诊断出 HIV 阳性的人立即开始治疗，这需要根据个人的行为和实际情况进行调整。本研究基于斯威士兰的一项纵向定性研究，我们探讨了无症状时开始治疗的选择、Treat-all 所依据的生物医学逻辑与个体对治疗必要性的理解之间的不和谐，以及随着时间的推移对持续护理的参与。我们还从负责实施 Treat-all 并对患者负有护理责任的医护人员的角度进行了反思。我们探讨了如何协调和平衡个人和公共卫生议程的潜在不同需求和优先事项。关于治疗的合理性不仅局限于生物医学领域，还需要调整自我意识和身份认同，以及做出基于具体情境和具有社会背景的决策。对于这一过程的选择权和自主权对于个人参与治疗和护理非常重要。
