Browsing by Author "Bukenya, Dominic"

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    Gender, land and responses to health and environmental shocks in rural South Western Uganda
    (Journal of Gender, Agriculture and Food Security, 2017) Rutakumwa, Rwamahe; Pain, Adam; Bukenya, Dominic; Tumwekwase, Grace; Ssembajja, Fatuma; Seeley, Janet
    We examine the gendered responses to shocks – including HIV-related illness and death, and environmental factors such as drought or too much rain – and how women in south western Uganda navigate structural barriers such as the gender constraints in land ownership, to cope with the impact of shocks. The study is based on data drawn from households selected from a General Population Cohort of 20,000 people in Kalungu District. As part of a larger study investigating the impact of HIV on agricultural livelihoods, 22 households were purposively sampled for a qualitative study. These households were stratified by sex of household head and by a death having occurred/not occurred of an HIV-positive individual in the household. Our findings show the gendered dimensions in household responses to crises are shaped by women and men’s position in the social structure in general and within their families and households. Women can make effective use of their social relations to obtain material support and information to improve their family’s livelihood.
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    “He was no longer listening to me”: A qualitative study in six Sub-Saharan African countries exploring next-of-kin perspectives on caring following the death of a relative from AIDS
    (AIDS Care, 2019) Ssekubugu, Robert; Renju, Jenny; Zaba, Basia; Seeley, Janet; Bukenya, Dominic; Ddaaki, William; Moshabela, Mosa; Wamoyi, Joyce; McLean, Estelle; Ondenge, Kenneth; Skovdal, Morten; Wringe, Alison
    In the era of widespread antiretroviral therapy, few studies have explored the perspectives of the relatives involved in caring for people living with HIV (PLHIV) during periods of ill-health leading up to their demise. In this analysis, we explore the process of care for PLHIV as their death approached, from their relatives’ perspective. We apply Tronto’s care ethics framework that distinguishes between care-receiving among PLHIV on the one hand, and caring about, caring for and care-giving by their relatives on the other. We draw on 44 in-depth interviews conducted with caregivers following the death of their relatives, in seven rural settings in Eastern and Southern Africa. Relatives suggested that prior to the onset of poor health, few of the deceased had disclosed their HIV status and fewer still were relying on anyone for help. This lack of disclosure meant that some caregivers spoke of enduring a long period of worry, and feelings of helplessness as they were unable to translate their concern and “caring about” into “caring for”. This transition often occurred when the deceased became in need of physical, emotional or financial care. The responsibility was often culturally prescribed, rarely questioned and usually fell to women. The move to “care-giving” was characterised by physical acts of providing care for their relative, which lasted until death. Tronto’s conceptualisation of caring relationships highlights how the burden of caring often intensifies as family members’ caring evolves from “caring about”, to “caring for”, and eventually to “giving care” to their relatives. This progression can lead to caregivers experiencing frustration, provoking tensions with their relatives and highlighting the need for interventions to support family members caring for PLHIV. Interventions should also encourage PLHIV to disclose their HIV status and seek early access to HIV care and treatment services.
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    Where are we now? A multicountry qualitative study to explore access to pre-antiretroviral care services: a precursor to antiretroviral therapy initiation
    (Sexually transmitted infections, 2017) Bukenya, Dominic; Wringe, Alison; Moshabela, Mosa; Skovdal, Morten; Ssekubugu, Robert; Paparini, Sara; Renju, Jenny; McLean, Estelle; Bonnington, Oliver; Wamoyi, Joyce; Seeley, Janet
    To explore barriers and facilitators to accessing postdiagnosis HIV care in five sub-Saharan African countries. Methods In-depth interviews were conducted with 77 people living with HIV (PLHIV) in pre-antiretroviral therapy care or not-yet-in care and 46 healthcare workers. Participants were purposely selected from health and demographic surveillance sites in Karonga (Malawi), Manicaland (Zimbabwe), uMkhanyakude (South Africa), Kisesa (Tanzania) and Rakai and Kyamulibwa (Uganda). Thematic content analysis was conducted, guided by the constructs of affordability, availability and acceptability of care.- Results Affordability: Transport and treatment costs were a barrier to HIV care, although some participants travelled to distant clinics to avoid being seen by people who knew them or for specific services. Broken equipment and drug stock-outs in local clinics could also necessitate travel to other facilities. Availability: Some facilities did not offer full HIV care, or only offered all services intermittently. PLHIV who frequently travelled complained that care was seldom available to them in places they visited. Acceptability: Severe pain or sickness was a key driver for accessing postdiagnosis care, whereas asymptomatic PLHIV often delayed care-seeking. A belief in witchcraft was a deterrent to accessing clinical care following diagnosis. Changing antiretroviral therapy guidelines generated uncertainty among PLHIV about when to start treatment and delayed postdiagnosis care. PLHIV reported that healthcare workers’ knowledge, attitudes and behaviours, and their ability to impart health education, also influenced whether they accessed HIV care. Conclusion Despite efforts to decentralise services over the past decade, many barriers to accessing HIV care persist. There is a need to increase sustained access to care for PLHIV not yet on treatment, with initiatives that encompass biomedical aspects of care alongside considerations for individual and collective challenges they faced. A failure to do so may undermine efforts to achieve universal access to antiretroviral therapy.