Understanding the Seriousness of ‘Self’ Identity and Changing Process of HIV among Zambian School Teachers Living with Antiretroviral Therapy (ART)

Abstract

Identity is often told through socially positioned narratives that take a biographical approach. Biomedical studies, though, tend to portray the ‘self’ of people with chronic illnesses from the physiological and clinical perspectives of effective diagnosis, treatment and care. Such perspectives may not provide adequate models for people with chronic illnesses to theorize, perform and live selfhood. The aim of this paper is to explore ways through which HIV positive teachers position themselves in their representations of life on ART, and important framings of identity that emerge. Semi-structured interviews with 41 HIV positive teachers (20 women and 21 men) in Zambia aged between 25–55 were conducted in an attempt to explore narrated sense of ‘self’ for individuals with HIV and on antiretroviral therapy (ART). A thematic analytical approach on different issues was employed. The ART practices around HIV were associated with, for instance, positionings within a supportive biomedical citizen-state contract around HIV treatment, in relation to de/professionalisation, in relation to ‘accepting’ or resisting lifelong medication. Positionality of the self -identity of living with this treatable though not curable virus, showed some high level of convoluted sense of being and representations of everyday lives on ART. The overall argument here is that identity issues among HIV positive teachers in Zambia appear to be influenced by the importance of community-based health care, by past experiences and present events, and by ongoing uncertainties about their desired futures. Further, the results show that ART is transforming and not removing HIV stigma related issues. Fragmentation and entanglements of identity under contemporary biomedicine and biopolitics seem to shape how HIV citizens live and self-identify. The research uncovers the need for enhanced social support and community-based health care systems in Zambia which will change attitudes and improve self-esteem for people living with HIV, such as the participants of this study.