Teaching within the context of ‘therapeutic citizenship’: a study on HIV governmentality among Zambian teachers living with ART.

Abstract

The concerns of HIV medicalization should not just be ‘normalised’ by clinical approaches. Therefore, the aim of this paper is to examine the extent to which HIV governmentality as mediated through a ‘therapeutic citizenship’ status, among school teachers, especially those on antiretroviral treatment (ART), have an effect on their everyday and development in Zambia. Semi-structured interviews with 41 (20 females and 21 males) purposively sampled HIV positive teachers in Zambia aged between 25 – 55 were conducted in western and southern provinces. Transcripts were processed using NVivo Pro 12®, following an inductive thematic analytic methodology. Results indicate that though a treatable illness, HIV has both latent and visible varying effects based on locality, language, gender, age, career, health care provisions, policy and social strata. Findings show that HIV has strong effect on individual identity and collective affect through past experiences, present events and medico-social uncertainties; stigma is still high and a big problem hindering disclosure; treatment access and adaptation are hard for some people; anxieties and mental health issues/stigma are high but unattended as they are outside set diagnostic medical categories; knowledge and information is averagely low. The results further point to medical success which places the disease somewhere between a disappearing tragedy – with some continuing effects of that history – and a chronic treatable pandemic with ongoing political as well as socio-economic consequences. This paper reveals that while issues around living with the HIV change – life on ART involves a governmentality process due to unending treatment practices that have human development implications. In the conclusion and final proposition, this paper shows that HIV can seem like a disappearing disease yet the challenges for ART are more medico-social and psychological than physiological. Since antiretroviral drugs increase life longevity, research focus and policy interventions should now shift from quantity (span) to quality of life on ART.