The Islamification of antiretroviral therapy: Reconciling HIV treatment and religion in northern Nigeria

Abstract

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 guidelines 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 religious 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.

Testing for saturation in qualitative evidence syntheses: An update of HIV adherence in Africa

“…Updated findings . New studies offered further examples that confirmed the significance of competing priorities [ 38 , 39 , 41 , 61 , 67 , 71 , 72 , 80 , 89 ] and unpredictable life events [ 15 , 53 , 66 ]. Priorities include going to school and writing exams, seeking care for other chronic diseases such as diabetes of hypertension, and meeting religious obligations.…”

“…Updated findings . New studies enriched our understanding of cognitive dissonance and individual beliefs that influence engagement in care [ 10 , 14 , 18 , 32 , 38 , 41 , 42 , 46 , 51 , 59 , 64 , 68 , 77 , 80 , 81 , 86 , 91 ]. Although knowledge about HIV generally increases over time, social perceptions and individual beliefs seem to have a greater influence on how PLHIV engage in care.…”

Ineffective health control: concept analysis

“…Keeping the diagnosis secret is one of the factors that hinder adherence, because, for fear of being discovered, the patient stops following the treatment (visits to the doctor, taking medications, searching for medications, etc.) (28) .…”

“…For PLWHA, their needs go beyond treating the disease and involve an entire emotional and social context that permeates the difficulties in dealing daily with situations such as depressive symptoms, stigma, discrimination, a reframing of their life history, in addition to adverse effects related to the therapeutic regimen. From the analysis, it was possible to identify five critical attributes (4) : patient's refusal to follow the therapeutic plan (7,(9)(10)13,21,(23)(24)(25)27,(31)(32)34,37,(40)(41)(45)(46)49,51) ; abandonment of treatment leading to ineffective results and worsening of symptoms (8,11,14,(16)(17)22,26,(28)(29)(35)(36)(38)(39)42,44,46,(48)(49)(50) ; difficulty in reaching goals agreed between the person and the health professional (6,12,15,(18)(19)(20)37,…”

How is the United States’s international HIV prevention programme evolving?

“…Meanwhile, lifetime risk of HIV Diagnosis continues to rise in the United States: "If current HIV diagnoses rates persist, about 1 in 2 black men who have sex with men (MSM) and 1 in 4 Latino MSM in the United States will be diagnosed with HIV during their lifetime, according to a new analysis by researchers at the Centers for Disease Control and Prevention (CDC)". (Villarosa 2017) 6 It is clearly still problematic to steer away from the abstinence discourse in several African countries for religious reason (Tocco 2017). The anti-gay culture only creates further difficulties (Sieff 2016).…”