Tobacco use in the context of ART adherence: insights from qualitative research in Uganda

We are now in the ‘treatment era’ for HIV, which means that patients on antiretroviral therapy (ART) have the same life expectancy as people who are not infected. However, receiving ART involves ‘therapeutic citizenship’ i.e. personal engagement that requires self-transformation (Nguyen 2007). PLWH in SSA also live with continuous uncertainty (Moyer & Hardon 2014) in relation to employment opportunities and food security, uncertainty which prevents them from leading a normal life (Russell & Seeley 2010).

I will present findings from a qualitative study in Uganda with current and former tobacco on ART and HIV clinic health workers. Health workers framed continuing use of tobacco as a failure to adhere to the ART regime, so PLWH concealed their tobacco use to protect their moral identity. It was the experience of TB rather than a HIV diagnosis which created the necessary ‘biographical disruption’ for tobacco abstinence. Tobacco was seen as providing strength for manual work but also distance from financial worries. Barriers to smoking cessation mapped onto barriers to ART adherence: economic precarity mediated depression, which mediated continued smoking.

Dr Frances Thirlway is a research fellow in the Department of Sociology at the University of York.