Therapeutic Borderlands: Austerity, Maternal HIV Treatment and the Elusive End of AIDS in Mozambique

Two Mozambican community activists on bikes heading to do home visits to people in the community living with HIV.
Mozambican community health activists do home visits
Chapman, Rachel R. 2020. "Therapeutic Borderlands: Austerity, Maternal HIV Treatment and the Elusive End of AIDS in Mozambique." In Medical Anthropology Quarterly. Forthcoming.

End of AIDS” requires ambitious testing, treatment, adherence benchmarks, like UNAIDS’ “90-90-90 by 2020”.  Mozambique’s efforts to improve essential maternal/infant antiretroviral treatment (ART) exposes how austerity-related health system short-falls impede public HIV/AIDS service-delivery and hinder effective maternal ART and adherence.  In therapeutic borderlands – the intersection where individual, household, community and health-system precarity overlap - HIV+ women, their kinfolk and over-worked care-providers circumnavigate stigma, disclosure risks, and austerity-related scarcity in ways that thwart effective service-delivery and undermine maternal ART uptake and retention.  Worrisome patterns of precarious use emerge - ART under-utilization, delayed initiation, intermittent adherence and low retention.  Ending HIV/AIDS requires ending austerity, and reinvesting in public health work forces to ensure universal health coverage as household and community safety-net.  In an austerity-free Mozambican health system, there would be more and better paid health workers in well-maintained facilities, space for families to seek healthcare together, and Mozambicans would call the shots.