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

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.