TY - JOUR
T1 - Time-space constraints to HIV treatment engagement among women who use heroin in Dar es Salaam, Tanzania
T2 - A time geography perspective
AU - Saleem, Haneefa T.
AU - Likindikoki, Samuel
AU - Silberg, Claire
AU - Mbwambo, Jessie
AU - Latkin, Carl
N1 - Funding Information:
We obtained informed oral consent from all participants. To protect confidentiality, we use pseudonyms when presenting findings. Ethical approval was granted by the ethical review bodies at the Muhimbili University of Health and Allied Sciences, the National Institute for Medical Research in Tanzania, and the Johns Hopkins Bloomberg School of Public Health.Ethical approval was granted by Institutional Review Boards at the Muhimbili University of Health and Allied Sciences and the Johns Hopkins Bloomberg School of Public Health, as well as the National Research Ethics Committee at the Tanzania National Institute for Medical Research.This research was funded by a 2017 developmental grant from the Johns Hopkins University Center for AIDS Research, an NIH funded program (1P30AI094189), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIA, NIGMS, NIDDK, NIMHD. The preparation of this article was partly funded by a career development grant through NIDA (1K01DA047142-01A1). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Funding Information:
This research was funded by a 2017 developmental grant from the Johns Hopkins University Center for AIDS Research , an NIH funded program (1P30AI094189), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID , NCI , NICHD , NHLBI , NIDA , NIA , NIGMS , NIDDK , NIMHD . The preparation of this article was partly funded by a career development grant through NIDA (1K01DA047142-01A1). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Publisher Copyright:
© 2020 Elsevier Ltd
PY - 2021/1
Y1 - 2021/1
N2 - Timely initiation and sustained adherence to antiretroviral therapy (ART) are essential to improving the health outcomes of people living with HIV and preventing onward HIV transmission. However, women who use heroin often face challenges to initiating and adhering to ART. In this paper we identify spatial, temporal, and social factors that affect HIV treatment engagement among women who use heroin, drawing from a time geography framework. We conducted in-depth interviews with 30 heroin-using women living with HIV in Dar es Salaam, Tanzania between January and March 2019. We found that unstable housing, high mobility, HIV-related stigma, and unpredictable daily paths due to heroin use and involvement in sex work spatially and temporally constrained women who use heroin from incorporating HIV treatment behaviors into daily routines. Some women, however, were able to overcome these time-space constraints to HIV treatment engagement through social support and social role performance. Time geography, including concepts of time-space constraints and daily paths, is a useful framework for identifying barriers to ART engagement. Structural, relational, and individual interventions aimed at eliminating time-space constraints hold the potential to improve HIV treatment engagement among particularly vulnerable and mobile populations.
AB - Timely initiation and sustained adherence to antiretroviral therapy (ART) are essential to improving the health outcomes of people living with HIV and preventing onward HIV transmission. However, women who use heroin often face challenges to initiating and adhering to ART. In this paper we identify spatial, temporal, and social factors that affect HIV treatment engagement among women who use heroin, drawing from a time geography framework. We conducted in-depth interviews with 30 heroin-using women living with HIV in Dar es Salaam, Tanzania between January and March 2019. We found that unstable housing, high mobility, HIV-related stigma, and unpredictable daily paths due to heroin use and involvement in sex work spatially and temporally constrained women who use heroin from incorporating HIV treatment behaviors into daily routines. Some women, however, were able to overcome these time-space constraints to HIV treatment engagement through social support and social role performance. Time geography, including concepts of time-space constraints and daily paths, is a useful framework for identifying barriers to ART engagement. Structural, relational, and individual interventions aimed at eliminating time-space constraints hold the potential to improve HIV treatment engagement among particularly vulnerable and mobile populations.
KW - Adherence
KW - Gender
KW - HIV
KW - Heroin
KW - People who use drugs
KW - Tanzania
KW - Time geography
KW - Women
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U2 - 10.1016/j.socscimed.2020.113379
DO - 10.1016/j.socscimed.2020.113379
M3 - Article
C2 - 32979773
AN - SCOPUS:85091232622
SN - 0277-9536
VL - 268
JO - Ethics in Science and Medicine
JF - Ethics in Science and Medicine
M1 - 113379
ER -