IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v273y2021ics0277953621000915.html
   My bibliography  Save this article

Tobacco use and cessation in the context of ART adherence: Insights from a qualitative study in HIV clinics in Uganda

Author

Listed:
  • Thirlway, Frances
  • Nyamurungi, Kellen Namusisi
  • Matovu, Joseph K.B.
  • Miti, Andrew Kibuuka
  • Mdege, Noreen Dadirai

Abstract

Sub-Saharan Africa carries a disproportionate burden of human immunodeficiency virus (HIV). Tobacco use amongst people living with HIV is higher than in the general population even though it increases the risk of life-threatening opportunistic infections including tuberculosis (TB). Research on tobacco use and cessation amongst people living with HIV in Africa is sparse and it is not clear what interventions might achieve lasting cessation. We carried out qualitative interviews in Uganda in 2019 with 12 current and 13 former tobacco users (19 men and 6 women) receiving antiretroviral therapy (ART) in four contrasting locations. We also interviewed 13 HIV clinic staff. We found that tobacco use and cessation were tied into the wider moral framework of ART adherence, but that the therapeutic citizenship fashioned by ART regimes was experienced more as social control than empowerment. Patients were advised to stop using tobacco; those who did not concealed this from health workers, who associated both tobacco and alcohol use with ART adherence failure. Most of those who quit tobacco did so following the biographical disruption of serious TB rather than HIV diagnosis or ART treatment, but social support from family and friends was key to sustained cessation. We put forward a model of barriers and facilitators to smoking cessation and ART adherence based on engagement with either ‘reputation’ or ‘respectability’. Reputation involved pressure to enjoy tobacco with friends whereas family-oriented respectability demanded cessation, but those excluded by isolation or precarity escaped anxiety and depression by smoking and drinking with their peers.

Suggested Citation

  • Thirlway, Frances & Nyamurungi, Kellen Namusisi & Matovu, Joseph K.B. & Miti, Andrew Kibuuka & Mdege, Noreen Dadirai, 2021. "Tobacco use and cessation in the context of ART adherence: Insights from a qualitative study in HIV clinics in Uganda," Social Science & Medicine, Elsevier, vol. 273(C).
    • Handle: RePEc:eee:socmed:v:273:y:2021:i:c:s0277953621000915
    DOI: 10.1016/j.socscimed.2021.113759
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953621000915
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2021.113759?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Cole, Steven M. & Tembo, Gelson, 2011. "The effect of food insecurity on mental health: Panel evidence from rural Zambia," Social Science & Medicine, Elsevier, vol. 73(7), pages 1071-1079.
    2. Panter-Brick, Catherine & Eggerman, Mark, 2018. "The field of medical anthropology in Social Science & Medicine," Social Science & Medicine, Elsevier, vol. 196(C), pages 233-239.
    3. Fassin, Didier, 2013. "A case for critical ethnography," Social Science & Medicine, Elsevier, vol. 99(C), pages 119-126.
    4. Dancause, Kelsey Needham & Akol, Helen A. & Gray, Sandra J., 2010. "Beer is the cattle of women: Sorghum beer commercialization and dietary intake of agropastoral families in Karamoja, Uganda," Social Science & Medicine, Elsevier, vol. 70(8), pages 1123-1130, April.
    5. Tsai, Alexander C. & Bangsberg, David R. & Frongillo, Edward A. & Hunt, Peter W. & Muzoora, Conrad & Martin, Jeffrey N. & Weiser, Sheri D., 2012. "Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda," Social Science & Medicine, Elsevier, vol. 74(12), pages 2012-2019.
    6. Barbeau, E.M. & Krieger, N. & Soobader, M.-J., 2004. "Working Class Matters: Socioeconomic Disadvantage, Race/Ethnicity, Gender, and Smoking in NHIS 2000," American Journal of Public Health, American Public Health Association, vol. 94(2), pages 269-278.
    7. Russell, Steven & Seeley, Janet, 2010. "The transition to living with HIV as a chronic condition in rural Uganda: Working to create order and control when on antiretroviral therapy," Social Science & Medicine, Elsevier, vol. 70(3), pages 375-382, February.
    8. Ezzy, Douglas, 2000. "Illness narratives: time, hope and HIV," Social Science & Medicine, Elsevier, vol. 50(5), pages 605-617, March.
    9. Siu, Godfrey E. & Seeley, Janet & Wight, Daniel, 2013. "Dividuality, masculine respectability and reputation: How masculinity affects men's uptake of HIV treatment in rural eastern Uganda," Social Science & Medicine, Elsevier, vol. 89(C), pages 45-52.
    10. Steve Russell & Faith Martin & Flavia Zalwango & Stella Namukwaya & Ruth Nalugya & Richard Muhumuza & Joseph Katongole & Janet Seeley, 2016. "Finding Meaning: HIV Self-Management and Wellbeing among People Taking Antiretroviral Therapy in Uganda," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-16, January.
    11. Harling, Guy & Ehrlich, Rodney & Myer, Landon, 2008. "The social epidemiology of tuberculosis in South Africa: A multilevel analysis," Social Science & Medicine, Elsevier, vol. 66(2), pages 492-505, January.
    12. de Kok, B.C. & Widdicombe, S. & Pilnick, A. & Laurier, E., 2018. "Doing patient-centredness versus achieving public health targets: A critical review of interactional dilemmas in ART adherence support," Social Science & Medicine, Elsevier, vol. 205(C), pages 17-25.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Piperata, Barbara A. & Schmeer, Kammi K. & Rodrigues, Andres Herrera & Salazar Torres, Virgilio Mariano, 2016. "Food insecurity and maternal mental health in León, Nicaragua: Potential limitations on the moderating role of social support," Social Science & Medicine, Elsevier, vol. 171(C), pages 9-17.
    2. Ingrid Eshun-Wilson & Anke Rohwer & Lynn Hendricks & Sandy Oliver & Paul Garner, 2019. "Being HIV positive and staying on antiretroviral therapy in Africa: A qualitative systematic review and theoretical model," PLOS ONE, Public Library of Science, vol. 14(1), pages 1-30, January.
    3. Boateng, Godfred O. & Workman, Cassandra L. & Miller, Joshua D. & Onono, Maricianah & Neilands, Torsten B. & Young, Sera L., 2022. "The syndemic effects of food insecurity, water insecurity, and HIV on depressive symptomatology among Kenyan women," Social Science & Medicine, Elsevier, vol. 295(C).
    4. Thirlway, Frances, 2019. "Nicotine addiction as a moral problem: Barriers to e-cigarette use for smoking cessation in two working-class areas in Northern England," Social Science & Medicine, Elsevier, vol. 238(C), pages 1-1.
    5. Tsai, Alexander C. & Tomlinson, Mark & Comulada, W. Scott & Rotheram-Borus, Mary Jane, 2016. "Food insufficiency, depression, and the modifying role of social support: Evidence from a population-based, prospective cohort of pregnant women in peri-urban South Africa," Social Science & Medicine, Elsevier, vol. 151(C), pages 69-77.
    6. Trudell, John Paul & Burnet, Maddison L. & Ziegler, Bianca R. & Luginaah, Isaac, 2021. "The impact of food insecurity on mental health in Africa: A systematic review," Social Science & Medicine, Elsevier, vol. 278(C).
    7. Di Novi, Cinzia & Jacobs, Rowena & Migheli, Matteo, 2018. "Smoking Inequality across Genders and Socio-economic Classes. Evidence from Longitudinal Italian Data," Department of Economics and Statistics Cognetti de Martiis. Working Papers 201802, University of Turin.
    8. Masa, Rainier & Khan, Zoheb & Chowa, Gina, 2020. "Youth food insecurity in Ghana and South Africa: Prevalence, socioeconomic correlates, and moderation effect of gender," Children and Youth Services Review, Elsevier, vol. 116(C).
    9. Haynes, Emma & Walker, Roz & Mitchell, Alice G. & Katzenellenbogen, Judy & D'Antoine, Heather & Bessarab, Dawn, 2021. "Decolonizing Indigenous health: Generating a productive dialogue to eliminate Rheumatic Heart Disease in Australia," Social Science & Medicine, Elsevier, vol. 277(C).
    10. Randell, Heather & Jiang, Chengsheng & Liang, Xin-Zhong & Murtugudde, Raghu & Sapkota, Amir, 2021. "Food insecurity and compound environmental shocks in Nepal: Implications for a changing climate," World Development, Elsevier, vol. 145(C).
    11. Fujishiro, Kaori & Xu, Jun & Gong, Fang, 2010. "What does "occupation" represent as an indicator of socioeconomic status?: Exploring occupational prestige and health," Social Science & Medicine, Elsevier, vol. 71(12), pages 2100-2107, December.
    12. Lönnroth, Knut & Jaramillo, Ernesto & Williams, Brian G. & Dye, Christopher & Raviglione, Mario, 2009. "Drivers of tuberculosis epidemics: The role of risk factors and social determinants," Social Science & Medicine, Elsevier, vol. 68(12), pages 2240-2246, June.
    13. Cho, Yoonyoung & Molina, Teresa, 2024. "The Importance of Existing Social Protection Programs for Mental Health in Pandemic Times," IZA Discussion Papers 16737, Institute of Labor Economics (IZA).
    14. Rhodes, Tim & Bernays, Sarah & Terzic, Katarina Jankovic, 2009. "Medical promise and the recalibration of expectation: Hope and HIV treatment engagement in a transitional setting," Social Science & Medicine, Elsevier, vol. 68(6), pages 1050-1059, March.
    15. Weden, Margaret M & Astone, Nan M & Bishai, David, 2006. "Racial, ethnic, and gender differences in smoking cessation associated with employment and joblessness through young adulthood in the US," Social Science & Medicine, Elsevier, vol. 62(2), pages 303-316, January.
    16. Pierret, Janine, 2007. "An analysis over time (1990-2000) of the experiences of living with HIV," Social Science & Medicine, Elsevier, vol. 65(8), pages 1595-1605, October.
    17. Maryam Dilmaghani, 2022. "The link between smoking, drinking and wages: Health, workplace social capital or discrimination?," Industrial Relations Journal, Wiley Blackwell, vol. 53(2), pages 160-183, March.
    18. Jessica Ho & Irma Elo, 2013. "The Contribution of Smoking to Black-White Differences in U.S. Mortality," Demography, Springer;Population Association of America (PAA), vol. 50(2), pages 545-568, April.
    19. Hilda Dhlakama & Siaka Lougue & Henry Godwell Mwambi & Ropo Ebenezer Ogunsakin, 2022. "A Multilevel Analysis of the Associated and Determining Factors of TB among Adults in South Africa: Results from National Income Dynamics Surveys 2008 to 2017," IJERPH, MDPI, vol. 19(17), pages 1-17, August.
    20. Hadley, Craig & Stevenson, Edward Geoffrey Jedediah & Tadesse, Yemesrach & Belachew, Tefera, 2012. "Rapidly rising food prices and the experience of food insecurity in urban Ethiopia: Impacts on health and well-being," Social Science & Medicine, Elsevier, vol. 75(12), pages 2412-2419.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:273:y:2021:i:c:s0277953621000915. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.