A qualitative exploration of the impact of HIV and ART on social disruption and household continuity in Uganda

With increased uptake of antiretroviral therapy (ART) throughout sub-Saharan Africa, it is critical to have a better understanding of the impact of ART on all health dimensions since the treatment can have the expected benefits as well as unintended negative consequences. We conducted semi-structured interviews with 24 adult HIV clients (19 women and 5 men) in Uganda who had been on ART for at least six months. A grounded approach and content analysis were used to explore the effects of having HIV and undergoing ART on household continuity, social engagement, experience of support and stigma, and children's school attendance. Most of the participants reported loss of a spouse/partner and household discontinuity (e.g. having to move in with extended family) because of HIV, and this was largely unchanged after being on ART. While experiences of HIV stigma and social disengagement were common after an HIV diagnosis, most participants reported improved social interaction after having commenced ART, which for some was tied to economic productivity. Many of the participants' children who had stopped going to school were able to return after the parent was on ART. HIV care and ART, with related improvements in clients' physical and work-related functioning, together with family support, helped to reverse some of the deleterious effects of having HIV. Nonetheless, support that augments healthcare is needed to help individuals provide for themselves and their families, both socially and economically.