Identity, Governmentality, Chronicity and Development: A Study of Zambian Teachers Living With and Affected by HIV and ‘Therapeutic Citizenship’

This research examines the nature and processes of the ‘therapeutic citizenship’ status acquired by HIV positive schoolteachers who are on antiretroviral therapy (ART), and further ascertains this status’s implications for Zambia’s national development prospects. Teachers, who are a key group for those prospects, are disproportionately affected by ART. The theoretical frames of identity, chronicity and governmentality are explored and used as lenses through which the therapeutic citizenship of teachers living with HIV and ART can be understood and appropriated. Additionally, the concept of ubuntu, derived from African philosophies, is used to decipher values and virtues of human community. Semi-structured interviews with 41 HIV positive teachers in Zambia aged 25–55 were conducted. Transcripts were processed using NVivo Pro 12, and thematic analysis in different areas of interest of the thesis was employed. The findings show that reported experiences of being on ART are affected by demographic factors such as location, age and gender. About 70% of participants described their health from a physical point of view, thus excluding mental-health issues caused by the ongoing uncertainties of HIV citizenship. Over 50% of participants found living on ART socially disruptive and medically difficult. For instance, the unending treatment practices around HIV were associated with positionings within a supportive biomedical citizen-state contract around ART, in relation to (de)professionalisation, in relation to ‘accepting’ or resisting lifelong medication, and in relation to citizenship within ‘pharmaceutical colonialism’. However, living with ART also increased pride in what the teachers’ students were achieving, making their HIV less relevant and perhaps less stigmatising. I argue in this thesis that being HIV positive and on ART in Zambia can create a specific form of ‘therapeutic citizenship’. This form of citizenship appears to be shaped by the importance of improving relationships between patients and clinic personnel, by community-based health care, by past experiences and present events, and by ongoing uncertainties about the future. Therefore, HIV citizenship can have both positive and negative influences on national development for a low-income country such as Zambia.