Medicalization of HIV and the African Response

Serah Gitome, Stella Njuguna, Zachary Kwena, Everlyne Ombati, Betty Njoroge, Elizabeth A. Bukusi


Since the discovery of HIV, the advent of anti-retrovirals in the late 80s heralded an era of medicalization of HIV and fostered major advancements in the management of the disease.  Africa, despite its high HIV burden, lagged behind in the adoption of these advancements due to major resource and logistical constraints. Innovative responses such as family-centered models of care, community systems strengthening, integration of HIV care with existing health services, and economic and mobile phonebased approaches have been critical in the successful roll-out of evidence-based HIV/AIDS treatment even in the most resourcelimited settings. (Afr J Reprod Health 2014; 18[3]: 25-33)  

Keywords: medicalization, HIV, Africa



Depuis la découverte du VIH, l'avènement des antirétroviraux à la fin des années 80 a marqué l'ère de la médicalisation du VIH et a favorisé des progres majeurs dans la gestion de la maladie.  En dépit de son lourd fardeau du VIH, l’Afrique traîne dans l'adoption de ces progrès en raison des contraintes importants de ressources et des logistiques. Des réponses innovantes telles que les modèles centrés sur les soins dans la famille, le renforcement des systèmes communautaires, l'intégration des soins du VIH dans les  services de santé existants, et les approches fondées sur l’économie et les téléphones portables ont joué un rôle crucial dans le succès de la mise à disposition de traitements du VIH fondés sur des preuves, même dans la plupart des pays à ressources limitées. (Afr J Reprod Health 2014; 18[3]: 25-33)


Mots-clés: Médicalisation, VIH, Afrique

Full Text:



Cacchioni T, Tiefer L. Why medicalization? Introduction to the special issue on the medicalization of sex.

Journal of sex research 2012;49(4):307-10

Conrad P. The shifting engines of medicalization. Journal of health and social behavior 2005;46(1):3-14

Conrad P. Medicalization and social control. Annual review of sociology 1992;18(209-232)

Beard R. Medicalization of aging. Encyclopedia of aging. 2002. 0254.html (accessed 26 March 2014).

Maturo A. Medicalization: current concept and future directions in a bionic society. Mens sana monographs 2012;10(1):122-33.

Ireland C. Scholars discuss medicalization of formerly normal characteristics. Harvard Gazette, 2009.

Wiley AS, Allen JS. Medical anthropology: A biocultural approach. New York: Oxford Uversity Press, 2009.

Dillon BE, Chama NB, Honig SC. Penile size and penile enlargement surgery: a review. International journal of impotence research 2008;20(6):519-29.

Sand MS, Fisher W, Rosen R, et al. Erectile dysfunction and constructs of masculinity and quality of life in the multinational Men's Attitudes to Life Events and Sexuality (MALES) study. The Journal of Sexual Medicine 2008;5(3):583-94

Tiefer L. Medicalizations and demedicalizations of sexuality therapies. Journal of Sex Research 2012;49(4):311-8.

Parens E. On good and bad forms of medicalization. Bioethics 2011;27(1):28-35.

Osborn JE. The AIDS epidemic: multidisciplinary trouble. The New England Journal of Medicine


Weiss RA. How does HIV cause AIDS? Science 1993;260(5112):1273-9

Gao F, Bailes E, Robertson DL, et al. Origin of HIV-1 in the chimpanzee Pan troglodytes troglodytes. Nature 1999;397(6718):436-41.

UNAIDS. Global Report 2012: UNAIDS Report on the Global AIDS Epidemic. 2012. http://books. google. er&dq=UNAIDS.+Global+Report+2012:+UNAIDS+ Report+on+the+Global+AIDS+Epidemic:+ebookpart nership.+com,+2013.&hl=en&sa=X&ei=_PHZU6P_ D6rH7Ab-noHIAQ&ved=0CB4Q6AEwAA#v= onepage&q&f=false Accessed 31 Jul 2014.

UNAIDS. Report on the HIV epidemic in Eastern and Southern Africa. 2013. http://www.unicef. org/esaro/ Getting-to-Zero-2013.pdf Accessed 31 Jul 2014.

UNICEF. UNICEF humanitarian action Eastern and Southern Africa in 2009. 2009. http://www.unicef. org /har09/files/har09_ESARO_regionalreport.pdf Accessed 23 Jul 2014.

Patton C. Bullets, balance, or both: medicalisation in HIV treatment. The Lancet 2007;369(9562):706-07

Giami A, Perrey C. Transformations in the medicalization of sex: HIV prevention between discipline and biopolitics. Journal of sex research 2012;49(4):35361.

NACC, NASCOP. Kenya AIDS epidemic update 2011.

Nairobi, 2012.

Kulzer JL, Penner JA, Marima R, et al. Family model of

HIV care and treatment: a retrospective study in Kenya. Journal of the International AIDS Society 2012;15(1):8.

Gourlay A, Birdthistle I, Mburu G, et al. Barriers and facilitating factors to the uptake of antiretroviral drugs for prevention of mother-to-child transmission of HIV in sub-Saharan Africa: a systematic review J Int AIDS Soc. 2013;16(1):185-8.

Muhamadi L, Nsabagasani X, Tumwesigye MN, et al. Inadequate pre-antiretroviral care, stock-out of antiretroviral drugs and stigma: Policy challenges/bottlenecks to the new WHO recommendations for earlier initiation of antiretroviral therapy (CD<350 cells/μL) in eastern Uganda. Health policy 2010;97(2):187-94.

Mills EJ, Nachega JB, Buchan I, et al. Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis. JAMA 2006;296:679-90

ITU. The world in 2013: ICT facts and figures. 2013 facts/ICTFactsFigures2013-e.pdf. Accessed 31 Jul 2014.

Lester RT, Ritvo P, Mills EJ, et al. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. The Lancet;376(9755):1838-45.

Pop-Eleches C TH, Habyarimana JP, Zivin JG et al. AIDS 2011;25. Mobile phone technologies improve adherence to antiretroviral treatment in a resourcelimited setting: a randomized controlled trial of text message reminders. Aids 2011;25:825-34.

Horvath T, Azman H, Kennedy GE, et al. "Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection.". Cochrane Database Syst Rev 2012;3

Odeny TA, Bailey RC, Bukusi EA, et al. Text messaging to improve attendance at post-operative clinic visits after adult male circumcision for HIV prevention: a randomized controlled trial. PloS one 2012;7(9): e43832.

Lemay NV, Sullivan T, Jumbe B, et al. Reaching Remote Health Workers in Malawi: Baseline Assessment of a Pilot mHealth Intervention. Journal of Health Communication 2012;17(sup1):105-17.

Karari C, Tittle R, Penner J, et al. Evaluating the Uptake, Acceptability, and Effectiveness of Uliza! Clinicians' HIV Hotline: A Telephone Consultation Service in Kenya. Telemedicine and e-Health. July/August 2011;17(6):420-26.

Yu D, Souteyrand Y, Banda MA, et al. Investment in HIV/AIDS programs: does it help strengthen health systems in developing countries? Globalization and Health 2008;4:8.

Ooms G, Van Damme W, Baker BK, et al. The 'diagonal' approach to Global Fund financing: a cure for the broader malaise of health systems? Globalization and Health 2008;4:6.

Odeny TA, Penner J, Lewis-Kulzer J, et al. Integration of HIV Care with Primary Health Care Services: Effect on Patient Satisfaction and Stigma in Rural Kenya. AIDS Research and Treatment 2013;2013:485715.

Howard A, El-Sadr W. Integration of tuberculosis and HIV services in sub-Saharan Africa: lessons learned. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2010;50 Suppl 3:S238-44

TGF. The Global Fund to fight AIDS, Tuberculosis and Malaria: Community systems strengthening framework, 2014.

Grossman D, Onono M, Newmann SJ, et al. Integration of family planning services into HIV care and treatment in Kenya: a cluster-randomized trial. Aids 2013;27 Suppl 1:S77-85.

Turan JM, Bukusi EA, Onono M, et al. HIV/AIDS stigma and refusal of HIV testing among pregnant women in rural Kenya: results from the MAMAS Study. AIDS and Behavior 2011;15(6):1111-20.

WHO. Partnership work: The health service–community interface for the prevention, care and treatment of HIV/AIDS. Report of a WHO consultation. In: Awe GA (ed). Geneva, Switzerland: WHO Library

Cataloguing-in-Publication Data. 2003.

Rachlis B, Sodhi S, Burciul B, et al. A taxonomy for community-based care programs focused on HIV/AIDS prevention, treatment, and care in resource-poor settings. Global health action 2013;6:1-21.

Lees S, Kielmann K, Cataldo F, et al. Understanding the linkages between informal and formal care for people living with HIV in sub-Saharan Africa. Global Public Health 2012;7(10):1109-19.

Mwai GW, Mburu G, Torpey K, et al. Role and outcomes of community health workers in HIV care in subSaharan Africa: a systematic review. Journal of the International AIDS Society 2013;16(1):18586.

Mburu G, Oxenham D, Hodgson I, et al. Community systems strengthening for HIV care: experiences from Uganda. Journal of Social Work in End-of-Life & Palliative Care 2013;9(4):343-68.

Fatti G, Meintjes G, Shea J, et al. Improved survival and antiretroviral treatment outcomes in adults receiving community-based adherence support: 5-year results from a multicentre cohort study in South Africa. JAIDS 2012;61(4):e50-8.

Wouters E, Van Damme W, van Rensburg D, et al. Impact of community-based support services on antiretroviral treatment programme delivery and outcomes in resource-limited countries: a synthetic review. BMC Health Services Research 2012;12:194.

Rich ML, Miller AC, Niyigena P, et al. Excellent clinical outcomes and high retention in care among adults in a community-based HIV treatment program in rural Rwanda. JAIDS 2012;59(3):e35-42.

Torpey KE, Kabaso ME, Mutale LN, et al. Adherence support workers: a way to address human resource constraints in antiretroviral treatment programs in the public health setting in Zambia. PloS One


Chang LW, Kagaayi J, Nakigozi G, et al. Effect of peer health workers on AIDS care in Rakai, Uganda: a cluster-randomized trial. PloS One 2010;5(6):e10923.

Zachariah R, Teck R, Buhendwa L, et al. Community support is associated with better antiretroviral treatment outcomes in a resource-limited rural district in Malawi. Transactions of the Royal Society of Tropical Medicine and Hygiene 2007;101(1):79-84.

Schneider H, Hlophe H, van Rensburg D. Community health workers and the response to HIV/AIDS in South Africa: tensions and prospects. Health Policy and Planning 2008;23(3):179-87.

Uwimana J, Zarowsky C, Hausler H, et al. Engagement of non-government organisations and community care workers in collaborative TB/HIV activities including prevention of mother to child transmission in South Africa: opportunities and challenges. BMC Health Services Research 2012;12:233.

Pinto AD, van Lettow M, Rachlis B, et al. Patient costs associated with accessing HIV/AIDS care in Malawi. Journal of the International AIDS Society 2013;16:18055.

Siedner MJ, Lankowski A, Tsai AC, et al. GPS-measured distance to clinic, but not self-reported transportation factors, are associated with missed HIV clinic visits in rural Uganda. AIDS 2013;27(9):1503-8.

Lim JL, Yih Y, Gichunge C, et al. The AMPATH Nutritional Information System: designing a food distribution electronic record system in rural Kenya. Journal of the American Medical Informatics Association : JAMIA 2009;16(6):882-8.

Nagata JM, Cohen CR, Young SL, et al. Descriptive Characteristics and Health Outcomes of the Food by Prescription Nutrition Supplementation Program for Adults Living with HIV in Nyanza Province, Kenya. PloS One 2014;9(3):e91403.

Biadgilign S, Reda AA, Digaffe T. Predictors of mortality among HIV infected patients taking antiretroviral treatment in Ethiopia: a retrospective cohort study. AIDS Research and Therapy 2012;9(1):15.

Anema A, Zhang W, Wu Y, et al. Availability of nutritional support services in HIV care and treatment sites in sub-Saharan African countries. Public Health Nutrition 2011;15(5):938.

Tang AM, Forrester J, Spiegelman D, et al. Weight loss and survival in HIV-positive patients in the era of highly active antiretroviral therapy. JAIDS 2002;31(2):230-6.

FHI360. Food and Nutrition Technical Assistance II Project (FANTA-2). Review of Kenya’s Food by Prescription Program. Washington, D.C: Academy for Educational Development, 2009.

Grobler L, Siegfried N, Visser ME, et al. Nutritional interventions for reducing morbidity and mortality in people with HIV. Cochrane Database Syst Rev 2013;2:CD004536.

Cantrell RA, Sinkala M, Megazinni K, et al. A pilot study of food supplementation to improve adherence to antiretroviral therapy among food-insecure adults in Lusaka, Zambia. JAIDS 2008;49(2):190-5.

Dworkin SL, Blankenship K. Microfinance and HIV/AIDS prevention: assessing its promise and limitations. AIDS Behav 2009;13(3):462-9.

Gibbs A, Willan S, Misselhorn A, et al. Combined structural interventions for gender equality and livelihood security: a critical review of the evidence

from southern and eastern Africa and the implications for young people. Journal of the International AIDS Society 2012;15 Suppl 1:1-10.

Pandit JA, Sirotin N, Tittle R, et al. Shamba Maisha: a pilot study assessing impacts of a micro-irrigation intervention on the health and economic wellbeing of HIV patients. BMC Public Health 2010;10:245.


  • There are currently no refbacks.