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      Social capital and resilience among people living on antiretroviral therapy in resource-poor Uganda

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          Abstract

          Background

          Despite the national roll-out of free HIV medicines in Uganda and other sub-Saharan African countries, many HIV positive patients on antiretroviral therapy (ART) are at risk of non-adherence due to poverty and other structural and health system related constraints. However, several patients exhibit resilience by attaining and sustaining high levels of adherence amid adversity. Social capital, defined as resources embedded within social networks, is key in facilitating resilience but the mechanism through which it operates remains understudied. This article provides insights into mechanisms through which social capital enables patients on ART in a resource-poor setting to overcome risk and sustain adherence to treatment.

          Methodology

          The article draws from an ethnographic study of 50 adult male and female HIV patients enrolled at two treatment sites in Uganda, 15 of whom were followed-up for an extended period of six months for narrative interviews and observation. The patients were selected purposively on the basis of socio-demographic and treatment related criteria.

          Findings

          Social capital protects patients on ART against the risk of non-adherence in three ways. 1) It facilitates access to scarce resources; 2) encourages HIV patients to continue on treatment; and 3) averts risk for non-adherence.

          Conclusions

          Social capital is a key resource that can be harnessed to promote resilience among HIV patients in a resource-limited setting amid individual, structural and health system related barriers to ART adherence. Invigoration and maintenance of collectivist norms may however be necessary if its protective benefits are to be fully realized.

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          Most cited references23

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          Ordinary magic. Resilience processes in development.

          A. S. Masten (2001)
          The study of resilience in development has overturned many negative assumptions and deficit-focused models about children growing up under the threat of disadvantage and adversity. The most surprising conclusion emerging from studies of these children is the ordinariness of resilience. An examination of converging findings from variable-focused and person-focused investigations of these phenomena suggests that resilience is common and that it usually arises from the normative functions of human adaptational systems, with the greatest threats to human development being those that compromise these protective systems. The conclusion that resilience is made of ordinary rather than extraordinary processes offers a more positive outlook on human development and adaptation, as well as direction for policy and practice aimed at enhancing the development of children at risk for problems and psychopathology.
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            SOCIAL NETWORKS AND STATUS ATTAINMENT

            Nan Lin (1999)
            Article 0 comments Cited 339 times – based on 0 reviews     Review now
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              From social integration to health: Durkheim in the new millennium.

              L. F. Berkman, T Glass, I Brissette … (2000)
              It is widely recognized that social relationships and affiliation have powerful effects on physical and mental health. When investigators write about the impact of social relationships on health, many terms are used loosely and interchangeably including social networks, social ties and social integration. The aim of this paper is to clarify these terms using a single framework. We discuss: (1) theoretical orientations from diverse disciplines which we believe are fundamental to advancing research in this area; (2) a set of definitions accompanied by major assessment tools; and (3) an overarching model which integrates multilevel phenomena. Theoretical orientations that we draw upon were developed by Durkheim whose work on social integration and suicide are seminal and John Bowlby, a psychiatrist who developed attachment theory in relation to child development and contemporary social network theorists. We present a conceptual model of how social networks impact health. We envision a cascading causal process beginning with the macro-social to psychobiological processes that are dynamically linked together to form the processes by which social integration effects health. We start by embedding social networks in a larger social and cultural context in which upstream forces are seen to condition network structure. Serious consideration of the larger macro-social context in which networks form and are sustained has been lacking in all but a small number of studies and is almost completely absent in studies of social network influences on health. We then move downstream to understand the influences network structure and function have on social and interpersonal behavior. We argue that networks operate at the behavioral level through four primary pathways: (1) provision of social support; (2) social influence; (3) on social engagement and attachment; and (4) access to resources and material goods.
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                Author and article information

                Contributors
                Esther Kalule Nanfuka:
                ORCID: http://orcid.org/0000-0003-1917-0432
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                David Kyaddondo: Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Sarah N. Ssali: Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Narathius Asingwire: Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Marcel Yotebieng: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 11 June 2018
                Publication date Collection: 2018
                Volume: 13
                Issue: 6
                Electronic Location Identifier: e0197979
                Affiliations
                [1 ] Department of Social Work and Social Administration, Makerere University, Kampala, Uganda
                [2 ] School of Gender and Women Studies, Makerere University, Kampala, Uganda
                The Ohio State University, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-1917-0432
                Article
                Publisher ID: PONE-D-16-51442
                DOI: 10.1371/journal.pone.0197979
                PMC ID: 5995438
                PubMed ID: 29889849
                SO-VID: b0a6e43e-7f0f-4e34-941d-d242ec0c956f
                Copyright © © 2018 Nanfuka et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 29 December 2016
                Date accepted : 12 May 2018
                Page count
                Figures: 0, Tables: 0, Pages: 21
                Funding
                Funded by: Volkswagenstiftung
                Award ID: I/86615
                Award Recipient :
                The study was funded by Volkswagenstiftung ( https://www.volkswagenstiftung.de), Grant number: I/86615 to DK. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Biology and Life Sciences
                Subject: Microbiology
                Subject: Medical Microbiology
                Subject: Microbial Pathogens
                Subject: Viral Pathogens
                Subject: Immunodeficiency Viruses
                Subject: HIV
                Subject: Medicine and Health Sciences
                Subject: Pathology and Laboratory Medicine
                Subject: Pathogens
                Subject: Microbial Pathogens
                Subject: Viral Pathogens
                Subject: Immunodeficiency Viruses
                Subject: HIV
                Subject: Biology and Life Sciences
                Subject: Organisms
                Subject: Viruses
                Subject: Viral Pathogens
                Subject: Immunodeficiency Viruses
                Subject: HIV
                Subject: Biology and Life Sciences
                Subject: Organisms
                Subject: Viruses
                Subject: Immunodeficiency Viruses
                Subject: HIV
                Subject: Biology and life sciences
                Subject: Organisms
                Subject: Viruses
                Subject: RNA viruses
                Subject: Retroviruses
                Subject: Lentivirus
                Subject: HIV
                Subject: Biology and Life Sciences
                Subject: Microbiology
                Subject: Medical Microbiology
                Subject: Microbial Pathogens
                Subject: Viral Pathogens
                Subject: Retroviruses
                Subject: Lentivirus
                Subject: HIV
                Subject: Medicine and Health Sciences
                Subject: Pathology and Laboratory Medicine
                Subject: Pathogens
                Subject: Microbial Pathogens
                Subject: Viral Pathogens
                Subject: Retroviruses
                Subject: Lentivirus
                Subject: HIV
                Subject: Biology and Life Sciences
                Subject: Organisms
                Subject: Viruses
                Subject: Viral Pathogens
                Subject: Retroviruses
                Subject: Lentivirus
                Subject: HIV
                Subject: Biology and Life Sciences
                Subject: Immunology
                Subject: Vaccination and Immunization
                Subject: Antiviral Therapy
                Subject: Antiretroviral Therapy
                Subject: Medicine and Health Sciences
                Subject: Immunology
                Subject: Vaccination and Immunization
                Subject: Antiviral Therapy
                Subject: Antiretroviral Therapy
                Subject: Medicine and Health Sciences
                Subject: Public and Occupational Health
                Subject: Preventive Medicine
                Subject: Vaccination and Immunization
                Subject: Antiviral Therapy
                Subject: Antiretroviral Therapy
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Socioeconomic Aspects of Health
                Subject: Medicine and Health Sciences
                Subject: Public and Occupational Health
                Subject: Socioeconomic Aspects of Health
                Subject: Medicine and Health Sciences
                Subject: Pharmacology
                Subject: Drugs
                Subject: Antimicrobials
                Subject: Antivirals
                Subject: Antiretrovirals
                Subject: Biology and Life Sciences
                Subject: Microbiology
                Subject: Microbial Control
                Subject: Antimicrobials
                Subject: Antivirals
                Subject: Antiretrovirals
                Subject: Biology and Life Sciences
                Subject: Microbiology
                Subject: Virology
                Subject: Antivirals
                Subject: Antiretrovirals
                Subject: Computer and Information Sciences
                Subject: Network Analysis
                Subject: Social Networks
                Subject: Social Sciences
                Subject: Sociology
                Subject: Social Networks
                Subject: Medicine and health sciences
                Subject: Diagnostic medicine
                Subject: HIV diagnosis and management
                Subject: Social Sciences
                Subject: Economics
                Subject: Finance
                Subject: Social Sciences
                Subject: Anthropology
                Subject: Cultural Anthropology
                Subject: Religion
                Subject: Social Sciences
                Subject: Sociology
                Subject: Religion
                Custom metadata
                Data Availability Data are from a study that sought to examine how people living with HIV on medicine mobilise social and medical resources for the day today management of antiretroviral therapy. This study is mine and part of my Ph.D project. All relevant data are contained within the manuscript and supporting information files.

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