Life projects and therapeutic itineraries: marriage, fertility, and antiretroviral therapy in Nigeria

Daniel Smith, Brown University
Benjamin Mbakwem, Community and Youth Development Initiatives (CYDI)

The study relies on the ethnographic methods of participant observation and in-depth interviews of individuals receiving antiretroviral therapy through a government-supported program in southeastern Nigeria to demonstrate that marriage and childbearing are paramount desires for people whose health is restored by antiretroviral therapy. The concept of life projects is introduced and combined with the established idea of therapeutic itineraries to show how participation in and adherence to treatment, disclosure of HIV status, and decisions about sexual behavior cannot be understood in purely medical terms. Marital and reproductive aspirations routinely impinge on and often trump clinical and public health priorities. Emblematic case studies are briefly narrated to illustrate the social dynamics that motivate and explain behavior seemingly inimical to individual and public health. Recommendations for public health policy are provided, focusing on the need to enable rather than ignore or thwart the reproductive aspirations of people receiving antiretroviral therapy.