Toni Copeland
Department of Anthropology and Middle Eastern Cultures
Mississippi State University (E-mail: tonicopeland@gmail.com)
To Keep this Disease from Killing You: Cultural
Competence, Consonance, and Health among
HIV-positive Women in Kenya
The HIV/AIDS crisis continues in sub-Saharan Africa, where nearly 70% of infec-
tions are found. Despite recent efforts to supply antiretroviral therapy to those in-
fected, most are not receiving medication and are forced to rely on self-management
to remain healthy. In Kenya, many of those infected are women living in ex-
treme poverty. This article presents the findings of research among poor women
in Nairobi that examined the relationship between knowledge of a cultural model
of self-managing HIV/AIDS, cultural consonance, and health. This biocultural study
expands on earlier findings showing that knowledge of the model (competence) is
a significant predictor of health by examining here how behavior consistent with
that knowledge (consonance) affects health outcomes, as measured by CD4 counts,
perceived stress, depressive symptoms, and recent illnesses. [cultural consonance,
HIV/AIDS, women, poverty, Africa]
Introduction
It was a warm December day in Nairobi as I entered the small church-funded clinic
that provides medical services to residents of a nearby slum. Constructed of brick
and stone rather than rusty tin and plastic and accessible via passable roads, the
clinic operates with a few doctors, several nurses, and an onsite laboratory that
performs medical tests daily. It was the nicest clinic I worked in while investigating
HIV/AIDS among poor women around the city.
The clinic provided a private room in which I could interview women, most
of whom are not clients of the clinic but are residents of the slum only a short
walk away. The room was small and windowless; the walls were plastered with
posters about HIV/AIDS, tuberculosis, or words of encouragement and hope. All
the women I interviewed had their CD4 counts tested in the clinic’s lab at no charge
as an indication of how well their immune systems were working, and were thus
able to fight HIV/AIDS and other infections.
Around midday, I met “Anne.” Anne was 37 years old, HIV-positive but not
on antiretroviral therapy (ART), engaged in informal work when she was able, and
272
MEDICAL ANTHROPOLOGY QUARTERLY, Vol. 32, Issue 2, pp. 272–292, ISSN 0745-
5194, online ISSN 1548-1387.
C
2017 by the American Anthropological Association. All rights
reserved. DOI: 10.1111/maq.12402
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