Second PhD in the MaxART programme

June 28, 2017

On June 27, 2017 at the University of Amsterdam Thandeka Dlamini – Simelane of Swaziland has successfully defended her dissertation entitled “De-Globalizing Global Public Health - Travelling HIV Treatment Policies and their Imprints on Local Healthcare Settings in Swaziland”. Thandeka is the second of three researchers who are affiliated to the MaxART programme.

Although she indicated to be very nervous, Thandeka was highly convincing and passionate in her defense. She left no room for doubt in her response to the PhD Examining Committee members. Nonetheless a sense of relief prevailed afterwards. "Doing a PhD had never featured into my life goals, hence my PhD journey started out spontaneously. This journey has been extremely rewarding and challenging as well. Today is a very special day". 

The PhD Examining Committee complimented Thandeka on her level of professionalism: "She met all deadlines, and took critique with pragmatism". Eileen Moyer, co-promotor: "She really deserves it. The struggle she has had being researcher, mother and wife, far away from family for a long periods of time. Of all students who want to change the world, she simply did it. She's a woman not to mess with." 

At Aidsfonds we congratulate Thandeka with this milestone and we are proud of what she has achieved, both personally and for the MaxART programme. 

Thesis abstract

Efforts to expand HIV treatment to reach all that need it in resource poor setting, is made possible through aid. Aid comes with many conditions attached to it, which chiefly include replicating implementation science (strategies) that have worked elsewhere. Also, reference documents are developed at the global level which countries with high disease burden are expected to apply to respond to the disease. Public health's approach backed by donors is premised on lack of access to services as a barrier to uptake of treatment, thus requiring a logistical fix. MaxART which is the project that this dissertation is based on was premised on the same. Resources were invested (equipment, skills) to bring care closer to the people yet regardless, non-uptake of HIV services at their disposal continued. The study showed the most important need that PLHIV esteemed was honor and belonging, and anything that could possibly jeopardize that was not considered favorably in decision-making about their own health.

Operating within an environment of limited resources, when HIV treatment started PLHIV volunteered to provide psychosocial support to newly diagnosed people within clinical settings and supported nurses to close the human resource gap. This move was applauded by global health proponents and therefore promoted to the point that it was almost impossible for countries to receive aid without demonstrating PLHIV involvement. It was a cutting-edge solution to avert acute health workers shortage in resource poor settings. Though a degree of success was achieved by the MaxART project by adopting this suggestion, more unintended consequences manifested. PHLIV's support to HIV response, unfortunately cultured an undercurrent of free services by PLHIV positing them as cheap labor which impacted on administration of care and negatively affected patient' stherapeutic experiences and pushed them out of care. This dissertation exposes 'what else' aid-supported interventions, treatment guidelines and strategies, promoted from the global do at the locales, beyond fulfilling the intended objectives.

A full version of the dissertation will be published soon.