Background: In sub-Saharan Africa and elsewhere, many people frequently still do not have access to health services that allow medical certification of the cause of their death. Health systems need estimates of cause-specific mortality for planning, and the only way to realistically obtain these in sub-Saharan Africa in the medium term will be through verbal autopsy (VA). Methods: This thesis investigates three methods for assigning HIV/AIDS as a cause of death – physician review, InterVA-4 and the Lopman algorithm – using VA data on 15–59 year-olds from two demographic surveillance systems in Tanzania (Kisesa) and Zimbabwe (Manicaland). The performance of the methods is assessed against the reference standard of known HIV status, allowing the calculation of performance metrics including specificity. Results The estimated proportion of adult deaths due to HIV/AIDS varied between methods, from 30–53% in Kisesa, and 58–73% in Manicaland. It was not possible to conclude with certainty which estimate was most accurate, nor was there any relationship between the estimated proportions and the performance measured by validity metrics. The methods had variable performance, with physician review having the highest specificity, followed by InterVA-4 and the Lopman algorithm. Findings were broadly consistent with the published literature. Analysis of the Lopman algorithm provided a clear illustration of the problems of using data-derived methods, even where reference-standard data are available to train them. Conclusion: Using validity to assess the quality of real-world VA findings is flawed. Cause-specific mortality estimation should move from seeking single best estimates based on assessment of validity to seeking plausible estimates using synthesis of multiple sources of data – including VA.

Background: NHS Regulations were amended in 2004, restricting access to secondary healthcare for refused asylum applicants. In recent years there have been substantial numbers of unsuccessful asylum applications from Zimbabwean nationals. HIV-positive Zimbabweans with insecure immigration status in the UK occupy a precarious medico-legal position, especially since HAART is not available to most in Zimbabwe. There has been little research on these policies or their effects on the lives of Zimbabwean HIV-positive women in the UK. Objectives: This thesis examines the development and implementation of UK policy relating to access to HIV-related services by Zimbabwean HIV-positive women with insecure immigration status, and explores how these policies influence women's healthcare. Methods: Three separate strategies were used for data collection. Policy analysis scrutinised 35 publicly available documents and additional material obtained through Freedom of Information (FOI) requests. Data for policy analysis were also collected through semistructured interviews with 24 HIV/immigration key informants. Further qualitative data were collected through semi-structured interviews with 13 Zimbabwean HIV-positive women with insecure immigration status. These different approaches allowed for data 'triangulation'. Results: Policy restricting access to healthcare for migrants is situated within three immigration control strategies of deterrence, internal control, and 'enforced discomfort'. Implementation of the policy has been limited by staff who interpret it to suit their own agendas. Access to HIV-care for Zimbabwean women seems to bear little relation to these policies, but their access to other health services and their wellbeing was influenced by a number of other socio-structural barriers associated with their immigration status. Conclusions: These results offer new evidence and theoretical models on the politics of immigration policy, the role of street-level bureaucrats as mediators of the gap between policy and practice, and on access to healthcare for migrants. There is a disjuncture between policy on entitlement and clinical practice, which may reflect a conflict between clinicians' duty of care and UK policy. Zimbabwean women's HIV- and migrant-status places them in a periphery, reducing the resources available to them that could mitigate some of the barriers they face.

This thesis follows the making of an archive of the UK HIV/AIDS epidemic (AAU) through a collaboration between archival professionals; a clinician in HIV medicine; and myself, a visual sociologist and participant observer. By framing this process as the making of a boundary object, the thesis attends to the various forms of expertise that were enacted and fostered in creating the archive. The thesis argues for an understanding of expertise as implicated in but not limited to disciplinary concerns, demonstrating how various other experiences, particularly those stemming from personal histories and affective relationships, became relevant sources of ‘expertise’ in relation to the task of assembling the archive. Similarly, the thesis describes the specific advantages afforded by adopting stances that are oblique to, yet dependent on, that of the expert, such as those of ‘amateur’ or ‘apprentice’. In the course of the research process the camera was employed in taking ‘fieldnotes’ and for the purpose of keeping present spaces and archival materials that I would come to lose access to. These photographs later came to be employed as storytelling devices and now constitute an archive in their own right – a repository of traces of processes and materials that will become invisible once AAU has become established. As such, the visual archive is employed and discussed through notions of translation; as navigating the in/visibilities of the archive; and in terms of the kind of account available through the constitution of this archive of photographs taken during the research process. In doing so, the thesis attends to the archive beyond the process of storing and classifying materials, and focuses instead on the implicit, often contingent forms of selection and interessement involved in the personal, professional and institutional relationships through which the archive comes into existence, before it is a clearly defined object.

I argue in this thesis that successful access and delivery of antiretroviral treatment essentially depends on the interrelatedness between individual, social, and political processes. It takes the case of Mozambique, a hard-hit poor country in Southern Africa, which offers free ARVs on a 'first come first served' basis, supported by all major international donors. The HIV epidemic will be analyzed in a time perspective to show this interrelated process. This entails a move between experience and politics using classical anthropological perspectives on power, politics, social order, taboo, rites of passage, risk environment, and structural, symbolic, cultural, social, and everyday violence. Life story interviews, ethnographic interviews, participant observation, and focus groups are key methods that lead the descriptive and analytical narrative of this particular landscape, which was pieced together by multi-site fieldwork in Maputo City, where all major government, international community, civil society, and treatment implementing actors reside. The outcome is unique and detailed accounts of the reality of ARV rollout in Mozambique, which relates experience living with ARVs, epidemiology, consequences living without ARVs, health worker experience delivering ARVs, health system capacity, advocacy, history, and politics of ARVs, health care, and nation-building. This will show how the individual level of access relates to the macro level of the political struggle for independence and sovereignty, intertwined by ever-changing social constraints that feed on the delicate (im)balance between experience and politics. The study thus deviates from classical adherence, stigma, civil society, and governance studies, which tend to focus exclusively on the patient, society, or political institutions. Such micro-macro anthropology invariably recognizes two sides of the coin: success and failure, which is a constant struggle between the state of endemic socio-structural crisis and (dis)order, political leadership, and international solidarity, against the creeping and concrete reality of normalization of life and death.

This thesis is an empirical literature of HIV/AIDS in China. The study presents the perspectives of people living with HIV/AIDS and analyses how the epidemic has been lived and experienced between 1998 and 2003 in China. One way of understanding AIDS is through official discourses, which focus on the cause of the disease and how it is transmitted but neglect social sufferings. The seemingly scientific AIDS discourses are biased as they are mainly from medical professionals who merely look at physical sufferings but neglect social implications of the epidemic. However, through representations and policies the discourses are influential towards policy and public opinions. AIDS does not only affect people physically; before the virus tears down the . human immune system and takes human lives, the disease also brings severe social stigma to people with the infection, relates them to immoral characters and leads them into social isolation and discrimination. Learning about AIDS can also come about people's experiences and stories of living with the epidemic. Hearing what people actually feel and experience is a way of gaining knowledge about AIDS. People who experience the disease understand both the social meanings of the disease and the physical sufferings of it. This way of studying AIDS calls for collecting the experiences, stories, voices and reflections of people living with the disease. People living with HIV/AIDS from all over China of different genders, sexualites, ages, economic and cultural backgrounds took part in this study. It is significant to gain knowledge about AIDS from people's experiences. The perspectives and views in this respect are broader than official AIDS discourses and are often different from them. AIDS is more than a medical issue, it is more of a social and cultural subject that longs for social treatment as well as a political response. Collecting perspectives and viewpoints from people living with the epidemic can bring substantial knowledge and give social meaning to the disease, which is useful in providing effective treatment. This study is to serve this purpose.

This study aims to assess and improve methodological approaches to the operationalisation of social categories in HIV research in the UK. Focusing on the social science of HIV stigma and discrimination, the study critically reviews the research designs used in this area with regards to the use of the categories of sex/gender, race/ethnicity and sexuality. In order to test the feasibility of a new methodology, based on intersectionality, a qualitative study of the experiences of 35 people living with HIV in the UK was carried out in 2010 using an experimental set of methods. These included new ways of sampling and analysing data through the use of five social categories (sex/gender, race/ethnicity, sexuality, citizenship and class) in intersection with each other. The research therefore contains both substantive findings on the topic of HIV-related discrimination and extensive reflections on methodology, in the hope of contributing to the improvement of the classification of people living with HIV in social-scientific research in the UK.

This study explores the housing related problems and constraints faced by poor people living with HIV/AIDS in Gaborone. The study concurrently examines the housing interventions provided by the different housing providers, particularly looking into the availability, accessibility and affordability of the housing-related services in the form suitable for PPLWHA. Housing is one of the largest unmet needs among the poor people living with HIV/AIDS in Gaborone although it is a basic need. The lack of sanitary and stable housing has been key in housing and HIV/AIDS debates around the world and has been attributed with profound effects on the management of HIV/AIDS among PPLWHA. The study hinges on critical realism theory and posits that the housing problems faced by PPLWHA are not an outcome of a single cause but of a web of interacting and interconnected, social, economic, political and environmental factors apparent in Botswana. A qualitative semi-structured strategy through in-depth interviews is used in this study to explore the following: firstly, the housing problems and constraints faced by PPLWHA as well as the strategies they adopt to respond to these problems. Secondly, to gain perspectives of lands and housing policy makers as well as personnel offering housing and housing related services who were interviewed to provide a picture of the implementation of policies, programs and services intended to respond to the housing for poor people. The major conclusion of the thesis is that poverty and HIV/AIDS are interconnected and primary in the everyday life of PPLWHA, and limit their opportunity to afford and access sanitary housing. Consequently they are limited to inhabit poor and unsanitary housing environments in informal housing markets which make it difficult for them to manage their health. The study argues that the housing problems faced by PPLWHA go beyond the observable conditions of poverty and HIV/AIDS. There are other underlying structural barriers, observable and non-observable, which contribute to the housing problems faced by PPLWHA. Firstly, the lack of sanitary and affordable housing, which incorporates the issue of housing finance which is suitable for those on a low income and the poor. Secondly, limited governmental support in the regulation and control of the informal housing market for low income people, thirdly the lack of collaboration of housing organisations aimed at housing the poor and vulnerable people in the country and fourthly the social structures such as cultural norms and traditional beliefs and gender inequalities which are interconnected with HIV/AIDS and poverty which exacerbate housing problems of PPLWHA. This study recommends that if Botswana is to tackle the spread and treatment of HI V and AIDS in society, the lack of adequate housing must be addressed as a barrier to effective HIV prevention, management and care. It is crucial to address the need for stable housing for people with HIV and AIDS.

The Kenyan HIV/AIDS burden differs greatly among its various regions. There are 42 different ethnic groups each with its unique culture. Nyanza province, the home of the Luos shares the highest HIV/AIDs prevalence of 15.1% while in the North Eastern region, the home of Somalis is at 0.5%. Nyanza province is the home of the counties with the highest HIV/AIDs prevalence rates: Homabay-26%, Siaya 24.8%, Kisumu 19.9% and Migori 14.3% while Wajir county in Northern Eastern province has 0.4% prevalence rate. The HIV/AIDS burden also is greatest among females between 15-49 years. Culture and ethnicity are generally associated with risky sexual behaviour in relation to HIV/AIDs. Paradoxically, this relationship has not been deeply investigated within the Kenyan context. Therefore, set against the backdrop of HIV/AIDs scourge in Kenya, the need to understand cultural meaning related to this problem and how social marketing intervention can be appropriately used is a necessary study area. This study explores the link between culture and risky sexual behaviour in relation to HIV/AIDs, for the purpose of seeking situated understanding of the consequences and possible intervention strategies. It explores the contextual and cultural realities faced by intervention programmers using a social marketing approach in a multi-culturally rich environment as Kenya. A Qualitative approach is used to probe cultural and contextual realities faced by intervention programme leaders to understand the barriers and opportunities presented by context and culture to their work. Instruments of open-ended questions and qualitative interviews are used to provide in-depth insights of their experiences from their own point of views. The results greatly link contextual realities and tribal cultures to the spread of HIV/AIDs. The findings imply that cultures and context of a market or target audiences greatly impact on social marketing programmes. A good understanding of the two should indeed be the foundations that guide the planning, implementing, monitoring and evaluating of cultural specific social marketing initiatives, rather than the use of generic or blanketed campaigns. They should also guide the application of upstream, in-stream and downstream social marketing approaches. There is need for programmers and other stakeholders to invest in cultural competency to avoid culturally incongruence in decision-making, policies and programmes. More resources are necessary to change deprived contexts for successful programme work. The study makes important contributions to social marketing and related disciplines. Firstly, it suggests cultural context assessment composite model and culturalcontextual assessment model for use by social marketers. These models can greatly help programmers understand their target audiences’ cultural and contextual environments, in order to actively use this intelligence in social marketing programmes. Secondly the study contributes to an understanding of the Kenyan tribal groups’ culturally sensitive knowledge on sexual beliefs and practices that have impact on HIV/AIDS. This knowledge greatly contributes to an understanding of patterns of HIV transmission within the country, as the significant aspects of seven major and three minor Kenyan tribes, accounting for 81.22% of the Kenyan population, are well explored and discussed in this study. Lastly, the study makes important recommendations in relations to cultural and contextual aspects, which social marketers, policy makers, the government and other stakeholders can work on for more effective social marketing interventions.

The 2013-2014 Zambia Demographic and Health Survey (ZDHS) reported HIV prevalence rate among adults aged 15-49 at 13.3%, ranking Zambia 7th among countries experiencing devastating effects of a mature and generalised epidemic. This report is particularly noted as the first to measure HIV incidence1. Chanda Kapata2 et al. posting results from Zambia’s largest population-based mobile testing survey (2013–2014) placed the HIV prevalence rate generally lower. In 2002, the National AIDS Council (NAC) was established to lead a multisectoral national response to stem the tide. Government Agencies and the United Nations led the responses. In 1992, The World Health Organisation (WHO) observed that abstinence and marital fidelity might constitute strategies capable of completely eliminating the risk of infection from HIV and other sexually transmitted diseases (STDs). Yet funding for applicable initiatives has seldom been prioritised in this respect. On one hand, from the onset of global interventions, condoms were seen primarily as most potent towards reducing the risk of infection. On the other hand, in due course, the implementation of Abstinence and Being Faithful (AB) initiatives by Churches among others, has since been seen as holding massive comparative advantage in facilitating sustainable interventions for prevention and mitigation of AIDS impact. However, church-congregation engagement in AIDS work, for a while, remained under-researched, and applicable interventions were often undocumented and unmeasured in relation to impact. This study investigated (1) how interventions affect impacts in congregation-based HIV/AIDS programmes, and (2) how abstinence and marital fidelity function within the larger picture of overall strategies to combat AIDS. It examined the community work of the Circle of Hope Family Care Centre, a congregation-based HIV/AIDS support group initiative undertaken by the Northmead Assembly of God Church in Lusaka, Zambia. The main research question was: 1) Is a person’s sexual behaviour influenced by their attitude and behaviour towards God? Two subsidiary questions were: i) what are the factors that affect a person’s sexual lifestyle? ii) Does attendance at the church’s HIV/AIDS programmes cause a change of behaviour in a person’s sexual relationships? A triangulated methodology required the collection of both quantitative and qualitative data. The experimental design included a purposively selected intervention group and a control group. Both groups were studied by employing baseline first, and follow-up measures after three months. Quantitative data analysis was carried out in two stages comprising first, cross tabulations to examine the relationship between safer sexual behaviour and socio-economic variables. For the statistical analysis, chi-square tests of independence were conducted at the bivariate level, and the differences were determined at P < 0.01 and P < 0.05 significant level. Next, major predictors were carried out with the help of logistic regression analysis. The results of the logistic regression models were converted into odds ratios, which represented the effect of a one-unit change in the explanatory variable on the indicator of experiencing safer sexual practices and abstaining from sex. Qualitative data were analysed using Atals.ti software to produce the attendant themes and sub-themes. The results of the logistic regression analysis show that those who participated in the interventions were 4.1 times more likely to report having adopted new behaviour or modified old behaviour, specifically to live positively, than those who did not attend the interventions. Similarly, participants in the faith-based interventions were 2.3 times more likely than those who did not take part to report having adopted safer sexual practices. Further analysis revealed that those participants were more likely to report abstinence from sex than those who did not attend. The conclusion is that church congregations have immense comparative advantage to influence sexual behaviour through increasing captive audiences constituting the churches’ presence in the community. Additionally, their morally based interventions such as abstinence and marital fidelity show significant impact on sexual behaviour change and have potential to turn the tide of HIV/AIDS, as the tested models are replicable, scalable and sustainable.

The thesis presents an ethnography of an action-research project carried out between 1992 and 1995 to evaluate co-ordination of health and social services for people with HTV/AIDS in Lothian. The study entailed detailed investigations of interactions and contacts between a small number of people with HIV and the professionals who were involved in their care. Interactions and communication among these professionals around the care of individuals as clients and patients were also studied in the context of specific service settings. The ethnography draws on literary and social science theory on narratives and narrative exchange. A large part of the material collected consists of information passed around for the purpose of service co-ordination, in the course of which people, behaviour and events were evaluated and plotted as stories or narratives addressing dilemmas and ambiguities of service provision. These ambiguities revolved around a central notion of 'control' to which were juxtaposed opposites such as 'manipulation' 'fraud', 'chaos'. Stories were plotted differently according to the narrator's position in the system of services, and they were passionately contested: one person's 'control' is another's 'manipulation'. The ethnography locates the narrative exchange within dynamics of power and authority which differed between settings studied. The social consequence of these dynamics is discussed in a) the way some issues prioritised by service users, e.g. welfare rights, were hidden in service provider discourse and b) in the stereotyping of service users such as 'the chaotic manipulative' drug user and the 'organised gay man'. The research process became entangled in these dynamics and the ethnography proceeds as a 'story' of the project, the ethnographer's evolving interactions with people, the material produced by research encounters and interpretations of them. The story-line follows (roughly) a sequence of events as they occurred in the time of the project. It carries an argument about rationality and power progressed through critiques of Habermas and Foucault.