spirit and healing in africa - University of the Free State

4.4.1 Quality of medical life
Until recently Western epidemiology largely shaped global responses to HIV/AIDS in Africa,
but this dominant position has been affected by an emerging focus on the social dimension of the
AIDS pandemic. Interestingly, the shift towards non-epidemiological factors does not only occur
within the whole of the HIV/AIDS discourse but within the discipline of epidemiology itself,
where attention to issues dealing with the patient and his or her environment is increasing. The
patient is no longer perceived only as a body that needs to be treated, nor is the disease any
longer perceived as a defect that can be removed from the body. This shift arises from the fact
that biomedical science has yet to develop an efficacious medicine or treatment against
HIV/AIDS. HIV/AIDS forced epidemiologists to look beyond the disease towards the patient
and his or her relations and environment.
As a result of this altered attention within the biomedical circuit, more research is carried out on
health-related quality of life for HIV-positive patients (see for example Cunningham et.al. 1998;
Nokes et.al. 2000; Carrieri et.al. 2003; Phaladze et.al. 2005). Medical treatment becomes
increasingly patient-oriented, and the identification of specific variables (such as biological and
physiological factors, symptom status, functional status, general health status and overall quality
of life) that are perceived to be relevant to the health-related quality of life of HIV/AIDS patients
has contributed to that development (Wilson & Cleary 1995). Surely the most important catalyst
in the search for quality of life of people living with HIV/AIDS is the availability of
antiretroviral treatment for patients in Sub-Saharan Africa. Due to antiretroviral treatment
“HIV/AIDS will no longer be a death sentence or the beginning of a series of losses of
employment or family life” (Phaladze et.al. 2005:121). Thus, within the medical world a new
concept has emerged: the concept of living well with HIV/AIDS. Based on antiretroviral
treatment, HIV/AIDS does not necessarily need to be associated with death.
Quality of life from a medical perspective still fits within the biomedical parameters of health,
illness and treatment of the body. Research on patients’ perceptions of the quality of their life
acknowledges the influence of the patient’s nature and even the characteristics of the patient’s
environment, but the main focus remains determined by biological and physiological factors,
symptom status, functional status and medicine intake that can contribute to quality of life
(Wilson & Cleary 1995). Essentially the patient’s physical status displays the quality of life that
can be experienced by the patient. The understanding is that when human life is afflicted by a
malignant disease, the body still needs to function as long and as normal as possible, with the
help of medicine and treatment. This implies that a diminishing of quality of life is directly
related to physical impairment.
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