Rethinking decision making: contributions from research on the health work of people living with
HIV/AIDS
Eric Mykhalovskiy, Ph.D.
Assistant Professor
Department of Community Health and Epidemiology
Dalhousie University
4
th
Floor, 5790 University Ave.
Halifax, N.S., Canada, B3H 1V7
Tel.: 1-902-494-2789, fax: 1-902-494-1597.
E-mail address:
eric.## email not listed ##
Abstract
The emergence of HAART as a standard of care for the treatment of HIV infection has been
coupled by growing social scientific interest in the decision-making practices of people living with
HIV. Established approaches to decision-making tend to rely on highly rational, individualized
conceptions of human action. As such, they fail to fully represent the complexities of how actual
people with HIV enter into relation with HAART. In response to this problem, this paper develops
an analysis of how people come to take HAART as a social, relational and embodied process. The
paper draws on the results of an institutional ethnographic study conducted in and around Toronto,
Canada that involved individual and focus group interviews with 79 people living with HIV (57men
and 22 women). Drawing on participants’ narratives of their “health work”, the paper explores two
features of the social character of coming to be on HAART. First, it examines the temporal
dimensions of coming to take treatment, emphasizing the work people do to “make” and “take
time” to decide about HAART. Second, it explores how the process of coming to take medications
relies on people actively constructing hybrid medico-experiential knowledge about the body and
HIV treatment. The paper closes by raising practical implications for supporting the health work of
people living with HIV that are suggested by the study’s findings.
Page 1 of 22 
Convention