• Haaland, Inga & Kristiansen, Hans Wiggo (2025). Managing collateral stigmatization while accessing biomedical HIV prevention for queer people in Dar es Salaam. Global Public Health. ISSN 1744-1692. 21(1). doi: 10.1080/17441692.2025.2610524. Full text in Research Archive
• Haaland, Inga & Ogillo, Karama (2025). Social Iatrogenesis and Social Risks Among Queer PrEP Users in Dar es Salaam. Medical Anthropology. ISSN 0145-9740. 44(1), p. 83–95. doi: 10.1080/01459740.2025.2453166. Full text in Research Archive
• Haaland, Inga & Ogillo, Karama (2023). Self-making and gender norms: sanctions and rewards in within the context of public health and sex work in Dar es Salaam. Journal of Feminist Anthropology and Gender Studies. ISSN 1388-4840. Full text in Research Archive
• Haaland, Inga; Metta, Emmy & Moen, Kåre (2023). The use of PrEP among men who have sex with men and transgender women as Biomedical Prevention Work: A conceptual framework. Social Science and Medicine. ISSN 0277-9536. 333. doi: 10.1016/j.socscimed.2023.116147. Full text in Research Archive
• Mauka, Wilhellmuss; Mbotwa, Christopher; Moen, Kåre; Lichtwarck, Hanne Ochieng; Haaland, Inga & Kazaura, Method Rwelengera [Show all 9 contributors for this article] (2021). Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. doi: 10.2196/23204. Full text in Research Archive Show summary

  Background: There is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed. Objective: We present the results of the development of a mobile app (Jichunge) intended to promote adherence to PrEP among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania. Methods: A participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW. Results: The relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app’s design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs. Conclusions: The participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion. Trial Registration: The trial registration number is PACTR202003823226570

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• Haaland, Inga (2026). From Allyship to Precarity: queer care, labour and the moral governance in Kenya’s HIV response. doi: https:/www.kristiania.no/en/research/research-groups/queer-research-group/queer-symposium/. Full text in Research Archive
• Haaland, Inga (2025). Ambivalent Intergenerational Care and the Moral Worlds of HIV Clinics: Living with and Through Epidemics. doi: https:/mae.univie.ac.at/home/. Full text in Research Archive
• Haaland, Inga (2025). Omstridd omsorg: Skeive liv, postkolonial makt og den skjøre støtta frå global helse. doi: https:/www.sv.uio.no/sai/forskning/aktuelt/arrangementer/konferanser/naf2025-umistelig.html. Full text in Research Archive
• Haaland, Inga (2025). Growing up and belonging to the Clinic: spaces of social support and care for people born with HIV in Kisumu. doi: https:/ecas2025.gcon.me/programme. Full text in Research Archive Show summary

  This paper investigates the role designated HIV clinics play as support systems for people born with HIV in Kisumu, Western Kenya, and examines the implications of reduced external funding for HIV care. Kisumu, a city hard-hit by the epidemic since the 1990s, became a focal point for NGOs and HIV research from 2004 and onwards. Through life-history interviews with people born with HIV, interlocutors fondly recalled their childhood memories of the clinic as spaces of support, food, transportation refunds and social care from healthcare providers and peers. Although born before the pills for prevention of mother-to-child transmission became available in 2008, they benefited from antiretroviral treatment and support programs at their clinic. Despite coming to terms with their condition, none of the interlocutors were fully open about their status outside the clinic as they had experienced stigma or anticipated stigma when disclosing their status to others outside the clinic. Interlocutors did not necessarily receive social and emotional support from their parents or caretakers; some were orphans, and other parents found it challenging to talk to their children about HIV. The clinics served as spaces where they could openly discuss their life challenges and coping strategies for living with HIV in different phases of their lives, where they gained social and emotional support from peers, healthcare workers and mentors. However, the future of these supportive networks is uncertain amid reduced funding and integration of HIV care into Kenya's general healthcare system.

• Haaland, Inga (2025). Growing Up in the Clinic: Intergenerational Care and the Role of Clinics for GenZ Born with HIV. doi: https:/mae.univie.ac.at/fileadmin/user_upload/k_mae/Panel_42__History_in_Care_Tracing_Historical_Entanglements.pdf. Full text in Research Archive Show summary

  This paper explores the vital role of clinics as caring spaces for individuals born with HIV in Kisumu, Western Kenya, especially amid declining external funding for HIV care. Since the onset of the epidemic in the 1990s, Kisumu has served as a key site for NGOs and HIV research, particularly following PEPFAR's initiation in 2003. Through life-history interviews with GenZ and millennials living with HIV alongside healthcare providers, this study examines intergenerational care practices, focusing on children born to mothers living with HIV, their mothers, and their relationships with clinics. Participants reflected on their childhood experiences in clinics, which functioned as safe havens and a place of belonging where the clinic offered antiretroviral treatments, material support, and emotional care from healthcare providers and peers. Many recounted growing up unaware of their HIV status because the mothers or caretakers had not informed them; this caring practice caused conflicts between mother and child. The clinic emerged as a crucial space for communication about their challenges and for social and emotional care and negotiations during conflicts with mothers or caretakers. This research argues that clinics operate as networks of care, expanding beyond biomedical treatment and fostering a sense of belonging and community for those living with HIV. However, these supportive care networks face sustainability challenges due to reduced funding and reliance on singular sources like PEPFAR. By situating these narratives within historical contexts, the paper examines the lasting influence of past healthcare practices on current experiences of care and belonging amidst health crises.

• Haaland, Inga (2024). Living with PrEP or HIV? Social moral worlds of queer PrEP users in Dar es Salaam. Full text in Research Archive Show summary

  Abstract: This ethnographic study is part of a larger project following the nationwide scale-up of Pre-exposure prophylaxis (PrEP) as HIV prevention for key (and vulnerable) populations in Dar es Salaam, particularly men who have sex with men and transgender women. PrEP is a biomedical HIV prevention that holds the promise of ending AIDS by 2030. PrEP comes in different forms; in this paper, we describe how the PrEP pill was received and used by queer people. It is safe to say that the local moralities of potential PrEP users and the socialites of HIV were not taken into account when planning and implementing the PEPFAR-funded PrEP program in Tanzania. PrEP was presented as a biomedical solution that could fix the 'problem' of new infections. However, the local moralities shaped the uptake and use of PrEP. While the introduction of PrEP provided safety and autonomy over HIV prevention and sexual freedom, PrEP also carried social meanings closely linked to HIV, promiscuity, and sex work. PrEP and ARVs are biomedically the same pills: with the same substances, pill regimens, pill shape and box used both for prevention and care. The close association of PrEP and ARVs and the persisting stigma and secrecy around serostatus for people living with HIV shaped in many ways how interlocutors lived with PrEP. While interlocutors emphasised the difference between taking PrEP, a pill they could use until they choose to stop using without fatal consequences, in contrast to ARVs, the social risk of exposing PrEP contributed to secrecy and silencing around their PrEP use. Unlike other parts of the world, HIV and PrEP were not explicitly associated with homosexuality; however, the fear of being marked as gay and experiences with or rumours of discriminatory public health services also affected the uptake and continuation of PrEP.

• Yusuf, Mariam Florence & Haaland, Inga (2024). What is ‘global’ in Global health: An analysis of ‘bodies in Africa’, in Ethics, Morality, and Inequities in the COVID-19 pandemic. Full text in Research Archive
• Yusuf, Mariam Florence & Haaland, Inga (2024). Ordering of wombs- reading into future fertilities: Navigating COVID-19 vaccination infertility fears among Kisa Women in Khwisero Kenya. Full text in Research Archive
• Haaland, Inga; Kristiansen, Hans Wiggo; Metta, Emmy & Moen, Kåre (2024). The Stigma of biomedical HIV Prevention among transgender women and men who have sex with men in Dar es Salaam. Full text in Research Archive Show summary

  Paper Short Abstract: The PrEP pill, intended to prevent HIV, also puts users at risk of different types of stigmatization related to gender, promiscuity and HIV. Social anthropology enables us to examine global health critically, explore the users' lived experiences, and understand what stigma means to PrEP users. Paper Abstract: Based on 11 months of ethnographic fieldwork following a Pre-exposure prophylaxis (PrEP) study for men who have sex with men and transgender women in Dar es Salaam, this study observed how the PrEP pill, intended to prevent HIV, also put users at risk of experiencing several types of social stigmatization. Anthropological perspectives and methods enable us to examine global health interventions critically, explore the users' lived experiences and employ theory to make sense of what, in this example, stigma means to PrEP users. Stigma was, above all, related to social exclusion when living with HIV, and being identified as a PrEP user might be (mis)read by the users' social environment to indicate HIV positivity. In this respect, PrEP use was mistaken for the use of ARVs. While neither PrEP use nor living with HIV was mainly linked to homosexuality, men who have sex with men were targets for PrEP interventions; PrEP users ran the risk of being stigmatized as "homosexual" or "gay". Lastly, for persons assigned male gender at birth who did sex work, PrEP became an important HIV preventative measure and enabled safer sex and more partners. However, the social risk of exposing PrEP use to clients was, for some, a constant concern, as their status as PrEP users could mark them off as promiscuous and as living with HIV. These findings show that HIV stigma persists and that interventions aimed at biomedically preventing HIV transmission may have the somewhat paradoxical effect of triggering different forms of stigmatization.

• Yusuf, Mariam Florence & Haaland, Inga (2024). From free to user fee! How making people pay for healthcare at government hospitals contributed to vaccine hesitancy among women in Khwisero, Kenya. Full text in Research Archive
• Haaland, Inga (2023). Anticipations of ending the HIV epidemic using Pre-exposure prophylaxis (PrEP): affective states and uncertainties among PrEP users in Dar es Salaam. Full text in Research Archive Show summary

  At a study site in Dar es Salaam, 'risk subjects' (Rose, 2007), in this case, transgender women and men who have sex with men, come to gain access to Pre-exposure prophylaxis (PrEP) – a novel HIV prevention pill. The pill holds the promise to 'end HIV by 2030' according to the WHO. This paper draws on ten months of ethnographic fieldwork between 2021/2022 at a PrEP study site in Tanzania. The paper explores how some PrEP users anticipated an HIV-negative future with PrEP as a temporal possibility (Adams et al., 2009) and hope for the best possible future for themselves, their partners and their community. The paper found that using PrEP not only introduced hope for the future but PrEP also introduced novel uncertainties and affective states into their users' lives, such as rumours about the spread of PrEP as an ineffective drug and uncertainty about PrEP's effectiveness caused by stress related to HIV status. Furthermore, PrEP users were concerned about the potential stigma they could experience as PrEP users, as PrEP was associated with promiscuity, sex work and HIV positivity. Lastly, the projectivization (Prince, 2014) of PrEP and the unstable provision at the beginning of the PrEP scale-up in Tanzania caused anxiety and uncertainty to its daily users. Finally, I speculate on whether biomedical interventions, such as PrEP, can hold their promise of ending an epidemic in solitude. I anticipate a need to include social and structural perspectives in present public health interventions to 'end AIDS' sometime in the future.

• Haaland, Inga (2023). The risk and uncertainties of using PrEP as HIV prevention: an ethnographic study among men who have sex with men and transgender women in Dar es Salaam. Full text in Research Archive Show summary

  At a study site in Dar es Salaam, transgender women and men who have sex with men come to get the novel biomedical technology: Pre-exposure prophylaxis (PrEP). PrEP is a pill proven to reduce the risk of contracting HIV by up to 99%. While PrEP may reduce the risks of contracting HIV, this paper argues that PrEP can also introduce new risks and uncertainties to their users’ lives. The data draws on ethnographic fieldwork mainly located at the PrEP study site for ten months in 2021/2022—rumours and stories about PrEP users becoming HIV positive made people uncertain about the promised 99% effectiveness. Furthermore, the complexity of PrEP also brought uncertainty to people’s lives: what happens if a pill is taken at the wrong time or not at all? How would this affect the known 99% protection covered by PrEP? These concerns and worries contributed to serostatus uncertainty. Secondly, some interlocutors experienced social delay about whether their PrEP use could impose a stigma on them, as PrEP was associated with HIV positivity and promiscuity/sex work. Lastly, the projectivization of PrEP programming, local stock-out and delays in the nationwide scale-up of PrEP contributed to an uncertain provision of PrEP to its users. While PrEP has shown to be important to the interlocutors in this study, PrEP also contributes to current uncertainties about life on PrEP here and now and concerns about the risks and uncertainties of whether their future would become HIV positive or remain HIV negative.

• Haaland, Inga (2023). Negotiating gendered appearance and representation in the context of a PrEP study for transgender women and men who have sex with other men in Dar es Salaam. Full text in Research Archive Show summary

  Pre-exposure prophylaxis, or PrEP, have been touted by WHO and UNAIDS as an essential tool in ‘ending AIDS’ by 2030, holding the promise of a future where HIV is no longer endemic. At a study site in Dar es Salaam, transgender women and men who have sex with men come to gain access to the novel pill, which, when taken daily, is proven to be up to 99% effective in reducing new infections of HIV. In this paper, we present the case of one PrEP user, Ibada, who performed a noticeable change in their appearance during fieldwork. Exemplified by Ibadas’ transformation and analysis of their transformation, this paper demonstrates how PrEP users may manage and negotiate gender expressions at the study site and in other areas of life, such as in sex work, dating or search for employment as a peer educator. As inclusion in the PrEP program depends on gender, sexual practices and eligibility for PrEP, discussions of the motivation for participation and appearance frequently occurred among staff at the study site. The data presented in this paper draws on a 10-month of ethnographic fieldwork between January 2021 and April 2022. Methods used were participant observation at the study site and a secondary health clinic and interviews with Ibada, research staff, health care workers and peer educators. The paper provides insight into gender discourses at a PrEP study site and how non-hetero-normative persons may navigate gender expression in creating a future for themselves.

• Haaland, Inga; Metta, Emmy & Moen, Kåre (2022). The role of Pre-Exposure Prophylaxis as HIV prevention for men who sell sex to other men in Dar es Salaam. Full text in Research Archive Show summary

  Background: Men who sell sex to other men are twice as likely to be infected with HIV compared to other men who have sex with men. PrEP use is very effective for preventing HIV infection among at risk populations including men who sell sex to other men. PrEP is freely available to key and vulnerable populations in Tanzania. However, there is limited information on PrEP use among men who sell sex to other men in Tanzania. Aim: Explore the role of PrEP as HIV prevention among male born persons who sell sex to other men. Method: This ethnographic field work and qualitative interviews was conducted between January 2021 and April 2022 in Dar es Salaam. In this paper, we focus on the findings from interviews with 16 participants who said they did ‘Ngono Pesa’, sex for money. Results: Participants saw several benefits with PrEP, as it provided safer working conditions and could facilitate condomless sex. Sex without a condom had a higher market price and was perceived to reduce pain associated with the unlubricated condoms in receptive anal sex. PrEP thus facilitated an increased number of clients per day. Regarding challenges, some clients mistook PrEP for HIV treatment, non-adherence to PrEP and stock-outs. The lack of PrEP could lead to either unprotected sex or temporary service disruption. Conclusion: As HIV prevention, PrEP were instrumental for men who sell sex. PrEP also facilitated less painful working conditions and contributed to a higher income. PrEP also caused challenges, such as loss of income for those who were perceived to be HIV positive by their clients. Secondly, unavailability of PrEP during travels and stock-outs put participants at risk of contracting HIV.

• Haaland, Inga; Metta, Emmy & Moen, Kåre (2021). Pre-exposure prophylaxis as HIV prevention in Dar es salaam: Perceptions and experiences among men who have sex with men and transgender women. Full text in Research Archive
• Mbotwa, Christopher; Mauka, Wilhellmuss; Lichtwarck, Hanne; Haaland, Inga; Kazaura, Method Rwelengera & Metta, Emmy [Show all 9 contributors for this article] (2021). mHealth interventions to enhance adherence to PrEP among Female Sex Workers in Tanzania: Lessons from the field. Full text in Research Archive Show summary

  Background: Pre-Exposure Prophylaxis (PrEP) is a recent biomedical tool recommended for HIV prevention among populations at increased risk. PrEP effectiveness largely depends on users’ adherence to medication but it has been a challenge in most trials. In Tanzania, the plan for roll-out are ongoing. However, poor adherence is one of the anticipated challenges. mHealth has emerged as one of the ways of promoting adherence in different medications. Aim: The aim is to highlight various challenges we experienced when implementing research on mHealth among female sex workers (FSW) in Tanzania. Methodology: This is pragmatic quasi-experimental study being implemented in Dar es Salaam (intervention) and Tanga (control). Respondent driven sampling was used to recruit 471 FSW in Dar es Salaam. All participants recruited were an mHealth app, a smartphone-based application called Jichunge. A subset of the sample was also invited to take part in qualitative interview. The findings for this study are based on the qualitative interviews and participant observation. Results: We experienced several challenges relating to phones and the app itself when enrolling participants to the Jichunge app. The lessons we learned includes the importance of having site equipped with all facilities for charging phones, strengthening screening for the ownership of phone as some participants could borrow phones, considering mHealth interventions accessible to both user and non-users of smartphone as well as online and offline services. Conclusions: Some prospective participants who did not had own smartphone wanted to take part in Jichunge intervention. In our case, to get access to PrEP was considerably more important to some people than to be straight forward about their phone ownership. We assume that many of the points we raise will be of relevance to consider also in other mHealth studies. Recommendations: To maximize usability of mHealth interventions in Tanzania and other developing countries, services accessible via non-smartphone and offline should be put forward. Early and continuously follow-up on people who stop using the mHealth is useful in mapping some issues relating to the app.

• Mauka, Wilhellmuss; Litchwarck, Hanne; Mbotwa, Christopher; Haaland, Inga; Kazaura, Method Rwelengera & Metta, Emmy [Show all 9 contributors for this article] (2021). The use of Jichunge app on Pre-exposure Prophylaxis adherence Among Men Who Have Sex With Men in Dar es Salaam Tanzania. Full text in Research Archive Show summary

  Background: Jichunge app is a mHealth intervention in a quasi-experimental study introduced to support PrEP adherence among Men who have Sex with Men (MSM) in Dar es Salaam Tanzania. Hence, this preliminary analysis aims to determine the Jichunge app use among MSM. Methods: A respondent-driven sampling (RDS) was used to recruit MSM between 23rd March 2021 and 17th July 2021. Through their mobile phones, the intervention group was installed with the Jichunge app and had access to register their daily PrEP, editorial & health educational content, a chatting forum with their peers, and online consultation with a doctor or peer educator expected to be followed for 12 months. The descriptive analysis was carried out to describe user status, accessing the app’s features, and drug registration. Results: A total of 422 MSM were involved in this analysis, whereby observation time was from 23rd March - 23rd July 2021, contributing 2073 days of data. MSM ever used the app overall, first and the third month from recruitment were 56.2%, 56.7%, and 89.8%, respectively; 51% ever visited editorial & health educational contents, 57.6% ever used chat forum, and 26.8% ever used online consultation. Overall, eighty-three percent (83%) ever registered their PrEP at least once into the app. Conclusion: The use of the Jichunge app and its features are optimum and may improve over time.

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