Browsing by Author "Brandt, René"

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    Childcare and poverty in South Africa: an ethnographic challenge to conventional interpretations
    (Taylor & Francis, 2007) Bray, Rachel; Brandt, René
    This article draws on ethnographic research with children and their caregivers to explore the interaction between poverty and the nature and quality of child care in a resource-poor urban community in South Africa. The authors attend to issues such as mobility and "family fragmentation," the role of the extended family and other networks, and children's contributions to their own and others' care, all matters that provoke particular concern in the context of HIV/AIDS. The research challenges some of the more conventional interpretations on these matters by pointing to the continuities children experience in what can appear a disrupted care setting as well as the positive aspects of children's involvement in care. It also supports the case for a closer look at men's participation in various child-care roles in a climate where they are often dismissed as absent or unemployed and therefore non-contributory. Future research and policy on child care would benefit from the conceptual approach adopted across this work, which employs a relational lens and encompasses the dynamic contexts in which care is experienced and performed.
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    Coping with HIV/AIDS: a case study of the psychological experiences of poor, HIV positive mothers and women caregivers on HAART
    (2005) Brandt, René
    The primary objective of the current study is to investigate the psychological experiences of HIV positive mothers and women caregivers on antiretroviral therapy, and the strategies they employ to cope psychologically. It is also intended to inform both the content and method of ongoing work on maternal well-being and caregiving in HIV affected environments. Five HIV positive women caregivers were interviewed. They had been receiving antiretroviral therapy for less than six months and were the primary caregiver of at least one HIV negative child who was less than six years old. Each woman was administered a questionnaire and a semi-structured interview was conducted. The key issues which emerged were the complexity of women's psychological functioning, the fact that many women made strategic decisions about disclosure aimed at protecting important social networks, and that it was necessary to view well-being over time as a function of both situational and dynamic factors, such as changes in household composition. Women also spoke of consistent concerns about dying before their children were able to care for themselves. The study provides evidence for the value of adopting a contextual approach to investigating the psychological functioning of HIV positive mothers and women caregivers living in communities in which HIV is highly prevalent and poverty endemic.
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    Does mental health matter for poor, HIV-infected women/mothers in the era of HAART?
    (2006) Brandt, René
    This paper reviews the available evidence regarding the relationship between HIV/AIDS, poverty, gender and mental health in order to address the question of whether mental health has any relevance for poor, HIV infected women and mothers in the era of HAART. Evidence points convincingly to the growing feminisation of the epidemic as well as the differential social and economic impact of HIV on women in general, and women in developing countries in particular. Further, HIV and poverty, both of which will be shown to be influenced by gender dynamics, independently contribute to elevated risk for poor mental health. It is argued that even with the advent of antiretroviral therapy, which has not been shown unequivocally to ameliorate poor psychological adjustment, mental health concerns remain relevant and significant for HIV infected women living in poverty. Further, this renders the relative neglect of mental health in the context of HIV/AIDS an important omission on the part of policymakers and service providers alike.
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    Maternal well-being, childcare and child adjustment in the context of HIV/AIDS: What does the psychological literature say?
    (2005) Brandt, René
    This paper outlines the findings of the psychosocial and psychological literature on the impact of mothers and primary caregivers’ HIV infection on maternal well-being, childcare and child adjustment. Drawing on an ecological approach, the paper outlines a model that both demonstrates the link between parental HIV/AIDS and child outcome, and examines the pathways that account for this relationship. These include personal, familial and environmental factors. Some of the key findings that emerge from the literature are that children of HIV positive mothers are at greater risk for emotional and psychological problems than children of uninfected mothers, especially internalising problems such as depression. However, children in poor, affected communities also experience detrimental developmental effects, indicating that HIV/AIDS typically serves as an added stressor in already at-risk communities. Further, disruptions to parental monitoring and the quality of the parent-child relationship are a key pathway whereby these impacts are felt, and are more likely where maternal HIV infection has progressed to AIDS. It is recommended that policy responses take cognisance of children’s contexts and the pathways to child outcomes when attempting to respond to the HIV/AIDS epidemic.
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    The mental health of people living with HIV/AIDS in Africa: a systematic review
    (2009) Brandt, René
    This paper reviews published quantitative research on the mental health of HIV-infected adults in Africa. Twentyseven articles published between 1994 and 2008 reported the results of 23 studies. Most studies found that about half of HIV-infected adults sampled had some form of psychiatric disorder, with depression the most common individual problem. People living with HIV or AIDS (PLHIV) tended to have more mental health problems than non-HIV-infected individuals, with those experiencing less problems less likely to be poor and more likely to be employed, educated and receiving antiretroviral treatment (ART). Being female, experiencing poor health, receiving poor-quality health services, and a lack of material and emotional support from family and friends were associated with greater psychiatric morbidity. While some key findings emerged from the studies, the knowledge base was diverse and the methodological quality uneven, thus studies lacked comparability and findings were not equally robust. Furthermore, more rigorous research is needed to put mental health services for PLHIV in Africa on the healthcare agenda. Priorities for future research should include replicating findings regarding common mental health problems among PLHIV, important issues among HIV-infected women, and the longer-term mental health needs of those on ART. Research is also needed into predictors of mental health outcomes and factors associated with adherence to ART, which can be targeted in interventions.
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    What is childcare really about? An ethnographic analysis of care relationships in a resource-poor community
    (2005) Bray, Rachel; Brandt, René
    The main aim of this paper is to examine critically the nature of childcare, including ideals and practices, in a resource-poor community through close ethnographic analysis of three sets of data generated over the course of two years. We argue that childcare in Masiphumelele should be conceptualised as having an emotional component that operates in parallel with, and is as important as, material provision and practical action. Further, the analysis reveals the extent to which childcare is shaped by poverty and must be thought about in relation to broader physical and social mobility, and the continuities within such movement. We also show that HIV can further shape childcare by challenging existing cultural practices, such as those pertaining to communication between children and adults regarding death. Future work on childcare would benefit from the conceptual approach adopted across this work, one which views children and their carers in a series of interrelated and dynamic contexts that include both kin and non-kin, and extend from the household to the broader family and friendship networks which support these multiple individuals.
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    Women coping with AIDS in Africa: contributions of a contextually grounded research methodology
    (Taylor & Francis, 2006) Brandt, René; Dawes, Andrew; Bray, Rachel
    The primary objective of this report is to describe a contextually grounded approach to the investigation of coping and psychological functioning in AIDS-sick mothers. Five AIDS-sick women on antiretroviral therapy who had at least one child under 6 years of age living in their households were interviewed. Among the issues that emerged was the complexity of the women's psychological functioning, the fact that they made strategic decisions about disclosure aimed at protecting important social support networks, and that their well-being was dynamically influenced by factors in the home and community. The study provides evidence for the value of a contextual approach when investigating the psychological functioning of HIV positive mothers living in poor high-HIV prevalence communities in developing countries.