Browsing by Author "Hodes, Rebecca"

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    Ancestors and antiretrovirals: the biopolitics of HIV/AIDS in post-apartheid South Africa and breaking the Silence: South African representations of HIV/AIDS
    (Oxford University Press, 2014) Hodes, Rebecca
    In the vast corpus of academic writing about HIV/AIDS in South Africa, now entering its fifth decade, generational shifts are perceptible. In the earliest texts, scholars in the global North grappled with the medical and social meanings of a new epidemic, emerging in a context of 1980s fiscal conservatism, the resurgence of the moral right in public life, and the backlash against the feminist and gay rights movements. In South Africa, the dismantling of apartheid and the medical challenges posed by HIV/AIDS provided the context in which this first generation of writings emerged. Barry D. Schoub’s AIDS & HIV in perspective: A guide to understanding the virus and its consequences (1994) is one such example. The second generation of texts about HIV/AIDS in South Africa grappled with the political circumstances of the democratic transition, and the medical realities of a burgeoning epidemic. Scholars confronted the questions posed by the fearful consequences of mass mortality from AIDS at precisely the moment of South Africa’s political rebirth, honed in on the crisis of AIDS denialism among the highest echelons of the ANC leadership, and marked the emergence of new forms of advocacy for access to HIV treatment and support. Nicoli Nattrass’s The Moral Economy of AIDS in South Africa (2004) is key among the texts which emerged during this era.
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    The antiretroviral moratorium in the Free State Province of South Africa: Contributing factors and implications
    (2011) Hodes, Rebecca; Grimsrud, Anna
    In November 2008, a moratorium on initiating new patients onto antiretroviral (ARV) treatment was enacted by the Provincial Department of Health in the Free State province of South Africa. The moratorium, which was part of a series of cost curtailment measures, lasted for four months. During this time, an estimated thirty additional patients in the province died from AIDS each day. The moratorium contradicted national government’s commitment to scaling-up of ARV treatment to 80% of those in need by 2011. This article uses the health systems components outlined by Harries et al. as crucial to the delivery of quality care as a conceptual framework to assess the causal elements of the antiretroviral moratorium. It examines the factors that contributed to the moratorium, including poor financial management systems, human resource and equipment shortages, weak monitoring and evaluation systems, and bureaucratic malfunctioning. This article describes South Africa’s system of fiscal federalism and its impact on health budgeting. As the first official cessation of provincial roll-out, the moratorium served as a litmus test for government’s reaction to critical challenges in the expansion of the ARV treatment programme at both national and provincial levels. It therefore provides a valuable case study for the state’s response to some of the systematic and health infrastructural problems that have characterised South Africa’s ARV roll-out since its inception.
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    Causes and implications of the 2008/2009 Antiretroviral moratorium in the Free State province of South Africa
    (2010) Hodes, Rebecca; Grimsrud, Anna
    In November 2008, a moratorium on initiating new patients onto antiretrovirals was enacted by the provincial Department of Health in the Free State. This paper examines the causes and implications of the Free State antiretroviral moratorium in the context of South Africa's provincial expansion of antiretroviral coverage. It argues that financial mismanagement, bureaucratic malfunctioning and a lack of monitoring and evaluation were the root causes of the moratorium. The more immediate causes are also discussed, primarily the change in financial delegations in November 2008, in which Provincial Treasury abruptly prevented health officials from further overspending. As the first official cessation of a provincial antiretroviral programme, the Free State moratorium provided a litmus test for government's reaction to a critical challenge in the provincial ART scale-up. Its therefore provides a valuable case study for the state's response to systematic and health infrastructural problems that have characterised the national roll-out since its inception.
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    Ezobudoda (manhood things) a qualitative study of HIV-positive adolescent boys and young mens health practices in the Eastern Cape Province of South Africa
    (2019) Gittings, Lesley Blinn; Colvin, Christopher; Hodes, Rebecca
    Men are less vulnerable to HIV acquisition than women, but have poorer HIV-related outcomes. They access HIV services less often and later, and are more likely to die while on antiretroviral therapy (ART). The adolescent HIV epidemic presents further challenges, and AIDS-related illness is the leading cause of death among adolescents in sub-Saharan Africa. Such deaths have tripled since 2000, while declining in all other age groups. There is a clear need to better understand health practices for adolescent boys and young men living with HIV, and the processes through which these practices are formed and sustained. This doctorate explores the biosocial lives of adolescent boys and young men living with HIV in the Eastern Cape Province of South Africa. It engaged health-focused life history narratives (n=36), semi-structured interviews (n=32) and analysis of health facility files (n=43), alongside semi-structured interviews with traditional and biomedical health practitioners (n=14). Young male participants were among the first generation to grow up with access to ART and democratic freedoms. In a context where HIV-positivity and men’s inability to fulfil traditional roles are considered signs of social and moral decay, they felt pressure to be ‘good’ HIV-positive patients and respectable young men. As younger children, they performed to norms of HIVpositive patienthood. As they became older, norms of masculinity, including financial achievement, ulwaluko (traditional initiation/circumcision), ‘moral’ behaviour and engaged fatherhood became more important and began to conflict with performances of ‘good’ patienthood. This was most apparent during and following ulwaluko, where societal norms made it difficult to engage with biomedical treatment and care. Despite this, participants and their families demonstrated agency, creativity and resilience in subverting and re-signifying these norms. Participants did not access traditional products or services for HIV-related issues, a finding that deviates from much of the literature. This study suggests that health practices are mediated not only by gender and culture, but also childhood experiences of growing up deeply embedded in the health system, through which participants forged additional health-seeking tools. Findings affirm the syncretic nature of traditional beliefs, documenting the plural and complementary ways that participants engaged with traditional products and services.
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    From manual to makeshift: the practice of community health work in Wallacedene and Bloekombos informal settlements
    (2012) Vale, Beth; Posel, Deborah; Hodes, Rebecca
    This thesis investigates community health workers' negotiation between the prescribed 'manual' for care and the lived realities of their field, exploring how prescriptions of public health are reappropriated through the micro-politics of everyday practice. What inventiveness, agency and tactical manoeuvres are woven between abstract ideals and situational demands? And how are these shaping the content of care? Community health work has been established as the model for health service delivery in resource-poor settings, particularly those hard-hit by AIDS. While its outcomes are widely celebrated, what this success looks like in practice remains under-explored. This dissertation investigates the messy application of this abstract model of care within a specific social context, exploring the place of care in the lives of carers, and how circumstantial pressures shape care delivery in unintended ways.
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    'Kink' and the colony: sexual deviance in the medical history of South Africa
    (Taylor and Francis, 2014) Hodes, Rebecca
    rom the late 19th century onwards, in keeping with the rise of modern medical specialisations, sex was established as a legitimate subject of scientific enquiry. Public interest in sexual health at the Cape was fuelled in part by the panic about epidemics of venereal disease in the wake of the South African War. Local doctors presented sex as a conduit for biological contagion and moral dissolution. Deviant sexuality, in its many manifestations, was unmasked as a source of grave public anxiety and political concern. Sexual defects among children – manifested both corporeally and behaviourally – attracted particular attention among doctors and health officials at the Cape. As exemplars of innocence and purity, and as heirs of colonial power, the health and moral rectitude of white children in the colony was of crucial importance. This article explores the history of sexual deviance at the Cape colony, and later the Union of South Africa. It traces how medical interpretations of sexual perversity among children advanced particular ideas regarding morality, health and hygiene, and examines how these ideas were imbricated in changing concepts of race and nation. My analysis is premised on articles featured in the South African Medical Journal, from its first year of publication in 1893, to the beginning of the Second World War. ‘Kink’ is explored here as both a social and medical metaphor, used by doctors to denote the moral threat posed by sexual deviance, in particular masturbation and sexual precocity. ‘Kink’ serves as an analytical anchor, providing thematic weight to a corpus of medical writings published over the course of half a century. Whereas doctors used the word ‘kink’ to describe social problems, in its contemporary usage the sexual codification is more direct. The archaic and current interpretations of the word are combined here to analyse the social and sexual dimensions of deviance in South Africa's medical history.
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    The Making of South Africa's Sexual Offences Act (2007): Structure and Agency in a Women's Rights Coalition
    (2011) Hodes, Rebecca
    How do women's rights groups campaign for institutional change to reform archaic rape laws in transitional democracies? This article presents the findings from a case study of a coalition of women's rights and legal advocacy organisations in South Africa, the National Working Group on Sexual Offences, established to campaign for progressive institutional change to national laws and policies on rape. It examines the opportunities provided by the shifting political and structural arrangements of transitional democracies for promoting sustainable social change, and describes the constraints faced by civil society coalitions within these contexts. This article describes the factors that facilitate the emergence of developmental coalitions and determine or impede their success. It concludes with a description of the substantive achievements and successes of the coalition.
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    The Medical History of Abortion in South Africa, c.1970– 2000
    (Taylor and Francis online, 2013) Hodes, Rebecca
    This article explores the medical history of abortion in South Africa during the last three decades of the twentieth century, focusing on the role played by doctors in their clinical encounters with abortion patients. It also examines doctors’ views of the state’s contested policies on abortion, while locating these policies within the wider global movement towards the legalisation of abortion. Many doctors and public health officials employed by the apartheid state occupied an ambiguous space, taking a racist and paternalistic approach to their patients, while also providing the services these patients demanded for the protection of their health, including contraception and abortion. I combine the analysis of medical articles, laws and policies governing abortion with the oral-historical recollections of doctors, to examine how changes in abortion laws were understood in medical writing and practice during this time. Two key issues dominated public debates about abortion from the 1970s: the procurement of abortion on psychiatric grounds and the health outcomes of illegal abortions. Ultimately, changes in abortion laws reflected the political transition from apartheid to democracy, during a period in which political leaders and women’s health advocates championed the legalisation of abortion despite public opposition.
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    Piloting ART in South Africa: the role of partnerships in the Western Cape's provincial roll-out
    (2011) Hodes, Rebecca; Naimak, Trude Holm
    In 1999, the provincial government of the Western Cape entered into a partnership with M?decins Sans Fronti?res (MSF) to provide HIV treatment through public health clinics in the peri-urban settlement of Khayelitsha. From 2000 onwards, this partnership ran South Africa’s first antiretroviral treatment (ART) programme. Due to the province’s limited experience in 1999 in implementing and monitoring an ART programme, and the National Health Department’s opposition to the public provision of ART, this partnership was instrumental in piloting and later scaling-up the Western Cape’s ART programme. The partnership demonstrated that ART programmes could be implemented successfully within resource-constrained settings, with high levels of adherence, low rates of loss to follow up, and excellent health outcomes. Its components and strategies are therefore of vital significance to the roll-out and maintenance of ART programmes in various contexts across the developing world. Based on information gathered through interviews with key players, this article examines the factors that facilitated the public provision of ART in the Western Cape. With a focus on Khayelitsha, it explores the partnerships that were established between the provincial government, civil society organisations, research institutes and service providers to support and expedite the public provision of ART.
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    South African Social Science in the Global HIV/AIDS Knowledge Domain
    (2016-07) Hodes, Rebecca; Morrell, Robert
    Research about HIV constitutes a global domain of academic knowledge. This domain is dominated by biomedicine, and by institutions and funders based in the ‘global North’. However, from the earliest years of the epidemic, African investigators have produced and disseminated knowledge about HIV. Using a ‘Northern’ standard for determining research impact - bibliometrical measures of citation count - we demonstrate how metrics for capturing the impact of knowledge may be repurposed. We explore how the research in this archive may be interpreted as ‘Southern Theory’. Our argument is not based on the geographical location, but instead on epistemological significance. With a focus on South Africa, we situate HIV social science within changing historical contexts, connecting research findings to developments in medicine, health sciences and politics. We focus on two key themes in the evolution of HIV knowledge: (1) The significance of context and locality - the ‘setting’ of HIV research; and (2) sex, race and risk – changing ideas about the social determinants of HIV transmission.
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    Structure and Agency in the Politics of a Women's Rights Coalition in South Africa: The Making of the South African Sexual Offences Act, 2007
    (2011) Hodes, Rebecca; Thorpe, Jennifer; Stern, Orly
    How do women’s rights groups campaign for vital institutional reform of archaic laws on sexual violence in new democracies? How can they best ‘work politically’ to achieve positive outcomes? What lessons are there for donors and supporters? The National Working Group on Sexual Offences (NWGSO), established to influence the progressive reform of national rape laws, became the largest civil society coalition to have collaborated on law reform in South Africa. It emerged at a time of profound change to South Africa’s political settlement, and was a product of the new political processes that unfolded in the early years of the democratic transition. This research paper uses findings from a study of this women’s coalition to demonstrate how civil society coalitions may draw on and expand their elite networks and exploit political and institutional arrangements to build developmental partnerships. It examines the strategies used by the coalition to broaden its support base and to achieve its objectives, as well as the factors influencing those areas where the coalition was less successful. In analysing the successes and setbacks of this groundbreaking coalition, this study offers lessons for civil society leaders, policy makers and developmental partners in how best to support developmental coalitions and strengthen their capacity to promote long-term, sustainable social change.
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    Televising Treatment: The Political Struggle for Antiretrovirals on South African Television
    (Society for the Social History of Medicine, 2010) Hodes, Rebecca
    Siyayinqoba/Beat It! is an activist-aligned television programme first broadcast on South African national television in 1999. This article documents how Beat It! used the educative power of television to demystify HIV treatment and generate support for public access to antiretroviral medicines (ARVs). It seeks to address gaps in scholarship about the historical representation of HIV in the South African media, and explores how Beat It!'s earliest critique was directed at the profiteering of pharmaceutical corporations, in reflection of the struggle of HIV treatment activists against the exorbitant cost of branded ARVs. This article also examines Beat It!'s broadcast of the activist struggle against the state's refusal to roll-out a public programme for the prevention of mother-to-child transmission of HIV. Through its galvanising portrayals of the imperatives of HIV treatments, Beat It! encouraged viewers to fight for public access.
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    Too many rights? Reproductive freedom in post-apartheid South Africa
    (2017-04) Hodes, Rebecca
    In this article, I explore contestations over the legislation and enactment of reproductive rights in South Africa. I argue that the public disapprobation surrounding teenage pregnancy relates, in complex ways, to broader suspicions about moral atavism among the polity. This is the sense that the democratic transition has dismantled established modes of social regulation, resulting in a rupture in the social fabric.i This article explores two elements of this idea: Firstly, that the legislation of democratic freedoms has licensed sexual promiscuity among youth. Secondly, that this sexual promiscuity is related to other forms of profligate consumption among ‘Born Frees’. I contrast claims about the social damage wrought by the empowerment of women in the post- apartheid era, with the experiential accounts of young women themselves. I compare statements made by President Jacob Zuma about teenage pregnancy, with the ideas and experiences of young South Africans, and their older relatives. I explore how disputes over reproductive agency and sexual freedom have been refracted through different experiential prisms, coloured by gender and generation. I describe the political utility of calls for the greater regulation of young women’s sexual and reproductive behaviours. Key claims arose from three years of primary research within the Mzantsi Wakho study, a longitudinal study which focuses on the health experiences of young people, caregivers, health workers and social service providers, in South Africa’s Eastern Cape.