Browsing by Author "Maughan-Brown, Brendan"

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    Attitudes towards people with HIV/AIDS: stigma and its determinants amongst young adults in Cape Town, South Africa
    (Taylor & Francis, 2006) Maughan-Brown, Brendan
    HIV/AIDS-related stigma is conceptualised as multi-dimensional, and indices are designed to measure its different dimensions. Findings show that it is uncommon for young adults to have high levels of negative behavioural intentions towards people living with HIV/AIDS, but the majority show some tendencies to discriminate. Expressions of negative judgement (symbolic stigma) and fear of HIV infection (instrumental stigma) are both prevalent. Instrumental stigma is expressed by more respondents and to greater degrees than symbolic stigma. Resource-based stigma, on the other hand, is rare. Understanding of HIV transmission is the most significant (negative) predictor of HIV/AIDSrelated stigma, thereby highlighting the importance of HIV/AIDS education campaigns for reducing stigma. The importance of education in general is atso indicated by the association of higher levels of education with less instrumental stigma. Symbolic stigma and prejudices towards other groups are also significant (positive) factors predicting negative behavioural intentions and stigmatising attitudes. This suggests that although HIV/AIDS education is necessary for stigma alleviation, it is by no means sufficient. In the case of Cape Town, racial differences are also salient in predicting both the magnitude of HIV/AIDS-related stigma and its determinants. This corroborates the theory of stigma as a complex social process dependent on particular cultural and environmental contexts. It also highlights the necessity of considering cultural and environmental aspects in understanding and addressing stigma.
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    Changes in HIV-related stigma among young adults in Cape Town, South Africa
    (2009) Maughan-Brown, Brendan
    Background: Stigma is a recognised problem for effective prevention, treatment and care of HIV/AIDS.? However, few studies have measured changes in the magnitude and character of stigma over time. This paper provides the first quantitative evaluation in Africa of the changing nature of stigma and the potential determinants of these changes. More specifically, it evaluates the dynamic relationship between stigma and (1) increased personal contact with people living with HIV/AIDS (i.e., the contact hypothesis) and (2) knowing people who died of AIDS. Methods: Panel survey data collected in 2003 and 2006 for 1074 young adults (54% women, 46% men) is used to evaluate changes in three distinct dimensions of stigma: behavioural intentions towards people living with HIV/AIDS, instrumental stigma (inflated fear of infection) and symbolic stigma (expressions of negative moral judgement). Individual fixed effects regression models are used to evaluate factors that influence stigma over time. Results: Each dimension of stigma increased in the population as a whole, and for all racial and gender sub-groups. Symbolic stigma increased most significantly, followed by instrumental stigma, while negative behavioural intentions showed a modest increase.? Knowing someone who died of AIDS was significantly associated with an increase in instrumental stigma (p < 0.01) and symbolic stigma (p < 0.001).? Increased personal contact with people living with HIV/AIDS was not significantly associated with changes in stigma. Importantly, increases in instrumental stigma (p < 0.001) predicted increases in negative behavioural intentions. Conclusion: Stigma increased despite interventions, such as public sector provision of HAART (which some hoped would have reduced stigma), and among a sample highly targeted with HIV-prevention messages. These findings emphasise that changes in stigma are difficult to predict and thus important to monitor. They also indicate an imperative for renewed efforts to reduce stigma, perhaps through interventions to weaken the association between HIV/AIDS and death, to reduce fear of HIV/AIDS, and to recast HIV as a chronic manageable disease.
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    Concurrent sexual partnerships among individuals on HAART in South Africa: an opportunity for HIV prevention
    (2009) Maughan-Brown, Brendan; Venkataramani, Atheendar S; Mah, Timothy L
    Concurrent sexual partnerships, a common form of sexual partnering in much of southern Africa, play an important role in HIV transmission dynamics. This study examines the prevalence of concurrency and condom use among the general population and a sample of HAART patients in Cape Town, South Africa. The prevalence of reported concurrency was relatively high among a sample of HAART patients and in the general population (24% and 18% respectively) and reported consistent condom use was significantly higher among HAART patients compared to the general population (58% versus 20%);? perceived concurrency among the study populations' sexual partners was higher among HAART patients (35% versus 20%). Individuals on HAART report higher and more consistent use of condoms than the general population but the prevalence of concurrent relationships remains worryingly high. Greater programmatic attention should be given to promoting risk awareness of and behaviour change around concurrency both in the general population and amongst people living with HIV.
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    Concurrent sexual partnerships and sexually transmitted diseases among African men in Cape Town, South Africa
    (Southern Africa Labour and Development Research Unit, 2015-05-28) Maughan-Brown, Brendan
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    A cut above the rest: Traditional Male Circumcision and HIV Risk Among Xhosa men in Cape Town, South Africa
    (Lippincot Williams and Wilkins, 2011) Maughan-Brown, Brendan; Venkataramani, Atheendar S; Nattrass, Nicoli; Seekings, Jeremy; Whiteside, Alan W
    Randomized clinical trials have shown that medical male circumcision substantially reduces the risk of contracting HIV. However, relatively little is known about the relationship between traditional male circumcision and HIV risk. This article examines variations in traditional circumcision practices and their relationship to HIV status. We used data from the fifth wave of the Cape Area Panel Study (n = 473) of young adults in Cape Town, South Africa, to determine attitudes towards circumcision, whether men were circumcised, at what age, and whether their foreskin had been fully or partially removed. Probit models were estimated to determine the association between extent and age of circumcision and HIV status. RESULTS: There was strong support for traditional male circumcision. 92.5% of the men reported being circumcised, with 10.5% partially circumcised. Partially circumcised men had a 7% point greater risk of being HIV positive than fully circumcised men (P < 0.05) and equal risk compared with uncircumcised men. Most (91%) men were circumcised between the ages of 17 and 22 years (mean 19.2 years), and HIV risk increased with age of circumcision (P < 0.10). CONCLUSIONS: Efforts should be made to encourage earlier circumcisions and to work with traditional surgeons to reduce the number of partial circumcisions. Data on the extent and age of circumcision are necessary for meaningful conclusions to be drawn from survey data about the relationship between circumcision and HIV status.
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    Disability grants and individual and household welfare among HAART patients in South Africa
    (2009) Venkataramani, Atheendar; Maughan-Brown, Brendan; Nattrass, Nicoli; Ruger, Jennifer
    Objective: To examine whether the loss of disability grants creates perverse incentives to forego treatment and negatively impacts health and economic welfare among individuals on highly active antiretroviral therapy (HAART) in South Africa. Design: Three-year panel study of a sample of individuals in Khayelitsha (a large poor, black township in Cape Town, South Africa) on HAART. Methods: Descriptive cross-tabulations and multivariate individual fixed effects regressions using self-reported health status, adherence to treatment, individual and household incomes and employment status as dependent variables and a binary indicator of disability grant status as the main independent variable. Results: We found no statistically significant association between grant receipt and adherence to treatment, self-reported health status, or side effects from HAART. None of the individuals in the sample reported that they would be willing to forego treatment to remain eligible for grants and all respondents reported perfect or near perfect adherence to treatment. However, a loss of a disability grant was associated with substantial decreases ion individual and household incomes, respectively. Conclusion: While we found no evidence of people trading off their health for income, there still appears to be a large financial burden associated with disability grant loss, which could increase the salience of perverse incentives, especially among those who are unable to find employment. Future research should examine alternative social welfare programs for AIDS-sick individuals that minimize incentives to trade-off health for economic security.
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    Effects of household shocks and poverty on the timing of traditional male circumcision and HIV risk in South Africa
    (AIDS and Behaviour, 2015-05-28) Venkataramani, Atheendar; Maughan-Brown, Brendan
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    Experiences and perceptions of HIV/AIDS-related stigma amongst people on antiretroviral treatment in Khayelitsha, South Africa
    (2007) Maughan-Brown, Brendan
    HIV/AIDS-related stigma is a recognised problem for people living with HIV/AIDS (PLWHA) yet little research on experiences of stigma has been conducted in sub-Saharan Africa, the epicentre of the disease.? This paper employs quantitative analysis to measure the extent and nature of stigma experienced by 242 people on antiretroviral treatment in Khayelitsha (an urban African community in Cape Town, South Africa). This research draws an important distinction between experienced stigma and perceived stigma (i.e. perceptions of stigma in the community). The results show that while relatively few respondents (17%) reported experiencing a lot of stigma, the majority (75%) had experienced some stigma. Experiences of stigma within households were found to be rare (thus adding to the emerging evidence of general support for PLWHA from family members). Although some reported no experiences of stigma, almost all individuals reported perceived stigma (i.e. believed they lived in a stigmatising environment). Both experienced stigma and perceived stigma were related to inconsistent condom use, fear of disclosure, depression/anxiety and lack of self-efficacy/confidence. As expected, experienced stigma influenced perceived stigma and those affiliated to a religious organisation were shown to manifest more perceived stigma.? Health-related problems and the clinic where treatment was obtained (which could be a proxy for different social contexts) were significant determinants of experienced stigma. This indicates the importance of the biophysical manifestations of HIV/AIDS and community-level variables in shaping PLWHA's experiences and fears of stigma.
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    Handwashing behavior and habit formation in the household: evidence from the pilot randomized evaluation of HOPE SOAP© in South Africa
    (2018) Sellman, Abigail; Burns, Justine; Maughan-Brown, Brendan
    Handwashing with soap at critical times is a simple and effective way to prevent the spread of communicable diseases, such as diarrhea and acute respiratory infection, which are major causes of morbidity and mortality in developing countries. However, rates of handwashing remain low throughout the world, and interventions which attempt to improve handwashing behaviors have largely been unsuccessful in practice. This may be because behavior change programs often fail to recognize the habitual drivers of handwashing behavior. In contrast, this paper examines the effectiveness of a novel soap technology, HOPE SOAP©, a child-size and colorful bar of soap with a toy embedded in its center, which aims to increase handwashing in children by specifically targeting its habitual nature. To rigorously evaluate HOPE SOAP©, this paper exploits data from a pilot randomized controlled trial whereby 229 households from a poor urban community in South Africa were randomly assigned to receive HOPE SOAP© for a period of 12-weeks. In an initial analysis of the effects of the intervention on children’s health and behavior, Burns, Maughan-Brown, and Mouzinho (2017) found that that HOPE SOAP© had positive impacts on children’s handwashing behaviors and health outcomes. Children who received HOPE SOAP© children were more likely to wash their hands, and had better overall health outcomes than control children (Burns, Maughan-Brown, and Mouzinho 2017). Although HOPE SOAP© aims to induce behavior change in children, this paper explores the spillover effects that it has on other members of children’s households. Specifically, this work uses regression analysis to investigate the impacts of HOPE SOAP© on the handwashing behaviors of children’s primary caregivers, and on the health outcomes of all non-treated household members. This paper finds compelling evidence illustrating that a child’s assignment to HOPE SOAP© has a positive impact on the handwashing behavior of their caregiver. Specifically, HOPE SOAP© increases the probability that a caregiver will wash their hands before eating a snack by 13 percentage points on average (p-value 0.17). A further investigation of the causal mechanisms for this improvement suggests that HOPE SOAP© affects caregiver behavior both by disrupting existing poor-hygiene habits, and by strengthening handwashing norms within households. Despite its positive effects on household handwashing behavior, this paper finds that a child’s assignment to HOPE SOAP© has no discernable shortterm impacts on the health of individual household members. Nevertheless, the positive influence of HOPE SOAP© on caregiver handwashing behavior is promising and, in conjunction with the finding that HOPE SOAP© improves children’s behaviors, provides reason to believe the intervention may be successful in inducing habitual handwashing behaviors which can persist in the long run.
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    Incorrect beliefs about male circumcision and male-to-female HIV transmission risk in South Africa: Implications for prevention
    (Journal of Acquired Immune Deficiency Syndromes, 2015-05-28) Maughan-Brown, Brendan; Venkataramani, Atheendar
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    Increasing access to HIV testing: Impacts on equity of coverage and uptake from a national campaign in South Africa
    (2015-05-28) Maughan-Brown, Brendan; Lloyd, Neil; Bor, Jacob; Venkataramani, Atheendar
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    Inequality and Diversity in Cape Town: An Introduction and User's Guide to the 2005 Cape Area Study
    (2005) Seekings, Jeremy; Jooste, Tracy; Langer, Mirah; Maughan-Brown, Brendan
    The 2005 Cape Area Study comprises a survey of aspects of diversity and inequality in the South African city of Cape Town. The survey was designed as both part of an ongoing study of Cape Town (that includes a series of surveys) and part of an international, multi-city study of aspects of urban life. This report provides an introduction to the survey for prospective users as well as important information for actual users, for example details of sample design and fieldwork.
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    Learning that circumcision is protective against HIV: Risk compensation among men and women in Cape Town, South Africa
    (PLoS ONE, 2012-07-19) Maughan-Brown, Brendan; Venkataramani, Atheendar
    Objectives: We examined whether knowledge of the HIV-protective benefits of male circumcision (MC) led to risk compensating behavior in a traditionally circumcising population in South Africa. We extend the current literature by examining risk compensation among women, which has hitherto been unexplored. Methods: We used data on Xhosa men and women from the 2009 Cape Area Panel Study. Respondents were asked if they had heard that MC reduces a man’s risk of contracting HIV, about their perceived risk of contracting HIV, and condom use. For each gender group we assessed whether risk perception and condom use differed by knowledge of the protective benefits of MC using bivariate and then multivariate models controlling for demographic characteristics, HIV knowledge/beliefs, and previous sexual behaviors. In a further check for confounding, we used data from the 2005 wave to assess whether individuals who would eventually become informed about the protective benefits of circumcision were already different in terms of HIV risk perception and condom use. Results: 34% of men (n = 453) and 27% of women (n = 690) had heard that circumcision reduces a man’s risk of HIV infection. Informed men perceived slightly higher risk of contracting HIV and were more likely to use condoms at last sex (p<0.10). Informed women perceived lower HIV risk (p<0.05), were less likely to use condoms both at last sex (p<0.10) and more generally (p<0.01), and more likely to forego condoms with partners of positive or unknown serostatus (p<0.01). The results were robust to covariate adjustment, excluding people living with HIV, and accounting for risk perceptions and condom use in 2005. Conclusions: We find evidence consistent with risk compensation among women but not men. Further attention should be paid to the role of new information regarding MC, and drivers of HIV risk more broadly, in modulating sexual behavior among women.
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    Male circumcision and sexual risk behaviors may contribute to considerable ethnic disparities in HIV prevalence in Kenya: an ecological analysis
    (Public Library of Science, 2014) Kenyon, Chris Richard; Vu, Lung; Menten, Joris; Maughan-Brown, Brendan
    BACKGROUND: HIV prevalence varies between 0.8 and 20.2% in Kenya's various ethnic groups. The reasons underlying these variations have not been evaluated before. METHODS: We used data from seven national surveys spanning the period 1989 to 2008 to compare the prevalence of a range of risk factors in Kenya's ethnic groups. Spearman's and linear regression were used to assess the relationship between HIV prevalence and each variable by ethnic group. RESULTS: The ethnic groups exhibited significant differences in a number of HIV related risk factors. Although the highest HIV prevalence group (the Luo) had the highest rates of HIV testing (Men 2008 survey: 56.8%, 95% CI 51.0-62.5%) and condom usage at last sex (Men 2008∶28.6%, 95% CI 19.6-37.6%), they had the lowest prevalence of circumcision (20.9%, 95% CI 15.9-26.0) the highest prevalence of sex with a non-married, non-cohabiting partner (Men: 40.2%, 95% CI 33.2-47.1%) and pre-marital sex (Men 2008∶73.9%, 95% CI 67.5-80.3%) and the youngest mean age of debut for women (1989 Survey: 15.7 years old, 95% CI 15.2-16.2). At a provincial level there was an association between the prevalence of HIV and male concurrency (Spearman's rho = 0.79, P = 0.04). Ethnic groups with higher HIV prevalence were more likely to report condom use (Men 2008 survey: R2 = 0.62, P = 0.01) and having been for HIV testing (Men 2008 survey: R2 = 0.47, P = 0.04). CONCLUSION: In addition to differences in male circumcision prevalence, variation in sexual behavior may contribute to the large variations in HIV prevalence in Kenya's ethnic groups. To complement the prevention benefits of the medical male circumcision roll-out in several parts of Kenya, interventions to reduce risky sexual behavior should continue to be promoted.
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    Measuring HIV/AIDS Stigma
    (2004) Maughan-Brown, Brendan
    This paper develops indices to measure HIV/AIDS stigma and explores potential determinants of this stigma. Indices are designed to measure the different dimensions of HIV/AIDS stigma. Findings show that levels of stigma vary depending on the measure of stigma used. Furthermore, despite stigma not being expressed consistently in each stigma index, the majority of respondents do exhibit HIV/AIDS stigma in some form. Judgemental attitudes and fear of infection are expressed with greater prevalence than intentions to discriminate against people living with HIV/AIDS (PLWHA). The respondents’ understanding of HIV transmission is found to have the greatest impact on predicting levels of HIV/AIDS stigma, providing evidence for the importance of education campaigns. Racial differences are also salient in predicting both the magnitude of HIV/AIDS stigma and its determinants. This suggests that cultural and environmental aspects need to be considered when addressing HIV/AIDS stigma.
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    A multidimensional quantitative evaluation of HIV/AIDS-related stigma in Cape Town, South Africa
    (2008) Maughan-Brown, Brendan; Nattrass, Nicoli
    This study arose out of a concern that previous South African national surveys may have underestimated the levels of HIV-related stigma because of limitations in the questions employed. It thus provides a more comprehensive evaluation of the extent and nature of HIV-related stigma through the measurement of several different dimensions of stigma (and regression analysis is used to conduct an exploratory examination of the factors associated with each dimension). It also presents the first assessment in South Africa of changes in stigmatising attitudes and behaviours towards people living with HIV/AIDS (PLWHA) over time.
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    Quantifying Stigma in the Adult Population of Cape Town
    (2006) Maughan-Brown, Brendan
    This paper builds on previous analyses of HIV/AIDS-related stigma among young adults (aged 15-23) in the Cape Metropolitan Area by using a representative sample of adults from the same area. It compares the findings from both surveys, and assesses whether the differences between the findings amongst young adults and previous national studies were due to the different age profiles of the samples. Findings show that age is not an important determinant of stigma, indicating similar levels of stigma for all ages, and AIDS education should target all age groups, not just young adults. As was the case with earlier research conducted with young adults only, the prevalence and magnitude of HIV/AIDS-related stigma in Cape Town was found to be significantly greater than stigma levels measured in previous national surveys. Most surveys measure stigma by focussing on behavioural intentions towards people living with HIV/AIDS, often concentrating on behavioural intentions towards family or friends. This paper measures behavioural intentions as well as three attitudinal components of HIV/AIDS-related stigma: instrumental (i.e. indicating fear of infection), symbolic (holding negative attitudes based on values) and resource-based (holding negative attitudes based on resources). Behavioural intentions are deconstructed into (1) intentions towards family/friends and (2) intentions towards strangers. Results show that behavioural intentions are less negative to family/friends with HIV than to strangers with HIV, and that if stigma is measured as symbolic stigma or instrumental stigma, then a higher degree of stigma is evident. Levels of resource-based stigma are very low. Instrumental stigma is a significant predictor of negative behavioural intentions towards people living with HIV/AIDS. This highlights the importance of HIV education. General bigotry and symbolic stigma also influence different dimensions of stigma. This suggests that although education is a necessary component for stigma alleviation, it is by no means sufficient. Racial differences are salient in predicting the determinants of the different dimensions of stigma. This highlights the necessity of considering cultural and environmental aspects in understanding stigma.