OpenUCT :: Browsing by Department "Aids and Society Research Unit"

Browsing by Department "Aids and Society Research Unit"

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Open Access
Alternative explanations about HIV and AIDS: re-examining distrust among young adults in Cape Town, South Africa
(2014-07-31) Rubincam, Clara
Alternative beliefs about HIV – such as the man-made origins of the virus or the existence of a cure – can undermine trust in and engagement with HIV prevention and treatment initiatives. It is therefore crucial to study the reasons why these beliefs are plausible to some individuals, and how we might better address them in future prevention and treatment campaigns. This study contributes to understanding these beliefs by examining the explanations provided by African respondents in Khayelitsha Township for the plausibility of alternative beliefs about HIV and AIDS. Drawn from a sub-selection of over 2900 respondents to the Cape Area Panel Study, ten focus group discussions (n=47) were held with African men and women from the township of Khayelitsha. Previous studies maintain that the experience of apartheid, of former President Mbeki’s AIDS denialism, and of the unsettling transformations of globalisation have negatively influenced the South African public’s trust in biomedical claims. This paper argues that in addition to these explanations, individuals express distrust about HIV science because certain aspects of these scientific explanations do not ‘add-up’, particularly when considered in light of their everyday observations and experiences. These disjunctures in information do not simply reflect a lack of HIV knowledge or rejection of scientific principles. Rather, in drawing on past and present experiences, individuals demonstrate their commitment to “street-level epistemologies of trust”, an informal manner of empirically engaging with science’s rationale. HIV prevention campaigns should draw on experiential aspects of HIV and AIDS to lend credibility to scientific claims and recognize that some doubts about science are a form of skeptical engagement rather than an outright rejection.
Open Access
Analyzing how notions of masculinity influence the vulnerability of men to HIV
(2008) Mumbengegwi, Elizabeth; Jubber, Ken
Includes abstract. Includes bibliographical references (leaves 77-84).
Open Access
Antiretroviral therapy in a community clinic - early lessons from a pilot project
(Health and Medical Publishing Group, 2003) Bekker, Linda-Gail; Orrell, Catherine; Reader, Larissa; Matoti, Larissa; Cohen, Karen; Martell, Rob; Abdullah, Fareed; Wood, Robin
Objectives. To report on operational and clinical problems encountered during the first 6 months of a community-based antiretroviral therapy (ART) programme. Methods. ART was implemented in a primary care setting utilising an easily replicable service-delivery model based on a medical officer and nurse. Therapeutic counsellors, themselves HIV-infected, provided counselling and adherence support. Drug and monitoring costs were charitably funded and provincial health authorities supplied the medical infrastructure. The HIV Research Unit, University of Cape Town, supplied training and additional clinical support. Local HIV primary care clinics provided patient referrals. Standardised ART regimens were used with strict entry criteria (AIDS or CD4 count < 200 cells/µl). Results. Demand for the service was high. Referred patients had advanced disease (AIDS 57%, median CD4 count 96/µl) and high pre-treatment mortality (83/100 person-years). Mycobacterial disease was a major contributor to this mortality (40%). Scheduled clinic visit hours were six times higher during recruitment than maintenance. Attributable costs were: drugs 61%, staff 27%, viral load and CD4 cell counts 10% and safety monitoring 2%. Viral load after 16 weeks of therapy was < 400 copies/ml in the first 16 patients. Conclusions. ART can be successfully implemented within a primary care setting. Drug purchases and staff salaries drive programme costing. The service model is capable of managing 250 - 300 patients on chronic ART, but staffing needs to be increased during recruitment. Attention must be given to the diagnosis of tuberculosis during screening and early ART. Incorporating therapeutic counsellors into the programme increased community involvement and utilised a valuable and previously untapped resource.
Open Access
Civil society and the state in Uganda’s AIDS response
(2014-07-06) Grebe, Eduard
This paper investigates state-civil society relations in the Ugandan AIDS response through a critical exploration of the history of Uganda’s ‘multi-sectoral’ and ‘partnership’ approaches, particularly as it pertains to The AIDS Support Organisation (TASO). It finds that the Ugandan government’s reputation for successful prevention campaigns is not necessarily deserved, and that the effectiveness of civil society is limited by an authoritarian political culture. Despite these limitations, however, state-civil society partnership did contribute to the emergence of a relatively effective coalition for action against HIV/AIDS. Donors were essential in encouraging the emergence of this coalition, but have also inadvertently undermined the emergence of strong and independent civil society voices able to hold the Ugandan state accountable.
Open Access
Community care worker approaches to working with HIV-positive male clients in Cape Town, South Africa
(2015-09) Gittings, Lesley
Caring is typically constructed as a feminized practice, resulting in women shouldering the burden of care-related work. Health-seeking behaviours are also constructed as feminine and men have poorer health outcomes globally. Employing men as carers may not only improve the health of the men they assist but also be transformative with regard to gendered constructions of caring. This working paper adds to the small but growing literature on men in caring by focusing on men as community care workers (CCWs) and their male clients. The empirical analysis draws on the perspectives of eight CCWs and three of their male clients from the Cape Town area. Using semi-structured interviews and observational home visits, this study explores the strategies that community care workers (CCWs) employ in providing support to HIV-positive male clients. In trying to avoid interrupting clients’ performance of hegemonic masculine norms, CCWs used techniques such as indirectly broaching sensitive subjects, acting friendly and being clear about the intention of their work.
Open Access
Considering alternatives to the predomination model of volentary councelling and testing practiced in South Africa
(2009) Brown, Sean; Head, Judith
Testing is widely acknowledged to be a useful and necessary secondary tool of Human Immunodeficiency Virus (HIV) prevention. It is the method by which to identify people who are living with the virus, so that their behaviour may be modified and medical condition treated in order to prevent further infection. Unfortunately, many persons in South Africa (SA) remain undiagnosed and therefore unaware of their HIV-positive status. This thesis explores why it is necessary to test for HIV in SA, where the incidence of the virus remains the highest in the world. Voluntary Counselling and Testing (VCT) or the &amp;acirc;opt-in&amp;acirc; approach has been adopted as the norm or &amp;acirc;sine qua non&amp;acirc;. The efficacy of this method will be interrogated and shortcomings identified. The most notable is that few people in SA undergo an HIV test in order to learn their status. When they do, it is often late in the progression of opportunistic infections, requiring hospitalisation that increases pressure on an already over-stretched healthcare system. Reasons for the poor uptake of VCT are explained, including pervasive stigma and deficiencies in leadership of SA&amp;acirc;s HIV and AIDS response. The expansion of testing is a proposed response to the challenge of persons remaining undiagnosed, and includes the acceleration of &amp;acirc;opt-out&amp;acirc; or routine HIV testing (RHT) among SA&amp;acirc;s high prevalence population. This model offers an HIV test routinely to persons attending government healthcare settings with an illness or for a routine check-up. Although the provider initiates the test, consent is necessary in order to proceed and there is an option to decline. While the key focus of this thesis is routine HIV testing, other approaches are explored in brief, including mandatory testing, mobile clinics and wellness screening. The thesis argues that if SA is to achieve the HIV and AIDS and STI National Strategic Plan (NSP) target of increasing the number of adults who have ever had a test to 70 percent by 2011, new approaches to testing, and especially opt-out, will need to be explored and more widely adopted. Key words: HIV/AIDS; Voluntary Counselling and Testing (VCT); Routine HIV Testing (RHT); Routinely Recommended Testing (RRT); Opt-out Testing; Provider-Initiated Testing and Counselling (PITC).
Open Access
Embracing new accountability : consequences for strategies and implemented policies
(2009) Dowden, Isabella; Mattes, Robert
Includes abstract. Includes bibliographical references (p. 83-90).
Open Access
The Emergence of Gender Scholarship in South Africa – reflections on Southern Theory
(2016-06) Morrell, Robert; Clowes, Lindsay
The late 20th century saw a steep rise in published works on gender in South Africa. This article analyses the production of gender research against a backdrop of current interest in southern theory, theory that is produced to analyse and challenge existing global knowledge inequalities. As a domain of research, South African gender writings draw both on global feminist impulses as well as national and local ones. We discuss what this means for understanding the particularity of South Africa’s gender scholarship which we trace back to the writings of Olive Schreiner at the beginning of the 20th century. In this paper we quantitatively identify the trajectory of gender research in South Africa and consider the genealogy of South African feminist writing. We show how the focus of gender research evolved noting that it sometimes was divided on grounds of race, but often was united by opposition to patriarchy which took forms of activist scholarship. We focus on a number of themes to show how feminist scholarship developed out of engagements with questions of inequality, race, class and gender. While gender research featured a strong, almost obsessive, engagement with local, South African issues which serve to give this body of work its cohesion, it also manifested divisions that reflected the very inequalities being researched.
Open Access
Evaluating the effectiveness of a multi-component intervention on early childhood development in paediatric HIV care and treatment programmes: a randomised controlled trial
(BioMed Central, 2018-07-09) Chingono, R; Mebrahtu, H; Mupambireyi, Z; Simms, V; Weiss, H A; Ndlovu, P; Charasika, F; Tomlinson, M; Cluver, L D; Cowan, F M; Sherr, L
Background HIV infection in a family may affect optimum child development. Our hypothesis is that child development outcomes among HIV-exposed infants will be improved through a complex early childhood stimulation (ECS) programme, and income and loans saving programme for HIV positive parents. Methods The study was a cluster-randomized controlled trial in 30 clinic sites in two districts in Zimbabwe. Clinics were randomised in a 1:1 allocation ratio to the Child Health Intervention for Development Outcomes (CHIDO) intervention or Ministry of Health standard care. The CHIDO intervention comprises three elements: a group ECS parenting programme, an internal savings and lending scheme (ISALS) and case-management home visits by village health workers. The intervention was aimed at caregiver-child dyads (child aged 0–24 months) where the infant was HIV exposed or infected. The primary outcomes were cognitive development (assessed by the Mullen Scales of Early Learning) and retention of the child in HIV care, at 12 months after enrolment. A comprehensive process evaluation was conducted. Discussion The results of this cluster-randomised trial will provide important information regarding the effects of multi-component interventions in mitigating developmental delays in HIV-exposed infants living in resource-limited environments. Trial registration This trial is registered with the Pan African Clinical Trials Registry ( www.pactr.org ), registration number PACTR201701001387209; the trial was registered on 16th January 2017 (retrospectively registered).
Open Access
An exploratory study into the factors that constrain or enable voluntary HIV testing among young adults in Cape Town, South Africa
(2008) Lane, Hannah
Despite exceptionally high HIV prevalence rates, South Africa experiences prohibitively low levels of HIV testing. Considered to be a key element in the prevention of HIV transmission and a necessary gateway for providing care and treatment for those who are infected, widespread ignorance of HIV status has become a mounting concern in countries with high prevalence rates. Strategies for increasing testing rates have most commonly focused on testing and treatment services, such as the availability and accessibility of clinics offering voluntary counselling and testing (VCT), the number of trained nurses and health practitioners able to administer HIV tests, the possibility of instituting routine HIV testing to increase coverage, and the provision of highly active antiretroviral treatment (HAART) in the event of a positive diagnosis. These efforts seek to either increase access to testing through infrastructural improvements or encourage testing by highlighting its function as a gateway to accessing medical services to manage HIV infection and future transmission. In a departure from these strategies, this thesis considers the physical, social, and psychological ramifications of living with HIV - and not simply issues of access, treatment, and prevention - in order to understand HIV testing practices. Qualitative in-depth interviews were conducted with 15 young adults (6 mole and 9 female) living in Cape Town, South Africa. Semi-structured in-depth interviews collected information about: 1) knowledge and sources of knowledge about HIV/AIDS, as well as how this knowledge changes over time; 2) beliefs and attitudes towards HIV and HIV testing, including corresponding health-seeking behaviours; 3) personal stories about HIV testing, including reasons for and reactions to testing; and 4) possible strategies to encourage HIV testing in the future. Study participants identified three broad threats that were perceived to be experienced by HIV positive people and explained how the HIV test served to either mitigate or expose an individual to these threats. Physical threats posed by HIV, such as opportunistic infections or death, encouraged HIV testing as it was only through testing that these potential threats could be mitigated. Conversely, an HIV test exposed an individual to social and psychological threats. The social threats of living with HIV included exclusion, rejection by family and friends, and social shame. Psychological threats included mental destruction, depression, and stress, among others. Where social and psychological threats were perceived to be strong, testing was actively avoided. The findings of this study are that the decision to voluntarily test for HIV can be explained through a balance of the physical, social, and psychological threats that may be managed or catalysed through an HIV test. When study participants perceived physical threats to outweigh perceived social and psychological threats of living with HIV, they were biased towards testing. When they viewed social and psychological threats to outweigh physical threats, they were biased against testing. This focus on the perceived threats of living with HIV highlights the need to have a comprehensive approach to AIDS and HIV, rather than merely focusing on the clinical diagnosis and treatment of symptoms; enhanced infrastructural resources and the opportunity for mitigation of the physical threats alone do not encourage HIV testing.
Open Access
Facilitating policy formulation and policy implementation : a case study of policy on the prevention of mother to child HIV transmission in South Africa
(2006) Peterson, Jennifer; Butler, Anthony
This case study explores the evolution of South African policy on prevention of mother to child HIV transmission (PMTCT). It employs the advocacy coalition framework developed by Paul Sabatier to analyse the factors that have hindered and facilitated the alteration and subsequent implementation of PMTCT policy. It provides a clear illustration of the impact that actors outside of the government can have on policy change and policy implementation.
Open Access
Factors shaping pre-service teacher identities in a South African HIV/AIDS context: An examination of experience, knowledge and perceptions
(2009) Arseneau, Robyn; Baxen, Jean
The HIV epidemic in South Africa is among the worst in the world with an estimated 5.7 million people living with HIV in 2007 (UNAIDS, 2008). South Africa's national education system has responded to the epidemic by introducing Life Skills HIV education across primary and secondary-level schools to promote HIV prevention, care and support among school learners. In particular, the Western Cape Education Department (WCED) has recommended that all teachers integrate HIV education across the curriculum. The Norms and Standards for Educators (NSE) policy document states that each pre-service teacher (PST) must meet 'community, citizenship and pastoral' practitioner roles; these roles entail student counselling, awareness and knowledge of issues impacting the community and corresponding support services, and promotion of HIV awareness in the school curriculum. HIV/AIDS education literature indicates that PST responses to teacher roles and responsibilities vary, and are often greatly influenced by the experiences PSTs bring with them into the teacher-training programme. This dissertation aimed to explore factors that shape PST identities in response to their HIV/AIDS teaching roles and responsibilities as outlined by the NSE policy document and the WCED. Research was conducted with a cohort of PSTs who attended the Post Graduate Certificate teachertraining programme at the University of Cape Town in 2007. A combination of qualitative and quantitative methods was used with a sample group of 81 PSTs. In total, 50 PSTs were surveyed and 19 PSTs were involved in 3 focus group discussions and 15 in-depth interviews. Findings from this study indicate that PSTs bring an array of their own experience, knowledge and perceptions to the teacher-training programme which ultimately shape and contribute to the teacher identity they create in responding to HIV/AIDS teaching roles and responsibilities. Based on evidence from the study, this thesis argues that the PST's experience, knowledge and perceptions of HIV I AIDS should be considered when developing teacher-training programmes in order to promote a comprehensive and effective response to HIV through the education sector in South Africa.
Open Access
Framing rights and responsibilities: accounts of women with a history of AIDS activism
(BioMed Central Ltd, 2011) MacGregor, Hayley; Mills, Elizabeth
BACKGROUND: In South Africa, policy with respect to HIV/AIDS has had a strong rights-based framing in line with international trends and in keeping with the constitutional overhaul in the post-Apartheid era. There have also been considerable advances since 1994 towards legal enshrinement of sexual and reproductive health rights and in the provision of related services. Since HIV in this setting has heavily affected women of reproductive age, there has been discussion about the particular needs of this subgroup, especially in the context of service integration. This paper is concerned with the way in which HIV positive women conceptualise these rights and whether they wish and are able to actualise them in their daily lives. METHODS: In 2003 a group of women involved with the Treatment Action Campaign and Medicines Sans Frontieres participated in an initiative to 'map' their bodies as affected by the virus. A book containing the maps and narratives was published and used as a political tool to pressure the government of the day to roll out antiretroviral therapy (ART) to the population. In 2008, the authors coordinated an initiative that involved conducting follow-up in-depth interviews in which five of these women reflected on those body maps and on how their lives had changed in the intervening five years since gaining the right to treatment through the public sector. RESULTS: Drawing upon this qualitative data and published sources, these new accounts are analysed in order to reflect the perspectives of these women living with chronic HIV with respect to their sexual relations and fertility desires. The paper reveals difficulties faced by these women in negotiating sexual relationships and disclosure of their HIV positive status. It focuses on how they perceive relative responsibilities in terms of taking preventative measures in sexual encounters. Women adopt tactics within a context characterised by various inequalities in order to 'make do', such as by remaining silent about their status. Concerns about childbearing can be addressed by information and support from a health care worker. CONCLUSIONS: Women's experience of HIV as a chronic illness and the need to adhere to ART, is linked to the way in which the language of responsibility can come to counter-balance a language of rights in treatment programmes.
Open Access
Growing up on HAART : the experiences and needs of HIV positive adolescents in care and treatment in the Western Cape province of South Africa
(2008) Li, Rachel; Nattrass, Nicoli
HIV positive adolescents are becoming a progressively more sizeable and prominent sub-group in the South African HIV/AIDS epidemic. As HAART becomes increasingly available, vertically infected children can be expected to survive into adolescence and adulthood. Additionally, sexual transmission of HIV remains a problem, and incidence and prevalence rates among South African youth are high. Experience from the developed world indicates that providing effective care and treatment for youth can be a challenging task. In light of the antiretroviral rollout in South Africa, this exploratory study aimed to identify the experiences and needs of adolescents growing up in care or on treatment for HIV in the Western Cape. To this end, a review of the existing literature on the psychosocial aspects of HIV infection in adolescents was undertaken. Relevant articles were identified, summarized and entered into a database, and particular attention was given to research conducted in the context of sub-Saharan Africa. Additionally, focus groups interviews were conducted with 26 young people attending an adolescent infectious diseases clinic at a tertiary hospital in the Western Cape. Focus groups proceeded according to a pre-set discussion guide and investigated participants' current life experinces, views on the future and self-perceived needs. All interviews were recorded, translated into English, and transcribed, and data were coded and analyzed using NVivo qualitative data analysis software. The study revealed that the psychosocial issues associated with HIV infection in adolescents coalesce around five central themes: knowledge and understanding about personal serostatus, mental health, network of support, treatment management, and healthy behaviour. These issues present challenges to HIV positive adolescents in the present, and affect their outlook on the future. Findings reveal that despite the fact that young seropositive South Africans live in a country where social contexts, available resources and healthcare systems differ markedly from those in developed countries, they share similar concerns and face many of the same challenges as other HIV positive young people around the world. Future studies should investigate each of the five identified themes in greater depth by determining the contextual correlates of individual views, experiences and needs.
Open Access
Herstory : Maidei Chivi, an HIV positive Zimbabwean woman
(2006) Mphisa, Abigael; Head, Judith
The thesis is based on the story of a 36 year old HIV positive middle class black Zimbabwean woman, Maidei Chivi (pseudonym). Maidei is well educated, financially secure and wields enormous power both within her family and at her workplace. She therefore, unlike many women, does not fall into the typical HIV victim category, characterised by poverty, coerced sex and desperation. Maidei's story demonstrates that economic security does not necessarily result in women taking decision making roles during sex.
Open Access
Heterosexual anal sex in the age of HIV : an exploratory study of a silenced subject
(2008) Duby, Zoe; Ju
This dissertation serves as a discursive exploration into the underdiscussed topic of heterosexual anal sex and pervading penile-vaginal heteronormativity. To understand the origins and character of the seemingly universal ambivalence towards heterosexual anal intercourse I attempt to situate it historically. There is general ignorance concerning the prevalence of this sexual behaviour, but there exist deep-seated taboos and undertones of immorality and abnormality associated with it. All these factors play a part in individual sexual decision making; an attempt is made at exploring the motivations and personal choices that culminate in an act of heterosexual anal intercourse.
Open Access
An HIV/AIDS intervention programme in the workplace: a case study of a medium-sized construction company in the Western Cape.
(2006) Griffiths, Roger; Head, Judith
Government and other NGOs want private sector companies to assist in countering the effects of HIV/AIDS by introducing interventions which follow generic outlined developed by the State and other institutions. The programmes are mainly aimed at the Human Rights of those who are HIV+, and do not have a commercial element. The assumption is that these programmes provide a cost benefit which outweighs the costs of a programme.
Open Access
Hope in view of HIV/AIDS in South Africa : public discourse, faith and the future
(2005) Olivier, Jill; Cochrane, James
Do discourses of "hope" have real and practical consequences when it come to crucial issues such as policy, prevention, stigma, risk perception or funding? The following exploratory and treansdisciplinary study seeks to pull together a wide variety of the theoretical and analytical stances in order to examine the social construction of hope in the context of HIV/AIDS in South Africa. the theoretical framework is built from a base of cultural theory, discourse analysis and theology, and binds these together into a transdisciplinary argument.
Open Access
Men, masculinities and HIV care work: A small-scale, exploratory study of the role of community care workers in supporting HIV positive men's health-seeking behaviour
(2015) Gittings, Lesley
Caring is typically constructed as a feminized practice, resulting in women shouldering the burden of care-related work. Health-seeking behaviours are also constructed as feminine and men have poorer health outcomes globally. Employing men as carers may not only improve the health of the men they assist but also be transformative with regard to gendered constructions of caring. This dissertation adds to the small but growing literature on men in caring by focusing on men as community care workers (CCWs) and their male clients. Using semi-structured interviews and observational home visits, this study explores whether male CCWs have a unique role to play in addressing harmful health-related gender norms and in supporting HIV positive men's health-affirming behaviour. The empirical analysis draws on the perspectives of eight CCWs and three of their male clients from the Cape Town area. Being problem-driven in nature and situated within a 'gender transformative' agenda, it explores male client preferences for gender concordant care workers and the techniques that CCWs (with a focus on male CCWs) employ to support HIV positive men's health-affirming behaviour. CCWs navigate around hegemonic masculine norms that require men to act tough, suppress emotion and deny weakness and sickness by using techniques such as indirectly broaching sensitive subjects, acting friendly and being clear about the intention of their work. The interviews revealed that CCWs strove not to rupture hegemonic masculine norms while encouraging male clients to engage in health-affirming behaviour . This dissertation also explores male client preferences for gender concordant CCWs and the potential that these pairings have to support health and to be 'gender transformative'. Here 'gender transformative' refers to the creation of more gender equitable environments. The variety of intertwined factors that contribute to male client preferences for male CCWs include gendered power dynamics, comfort in sharing intimate health information and a fear of women gossiping. Drawing on current literature on men, caring and gender transformation to inform the analysis of participant perspectives and experiences, this study explores the barriers to encouraging men to seek health and also considers the challenges in recruiting an d retaining men as CCWs. Employing more male CCWs is a strategy that could improve male client's health outcomes and also contribute to the development of more gender equitable norms. Shifting such norms requires much more than simply hiring men. To contribute to gender transformation, male CCWs should ideally resonate emotionally with their work, possess gender equitable beliefs and ground these beliefs in practice.
Open Access
Peer educators’ responses to mistrust and confusion about HIV and AIDS science in Khayelitsha, South Africa
(2014-08-30) Rubincam, Clara
Peer educators are on the front lines of communication between sources of scientific authority about HIV and AIDS and target populations. This study focuses on a group of peer educators from the Treatment Action Campaign working in Khayelitsha, South Africa (n=20), highlighting perceptions of their treatment literacy activities and the challenges faced in these encounters. In order to maintain clients’ trust in themselves and their information about HIV, they employ various “rhetorics of persuasion”, including accurate mobilisation of biomedical facts, personal testimonies, and figurative language such as parables and metaphors. These tactics build on community members’ everyday observations and experiences and draw from peer educators’ own credibility and trustworthiness as TAC members, and as members of the community. This paper draws attention to the ways in which peer educators’ personal agency and judgement are brought to the task of peer education, as well as the implications for future programmes using treatment literacy to advocate on behalf of biomedical facts about HIV and AIDS.