Browsing by Subject "Women"

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    A collection of discrete essays with the common theme of gender and slavery at the Cape of Good Hope with a focus on the 1820s
    (1993) Van der Spuy, Patricia; Worden, Nigel
    This is a collection of discrete essays, each embodying original research and bearing on the theme of gender and slavery at the Cape of Good Hope. Amelioration at the Cape profoundly altered gendered perceptions of slaves, both on the part of slaveholders, and of the slaves themselves. The amelioration regulations entailed a redefinition of the gender of female slaves, which was resisted by slaveholders and transformed by slave women, while slave men began to redefine their own gendered identities in this light. Slaveholders' traditional patriarchal self-concepts were severely threatened in this context, as they progressively lost power and authority, both to the new paternalist colonial state and to those who had formerly been subsumed within the patriarchal family. There are five papers, the first an introduction to the theoretical framework of the collection and an outline of the general argument as outlined above. The second paper provides a critique of existing Cape slave historiography from a gendered perspective. It examines the problems of this literature methodologically and theoretically, focusing on the implications of the slave sex ratio for the history of slave women. The final three papers are based on empirical research. The third paper examines the structural constraints on slave family formation in Cape Town from the perspective of slave women. The fourth and fifth papers explore issues related to infanticide and slave reproduction, and slave resistance in relation to the Bokkeveld rebellion of 1825, respectively.
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    A structural equation modelling of the buffering effect of social support on the report of common mental disorders in Zimbabwean women in the postnatal period
    (BioMed Central, 2019-02-28) Kaseke, Tanaka; January, James; Tadyanemhandu, Catherine; Chiwaridzo, Matthew; Dambi, Jermaine M
    Objective Globally, 13–20% of women experience a common mental disorder (CMD) postnatally. Unfortunately, the burden of CMDs is disproportionally substantial in women from low-income countries. Nevertheless, there is a growing recognition of the buffering effect of social support (SS) on psychiatric morbidity and the need for mental well-being support services/interventions. This study evaluated the relationship between psychiatric morbidity and SS levels, and factors influencing the mental health functioning of Zimbabwean women postnatally. Data were collected from 340 mothers and were analysed through structural equation modelling. Results The mothers’ mean age was 26.6 (SD 5.6) years. The mean Multidimensional Scale of Perceived Social Support score was 42.7 (SD 10.8), denoting high levels of SS. Additionally, 29.1% of the population reported excessive psychiatric morbidity, the median Shona Symptoms Questionnaire score was 5 (IQR: 2–8). The structural equation model demonstrated the buffering effects of SS on psychiatric morbidity (r = − 0.585, p = 0.01), and accounted for 70% of the variance. Being unmarried, increased maternal age, lower educational and income levels were associated with poorer maternal mental health. There is a need for routine; surveillance and treatment of CMDs in women in the postnatal period, including integration of low-cost, evidenced-based and task-shifting SS interventions.
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    Accuracy and determinants of perceived HIV risk among young women in South Africa
    (2018) Venkataramani, Atheendar S
    Abstract Background HIV risk perceptions are a key determinant of HIV testing. The success of efforts to achieve an AIDS-free generation – including reaching the UNAIDS 90–90-90 target – thus depends critically on the content of these perceptions. We examined the accuracy of HIV-risk perceptions and their correlates among young black women in South Africa, a group with one of the highest HIV incidence rates worldwide. Methods We used individual-level longitudinal data from the Cape Area Panel Study (CAPS) from 2005 to 2009 on black African women (20–30 years old in 2009) to assess the association between perceived HIV-risk in 2005 and the probability of testing HIV-positive four years later. We then estimated multivariable logistic regressions using cross-sectional data from the 2009 CAPS wave to assess the relationship between risk perceptions and a wide range of demographic, sexual behaviour and psychosocial covariates of perceived HIV-risk. Results We found that the proportion testing HIV-positive in 2009 was almost identical across perceived risk categories in 2005 (no, small, moderate, great) (χ 2 = 1.43, p = 0.85). Consistent with epidemiologic risk factors, the likelihood of reporting moderate or great HIV-risk perceptions was associated with condom-use (aOR: 0.57; 95% CI: 0.36, 0.89; p < 0.01); having ≥3 lifetime partners (aOR: 2.38, 95% CI: 1.53, 3.73; p < 0.01); knowledge of one’s partner’s HIV status (aOR: 0.67; 95% CI: 0.43, 1.07; p = 0.09); and being in an age-disparate partnerships (aOR: 1.73; 95% CI: 1.09, 2.76; p = 0.02). However, the likelihood of reporting moderate or great self-perceived risk did not vary with sexually transmitted disease history and respondent age, both strong predictors of HIV risk in the study setting. Risk perceptions were associated with stigmatising attitudes (aOR: 0.53; 95% CI: 0.26, 1.09; p = 0.09); prior HIV testing (aOR: 0.21; 95% CI: 0.13, 0.35; p < 0.01); and having heard that male circumcision is protective (aOR: 0.38; 95% CI: 0.22, 0.64; p < 0.01). Conclusions Results indicate that HIV-risk perceptions are inaccurate. Our findings suggest that this inaccuracy stems from HIV-risk perceptions being driven by an incomplete understanding of epidemiological risk and being influenced by a range of psycho-social factors not directly related to sexual behaviour. Consequently, new interventions are needed to align perceived and actual HIV risk.
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    Aggressive behaviour among drug-using women from Cape Town, South Africa: ethnicity, heavy alcohol use, methamphetamine and intimate partner violence
    (2017) Carney, Tara; Myers, Bronwyn; Kline, Tracy L; Johnson, Kim; Wechsberg, Wendee M
    BACKGROUND: Women have generally been found to be the victims of violence, but scant attention has been paid to the characteristics of women who perpetrate aggression and violence. In South Africa, violence is a prevalent societal issue, especially in the Western Cape. METHOD: This study aimed at identifying factors that were associated with aggression among a sample of 720 substance-using women. We conducted multivariate logistic regression to identify factors that are significantly associated with these behaviours. RESULTS: Ethnicity (Wald Χ2 = 17.07(2), p < 0.01) and heavy drinking (Wald Χ2 = 6.60 (2), p = 0.01) were significantly related to verbal aggression, methamphetamine use was significantly related to physical (Wald Χ2 = 2.73 (2), p = 0.01) and weapon aggression (Wald Χ2 = 7.94 (2), p < 0.01) and intimate partner violence was significantly related to verbal (Wald Χ2 = 12.43 (2), p < 0.01) and physical aggression (Wald Χ2 = 25.92 (2), p < 0.01). CONCLUSIONS: The findings show high levels of aggression among this sample, and highlight the need for interventions that address methamphetamine, heavy drinking and intimate partner violence among vulnerable substance-using women.
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    Cardiovascular magnetic resonance in women with cardiovascular disease: position statement from the Society for Cardiovascular Magnetic Resonance (SCMR)
    (2021-05-10) Ordovas, Karen G; Baldassarre, Lauren A; Bucciarelli-Ducci, Chiara; Carr, James; Fernandes, Juliano L; Ferreira, Vanessa M; Frank, Luba; Mavrogeni, Sophie; Ntusi, Ntobeko; Ostenfeld, Ellen; Parwani, Purvi; Pepe, Alessia; Raman, Subha V; Sakuma, Hajime; Schulz-Menger, Jeanette; Sierra-Galan, Lilia M; Valente, Anne M; Srichai, Monvadi B
    Abstract This document is a position statement from the Society for Cardiovascular Magnetic Resonance (SCMR) on recommendations for clinical utilization of cardiovascular magnetic resonance (CMR) in women with cardiovascular disease. The document was prepared by the SCMR Consensus Group on CMR Imaging for Female Patients with Cardiovascular Disease and endorsed by the SCMR Publications Committee and SCMR Executive Committee. The goals of this document are to (1) guide the informed selection of cardiovascular imaging methods, (2) inform clinical decision-making, (3) educate stakeholders on the advantages of CMR in specific clinical scenarios, and (4) empower patients with clinical evidence to participate in their clinical care. The statements of clinical utility presented in the current document pertain to the following clinical scenarios: acute coronary syndrome, stable ischemic heart disease, peripartum cardiomyopathy, cancer therapy-related cardiac dysfunction, aortic syndrome and congenital heart disease in pregnancy, bicuspid aortic valve and aortopathies, systemic rheumatic diseases and collagen vascular disorders, and cardiomyopathy-causing mutations. The authors cite published evidence when available and provide expert consensus otherwise. Most of the evidence available pertains to translational studies involving subjects of both sexes. However, the authors have prioritized review of data obtained from female patients, and direct comparison of CMR between women and men. This position statement does not consider CMR accessibility or availability of local expertise, but instead highlights the optimal utilization of CMR in women with known or suspected cardiovascular disease. Finally, the ultimate goal of this position statement is to improve the health of female patients with cardiovascular disease by providing specific recommendations on the use of CMR.
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    CareConekta: study protocol for a randomized controlled trial of a mobile health intervention to improve engagement in postpartum HIV care in South Africa
    (2020-03-12) Clouse, Kate; Phillips, Tamsin K; Camlin, Carol; Noholoza, Sandisiwe; Mogoba, Phepo; Naidoo, Julian; Langford, Richard; Weiss, Martin; Seebregts, Christopher J; Myer, Landon
    Abstract Background South Africa is home to the world’s largest antiretroviral therapy program but sustaining engagement along the HIV care continuum has proven challenging in the country and throughout the wider region. Population mobility is common in South Africa, but there are important research gaps in describing this mobility and its impact on engagement in HIV care. Postpartum women and their infants in South Africa are known to be at high risk of dropping out of HIV care after delivery and are frequently mobile. Methods In 2017, we developed a beta version of a smartphone application (app) - CareConekta - that detects a user’s smartphone location to allow for prospective characterization of mobility. Now we will adapt and test CareConekta to conduct essential formative work on mobility and evaluate an intervention - the CareConekta app plus text notifications and phone calls and/or WhatsApp messages - to facilitate engagement in HIV care during times of mobility. During the 3-year project period, our first objective is to evaluate the feasibility, acceptability, and initial efficacy of using CareConekta as an intervention to improve engagement in HIV care. Our second objective is to characterize mobility among South African women during the peripartum period and its impact on engagement in HIV care. We will enroll 200 eligible pregnant women living with HIV and receiving care at the Gugulethu Midwife Obstetric Unit in Cape Town, South Africa. Discussion This work will provide critical information about mobility during the peripartum period and the impact on engagement in HIV care. Simultaneously, we will pilot test an intervention to improve engagement with rigorously assessed outcomes. If successful, CareConekta offers tremendous potential as a research and service tool that can be adapted and evaluated in multiple geographic regions, study contexts, and patient populations. Trial registration ClinicalTrials.gov: NCT03836625. Registered on 8 February 2019.
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    Characteristics of perinatal depression in rural central, India: a cross-sectional study
    (BioMed Central, 2018-11-12) Rathod, Sujit D; Honikman, Simone; Hanlon, Charlotte; Shidhaye, Rahul
    Background Perinatal depression is associated with negative effects on child behavioural, cognitive and emotional development, birth outcomes, and physical growth. In India, increased priority accorded to mental health programs mean it is now possible to reduce the population-level burden of perinatal depression. In this secondary analysis of two studies, we aimed to describe the epidemiological features of depression among community- and facility-based samples of perinatal women from rural central India, and to describe the help-seeking behaviours from those women who screened positive for depression. Methods The Community Study was a multi-round population-based cross-sectional survey (n = 6087). The Facility Study was a multi-round facility-based cross-sectional survey (n = 1577). Both studies were conducted in Sehore District, Madhya Pradesh between 2013 and 2017. Field workers conducted structured interviews with perinatal women. The questionnaire had sections relating to sociodemographic characteristics, depression screening using the Patient’s Health Questionnaire (PHQ9), treatment seeking for depression-related symptoms, and disability. Using data pooled from both studies, we tested each characteristic for association with the total screening score and with screening positive for depression. Results We identified 224 perinatal women from the Community Study and 130 perinatal women from the Facility Study, of whom 8.8% and 18.5% screened positive for depression, respectively. For the continuous PHQ9 score, there was evidence of a “U” shaped association with age, and positive associations with pregnancy, disability score, suicidality and being a health facility attendee. For the binary PHQ9 score, there was evidence of positive associations with pregnancy, disability score, suicidality and being a health facility attendee. Conclusions This study highlights where the largest population-level variations in perinatal depression symptoms are present in this Indian sample, for which mental health service provision should be made a priority. Epidemiological evidence generated by this study, as well as new evidence on peer-delivered interventions for perinatal depression, must be utilized by policy-makers to prioritize mental health services for mothers along with maternal and child health services.
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    Coming to voice : identity and change in the teaching of writing to women
    (1997) Schuster, Anne; Thesen, Lucia
    As a teacher of creative writing, the researcher is interested in the most effective and appropriate approach to the teaching of writing to women. This study considers two approaches to the teaching of writing - writing as self expression, and writing as social practice. It outlines the theoretical framework of these two approaches, in terms of three key concepts - self, language and change. It looks at the implications of these approaches in terms of their approach to autobiography and in terms of 'the writing scene' - the context for women writers - and in particular, it looks at how women are affected by the approaches. The study then explores the implications of a feminist poststructuralist approach to the teaching of writing. The theoretical framework of this approach is discussed, again in terms of the three key concepts of self, language and change; and the approach is then 'translated' into the practical research of the study. Positioning itself as feminist advocacy research, it takes the form of an action research study where a series of writing workshops is designed and then facilitated in a selected group of women participants. The study analyses the process, the writing produced in the workshops, and the interviews with the participants after the workshops, in terms of how they reflect the central concepts, self, language and change of the feminist poststructuralist approach. The study concludes with a summary of the essential ingredients of a poststructuralist approach, it comments on the generalisability of the research to other groups, and comments on the research process in terms of the researcher's intentions as a piece of feminist advocacy research. In line with feminist research, the researcher is concerned that this dissertation is written in such a way as to be of practical use to a teacher of writing who might like to adopt a feminist poststructuralist approach. With this in mind, a complete set of workshop outlines is given in Appendix A, a complete set of handouts in Appendix B, and some resource material for teachers in Appendix C. Bibliography: pages 121-129.
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    Ethnic differences in alcohol and drug use and related sexual risks for HIV among vulnerable women in Cape Town, South Africa: implications for interventions
    (BioMed Central Ltd, 2013) Myers, Bronwyn; Kline, Tracy; Browne, Felicia; Carney, Tara; Parry, Charles; Johnson, Kim; Wechsberg, Wendee
    BACKGROUND: Alcohol and other drug (AOD) use among poor Black African and Coloured women in South Africa compounds their sexual risk for HIV. Given South Africa's history of ethnic disparities, ethnic differences in sex risk profiles may exist that should be taken into account when planning HIV risk reduction interventions. This paper aims to describe ethnic differences in AOD use and AOD-related sexual risks for HIV among vulnerable women from Cape Town, South Africa.METHOD:Cross-sectional data on 720 AOD-using women (324 Black African; 396 Coloured) recruited from poor communities in Cape Town were examined for ethnic differences in AOD use and AOD-related sexual risk behavior. RESULTS: Ethnic differences in patterns of AOD use were found; with self-reported drug problems, heavy episodic drinking and methamphetamine use being most prevalent among Coloured women and cannabis use being most likely among Black African women. However, more than half of Black African women reported drug-related problems and more than a third tested positive for recent methamphetamine use. More than a third of women reported being AOD-impaired and having unprotected sex during their last sexual encounter. Coloured women had four-fold greater odds of reporting that their last sexual episode was AOD-impaired and unprotected than Black African women. In addition, close to one in two women reported that their sexual partner was AOD-impaired at last sex, with Coloured women having three-fold greater odds of reporting that their partner was AOD-impaired at last sex than Black African women. CONCLUSIONS: Findings support the need to develop and test AOD risk reduction interventions for women from both ethnic groups. In addition, findings point to the need for tailored interventions that target the distinct profiles of AOD use and AOD-related sex risks for HIV among Black African and Coloured women.
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    Factors influencing adolescent girls and young women’s participation in a combination HIV prevention intervention in South Africa
    (2021-02-27) McClinton Appollis, Tracy; Duby, Zoe; Jonas, Kim; Dietrich, Janan; Maruping, Kealeboga; Abdullah, Fareed; Slingers, Nevilene; Mathews, Catherine
    Background For interventions to reach those they are intended for, an understanding of the factors that influence their participation, as well as the facilitators and barriers of participation are needed. This study explores factors associated with participation in a combination HIV prevention intervention targeting adolescent girls and young women (AGYW) aged 15–24-years-old, as well as the perspectives of AGYW, intervention implementers, and facilitators who participated in this intervention. Methods This study used mixed-methods approach with quantitative household survey data from 4399 AGYW aged 15–24-years-old in six of the ten districts in which the intervention was implemented. In addition, qualitative methods included a total of 100 semi-structured in-depth interviews and 21 focus group discussions in five of the ten intervention districts with 185 AGYW who participated in one or more of the key components of the intervention, and 13 intervention implementers and 13 facilitators. Thematic analysis was used to explore the perspectives of participating and implementing the intervention. Results Findings reveal that almost half of AGYW (48.4%) living in the districts where the intervention took place, participated in at least one of the components of the intervention. For both 15–19-year-olds and 20–24-year-olds, factors associated with increased participation in the intervention included being HIV negative, in school, never been pregnant, and having had a boyfriend. Experiencing intimate partner violence (IPV) and/or sexual violence in the past 12 months was associated with increased levels of participation in the intervention for 20–24-year-olds only. In our analysis of the qualitative data, facilitators to participation included motivating participants to join the interventions through explaining the benefits of the programme. Barriers included misguided expectations about financial rewards or job opportunities; competing responsibilities, interests or activities; family responsibilities including childcare; inappropriate incentives; inability to disrupt the school curriculum and difficulties with conducting interventions after school hours due to safety concerns; miscommunication about meetings; as well as struggles to reach out-of-school AGYW. Conclusion Designers of combination HIV prevention interventions need to address the barriers to participation so that AGYW can attend without risking their safety and compromising their family, childcare and schooling responsibilities. Strategies to create demand need to include clear communication about the nature and potential benefits of such interventions, and the inclusion of valued incentives.
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    Gender, community and identity : women and Afrikaner nationalism in the Volksmoeder discourse of Die Boerevrou (1919-1931)
    (1991) Kruger, Lou-Marie; Du Toit, André
    As a feminist exploration of the problematic relationship between Afrikaans women and Afrikaner nationalism, this thesis is primarily concerned with the construction of the social identities of Afrikaans women between 1919 and 1931, the crucial formative years of Afrikaner nationalism. The relationship between women and Afrikaner nationalism is thus addressed by an investigation at the level of intellectual history. The emergence of Afrikaner nationalism at the beginning of the 20th century was accompanied by the articulation of a distinctive gender discourse, the study of which is central to this thesis. Within this discourse, which may be termed the "volksmoeder" discourse, a new identity and new roles were contrived for Afrikaner women. We first investigate the social and historical context in which the discourse was generated and then analyse the "volksmoeder" discourse itself by focusing on texts from Die Boerevrou, a women's magazine launched by Mabel Malherbe in 1919. Rather than taking the Die Boerevrou-texts for granted or seeing them as simple reflections of reality, they are investigated as constructions. The questions of why these particular constructions had appeared in that specific context and what ends they achieved are posed. Rather than simply taking the discursive constructions at face value they are construed as "answers" to certain underlying social and historical issues. On a theoretical level the problem of the construction of gender and ethnic identities is informed by recent work in the field of discourse analysis, while the imagining or invention of nation-communities is discussed with reference to the work of Benedict Anderson, Ernst Gellner, Eric Hobsbawm and Tom Nairn. The investigation of Die Boerevrou-texts as particular articulations of the volksmoeder discourse shows how the social identities of Afrikaans women were socially constructed in the volksmoeder discourse. It suggests that the social subjectivities of Afrikaans women were by no means simple or transparent. In the texts of Die Boerevrou it becomes clear that even while being shaped by Afrikaner nationalism, women themselves were active in the shaping of Afrikaner nationalism. While they were constituted as subjects in the anti-feminist discourse of Afrikaner nationalism, they remained mobile within this discourse: always negotiating, planning, creating and articulating new identities and roles for themselves. The image of women as passive victims of a male Afrikaner discourses is thus denied. However, it is asserted that the volksmoeder discourse as a gender discourse can and should be severely criticised from a feminist perspective.
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    The global development agenda and the human rights of women in Africa
    (2015) Moorad, Anah Kelone; Manjoo, Rashida
    2015 signals the end of the Millennium Development Goals. Amidst the present reflection on, and analysis of, the progress of the implementation of the current development agenda, the draft post-2015 SDGs are in the final stages of their development. With the imminent adoption of the new goals by UN Member States in September 2015 the post-2015sustainable development agenda aims to integrate the principle of sustainability in order to continue the global drive for economic and human development within environmental limits. Through a comparative analysis of the Millennium Development Goals, the draft post-2015 Sustainable Development Goals as well as the documents that have contributed to their development, this paper critiques the manner in which the human rights of women have been, and will continue to be, addressed by the global development agenda. Additionally, using the African continent as a case study, this dissertation exposes the role played by regional political and human rights systems on the implementation of the global intention. Neglecting to adequately promote and protect the human rights of women in the continent reflects a lack of consideration for the interconnected nature of socioeconomic and environmental development and has wider consequences globally.
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    “It’s only fatness, it doesn’t kill”: a qualitative study on perceptions of weight gain from use of dolutegravir-based regimens in women living with HIV in Uganda
    (2022-06-21) Alhassan, Yussif; Twimukye, Adelline; Malaba, Thokozile; Myer, Landon; Waitt, Catriona; Lamorde, Mohammed; Colbers, Angela; Reynolds, Helen; Khoo, Saye; Taegtmeyer, Miriam
    Background Dolutegravir (DTG)-based regimens have been recommended by the WHO as the preferred first-line and second-line HIV treatment in all populations. Evidence suggests an association with weight gain, particularly among black women. Our study investigated perceptions of weight gain from DTG-based regimen use on body image and adherence of antiretroviral therapy in women living with HIV (WLHIV) in Uganda. Methods Between April and June 2021, we conducted semi-structured interviews involving 25 WLHIV (adolescents, women of reproductive potential and post-menopausal women) and 19 healthcare professionals (clinicians, nurses, ART managers and counsellors) purposively selected from HIV clinics in Kampala. The interviews explored perceptions of body weight and image; experiences and management of weight related side effects associated with DTG; and knowledge and communication of DTG-related risks. Data was analysed thematically in NVivo 12 software. Results Our findings indicate WLHIV in Uganda commonly disliked thin body size and aspired to gain moderate to high level body weight to improve their body image, social standing and hide their sero-positive status. Both WLHIV and healthcare professionals widely associated weight gain with DTG use, although it was rarely perceived as an adverse event and was unlikely to be reported or to alter medication adherence. Clinical management and pharmacovigilance of DTG-related weight gain were hampered by the limited knowledge of WLHIV of the health risks of being over-weight and obesity; lack of diagnostic equipment and resources; and limited clinical guidance for managing weight gain and associated cardiovascular and metabolic comorbidities. Conclusions The study highlights the significance of large body-size in promoting psychosocial wellbeing in WLHIV in Uganda. Although weight gain is recognized as a side effect of DTG, it may be welcomed by some WLHIV. Healthcare professionals should actively talk about and monitor for weight gain and occurrence of associated comorbidities to facilitate timely interventions. Improved supply of diagnostic equipment and support with sufficient guidance for managing weight gain for healthcare professionals in Uganda are recommended.
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    Perceived need for substance use treatment among young women from disadvantaged communities in Cape Town, South Africa
    (BioMed Central Ltd, 2014) Myers, Bronwyn; Kline, Tracy; Doherty, Irene; Carney, Tara; Wechsberg, Wendee
    BACKGROUND: Initiation of treatment for substance use disorders is low among young women from disadvantaged communities in Cape Town, South Africa. Yet little is known about the factors that influence perceived need for treatment (a determinant of treatment entry) within this population. METHODS: Baseline data on 720 young, drug-using women, collected as part of a randomized field experiment were analyzed to identify predisposing, enabling and health need factors associated with perceived need for treatment. RESULTS: Overall, 46.0% of our sample perceived a need for treatment. Of these participants, 92.4% wanted treatment for their substance use problems but only 50.1% knew where to access services. In multivariable logistic regression analyses, we found significant main effects for ethnicity (AOR=1.54, 95% CI=1.05-1.65), income (AOR=0.96, 95% CI=0.93-0.99), anxiety (AOR=1.22, 95% CI=1.05-1.45), and not having family members with drug problems (AOR=1.45, 95% CI=1.05-2.04) on perceived need for treatment. When the sample was stratified by methamphetamine use, income (AOR=0.87, 95% CI=0.79-0.96), awareness of treatment services (AOR =1.84, 95% CI=1.03-3.27), anxiety (AOR =1.41, 95% CI=1.06-1.87) and physical health status (AOR=6.29, 95% CI=1.56-25.64) were significantly associated with perceived need for treatment among those who were methamphetamine-negative. No variables were significantly associated with perceived need for treatment among participants who were methamphetamine-positive. CONCLUSIONS: A sizeable proportion of young women who could benefit from substance use treatment do not believe they need treatment, highlighting the need for interventions that enhance perceived need for treatment in this population. Findings also show that interventions that link women who perceive a need for treatment to service providers are needed. Such interventions should address barriers that limit young women's use of services for substance use disorders.
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    Probiotics for vaginal health in South Africa: what is on retailers’ shelves?
    (BioMed Central, 2017-01-19) Happel, Anna-Ursula; Jaumdally, Shameem Z; Pidwell, Tanya; Cornelius, Tracy; Jaspan, Heather B; Froissart, Remy; Barnabas, Shaun L; Passmore, Jo-Ann S
    Background: Probiotics are widely used to improve gastrointestinal (GI) health, but they may also be useful to prevent or treat gynaecological disorders, including bacterial vaginosis (BV) and candidiasis. BV prevalence is high in South Africa and is associated with increased HIV risk and pregnancy complications. We aimed to assess the availability of probiotics for vaginal health in retail stores (pharmacies, supermarkets and health stores) in two major cities in South Africa. Methods: A two-stage cluster sampling strategy was used in the Durban and Cape Town metropoles. Instructions for use, microbial composition, dose, storage and manufacturers’ details were recorded. Results: A total of 104 unique probiotics were identified in Cape Town and Durban (66.4% manufactured locally). Cape Town had more products than Durban (94 versus 59 probiotics), although 47% were common between cities (49/104). Only four products were explicitly for vaginal health. The remainder were for GI health in adults (51.0%) or infants (17.3%). The predominant species seen overall included Lactobacillus acidophilus (53.5%), L. rhamnosus (37.6%), Bifidobacterium longum ssp. longum (35.6%) and B. animalis ssp. lactis (33.7%). Products for vaginal health contained only common GI probiotic species, with a combination of L. acidophilus/B. longum ssp. longum/B. bifidum, L. rhamnosus/L. reuteri or L. rhamnosus alone, despite L. crispatus, L. gasseri, and L. jensenii being the most common commensals found in the lower female reproductive tract. Conclusion: This survey highlights the paucity of vaginal probiotics available in South Africa, where vaginal dysbiosis is common. Most vaginal products contained organisms other than female genital tract commensals
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    A randomized comparison of health-related quality of life outcomes of dolutegravir versus efavirenz-based antiretroviral treatment initiated in the third trimester of pregnancy
    (2022-06-07) Ochanda, Perez N; Lamorde, Mohammed; Kintu, Kenneth; Wang, Duolao; Chen, Tao; Malaba, Thokozile; Myer, Landon; Waitt, Catriona; Reynolds, Helen; Khoo, Saye
    Introduction Evidence on health-related quality of life (HRQoL) outcomes is limited for new antiretroviral therapies (ART). Dolutegravir-based treatment is being rolled out as the preferred first-line treatment for HIV in many low- and middle-income countries. We compared HRQoL between treatment-naïve pregnant women randomized to dolutegravir- or efavirenz-based ART in a clinical trial in Uganda and South Africa. Methods We gathered HRQoL data from 203 pregnant women of mean age 28 years, randomized to either dolutegravir- or efavirenz-based ART. We used the medical outcomes study-HIV health survey at baseline, 24 and 48 weeks between years 2018 and 2019. Physical health summary (PHS) and mental health summary (MHS) scores were the primary study outcomes, while the 11 MOS-HIV subscales were secondary outcomes. We applied mixed model analysis to estimate differences within and between-treatment groups. Multivariate regression analysis was included to identify associations between primary outcomes and selected variables. Results At 24 weeks postpartum, HRQoL scores increased from baseline in both treatment arms: PHS (10.40, 95% CI 9.24, 11.55) and MHS (9.23, 95% CI 7.35, 11.10) for dolutegravir-based ART; PHS (10.24, 95% CI 9.10, 11.38) and MHS (7.54, 95% CI 5.66, 9.42) for efavirenz-based ART. Increased scores for all secondary outcomes were significant at p < 0.0001. At 48 weeks, improvements remained significant for primary outcomes within group comparison. Estimated difference in PHS were higher in the dolutegravir-based arm, while increases in MHS were more for women in the efavirenz-based armat 24 and 48 weeks. No significant differences were noted for corresponding PHS scores at these time points compared between groups. Differences between arms were observed in two secondary outcomes: role function (1.11, 95% CI 0.08, 2.13), p = 0.034 and physical function outcomes (2.97, 95% CI 1.20, 4.73), p = 0.001. In the multivariate analysis, internet access was associated with higher PHS scores while owning a bank account, using the internet and longer treatment duration were associated with an increase in MHS scores. Conclusion We found no important differences in HRQoL outcomes among HIV-positive women started on dolutegravir relative to efavirenz in late pregnancy. Increases in HRQoL in the first year after delivery provide additional support for the initiation of ART in HIV-positive women presenting late in pregnancy. Trial Registration Clinical Trial Number: NCT03249181
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    Sexual behaviour of women in rural South Africa: a descriptive study
    (2016) Dubbink, Jan Henk; van der Eem, Lisette; McIntyre, James A; Mbambazela, Nontembeko; Jobson, Geoffrey A; Ouburg, Sander; Morré, Servaas A; Struthers, Helen E; Peters, Remco P H
    Abstract Background Sexual behaviour is a core determinant of the HIV and sexually transmitted infection (STI) epidemics in women living in rural South Africa. Knowledge of sexual behaviour in these areas is limited, but constitutes essential information for a combination prevention approach of behavioural change and biomedical interventions. Methods This descriptive study was conducted in rural Mopani District, South Africa, as part of a larger study on STI. Women of reproductive age (18–49 years) who reported sexual activity were included regardless of the reason for visiting the facility. Questionnaires were administered to 570 women. We report sexual behaviour by age group, ethnic group and self-reported HIV status. Results Young women (34 years); there was no difference for condom use during last sex act (36 % overall). Sotho women were more likely to report concurrent sexual partners whereas Shangaan women reported more frequent intravaginal cleansing and vaginal scarring practice in our analysis. HIV-infected women were older, had a higher number of lifetime sexual partners, reported more frequent condom use during the last sex act and were more likely to have a known HIV-infected partner than women without HIV infection; hormonal contraceptive use, fellatio, and a circumcised partner were less often reported. Conclusions This study provides insight into women’s sexual behaviour in a rural South African region. There are important differences in sexual behaviour by age group and ethnicity and HIV status; these should be taken into account when designing tailor-made prevention packages.
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    TB epidemiology: where are the young women? Know your tuberculosis epidemic, know your response
    (BioMed Central, 2018-03-27) Perumal, Rubeshan; Naidoo, Kogieleum; Padayatchi, Nesri
    Background The global predominance of tuberculosis in men has received significant attention. However, epidemiological studies now demonstrate that there is an increased representation of young women with tuberculosis, especially in high HIV burden settings where young women bear a disproportionate burden of HIV. The role of the HIV epidemic, as well as changes in behavioural, biological, and structural risk factors are explored as potential explanations for the increasing burden of tuberculosis in young women. Discussion As young women are particularly vulnerable to HIV infection in sub-Saharan Africa, it is unsurprising that the TB epidemic in this setting has become increasingly feminised. This age-sex trend of TB in South Africa is similar to WHO estimates for other countries with a high HIV prevalence where there are more female than male cases notified up to the age of 25 years. The high prevalence of anaemia of chronic disease in young women with HIV is an additional potential reason for their increased TB risk. The widespread use of injectable medroxyprogesterone acetate contraception, which has been shown to possess selective glucocorticoid effect and oestrogen suppression, in young women may be an important emerging biological risk factor for tuberculosis in young women. Behavioural factors such as alcohol use and tobacco smoking patterns are further factors which may be responsible for the narrowing of the sex gap in TB epidemiology. In comparison to the significantly higher alcohol consumption rates in men globally, there is a narrowing gap in alcohol consumption between the sexes in South Africa with alarming rates of alcohol abuse in young women. There is a similar narrowing of the tobacco smoking gap between the sexes in South Africa, with increasing smoking prevalence in young women. Conclusion With nearly 70% of all TB patients being co-infected with HIV in our setting, it is not surprising that the age and sex distribution of TB is increasingly resembling the distribution of HIV in this region of dual hyperendemicity. New TB service design must begin to reflect the presence of young women as a significant group burdened by the disease.
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    The association between high-sensitivity C-reactive protein and metabolic risk factors in black and white South African women: a cross-sectional study
    (BioMed Central, 2018-05-07) George, Cindy; Evans, Juliet; Micklesfield, Lisa K; Olsson, Tommy; Goedecke, Julia H
    Background High-sensitivity C-reactive protein (hsCRP) is associated with metabolic risk, however it is unclear whether the relationship is confounded by racial/ethnic differences in socioeconomic status (SES), lifestyle factors or central adiposity. The aims of the study was, (1) to investigate whether hsCRP levels differ by race/ethnicity; (2) to examine the race/ethnic-specific associations between hsCRP, HOMA-IR and serum lipids [total cholesterol (TC), triglycerides (TG), high-density lipoproteins (HDL-C) and low-density lipoproteins (LDL-C)]; and (3) to determine whether race/ethnic-specific associations are explained by SES, lifestyle factors or waist circumference (WC). Methods The convenience sample comprised 195 black and 153 white apparently health women, aged 18–45 years. SES (education, assets and housing density) and lifestyle factors (alcohol use, physical activity and contraceptive use) were collected by questionnaire. Weight, height and WC were measured, and fasting blood samples collected for hsCRP, glucose, insulin, and lipids. Results Black women had higher age- and BMI-adjusted hsCRP levels than white women (p = 0.047). hsCRP was associated with HOMA-IR (p < 0.001), TG (p < 0.001), TC (p < 0.05), HDL-C (p < 0.05), and LDL-C (p < 0.05), independent of age and race/ethnicity. The association between hsCRP and lipids differed by race/ethnicity, such that hsCRP was positively associated with TG and LDL-C in white women, and inversely associated with HDL-C in black women. Higher hsCRP was also associated with higher TC in white women and lower TC in black women. Furthermore, when adjusting for SES and lifestyle factors, the associations between hsCRP, and TC and TG, remained, however the associations between hsCRP, and HDL-C and LDL-C, were no longer significant. Conclusion Although circulating hsCRP may identify individuals at increased metabolic risk, the heterogeneity in these associations between racial/ethnic groups highlights the need for prospective studies investigating the role of hsCRP for risk prediction in different populations.
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    The effects of different dimensions of HIV-related stigma on HIV testing uptake among young men and women in Cape Town, South Africa
    (Southern Africa Labour and Development Research Unit, 2015-05-28) Maughan-Brown, Brendan; Nyblade, Laura