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Sikweyiya Y, Nkosi S, Langa M, Operario D, Lurie MN. "You see this thing is hard… ey, this thing is painful": The burden of the provider role and construction of masculinities amongst Black male mineworkers in Marikana, South Africa. PLoS One 2022; 17:e0268227. [PMID: 35604897 PMCID: PMC9126392 DOI: 10.1371/journal.pone.0268227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 04/25/2022] [Indexed: 02/04/2023] Open
Abstract
In this paper we examine men's insights on how migration and minework affect their perceptions and performances of masculinity in the settings of minework and in their "real home" communities and explore the potential consequences of masculinity constructions for their own and their family's health. This study used qualitative methodology. Findings are based on 13 in-depth interviews conducted over two phases of data collection with adult men who were either working or seeking work in the mines in North-West province, South Africa. Data suggest that for these men, migration to and working in the mines meant they must straddle the temporal space of work and the rural home space. For these men, the role of provider was an inescapable demand and, resulting from migration for work, their experience of fatherhood was solely centred on material provision with little or no emotional involvement with their children. Findings further illustrate the impact of minework on men's health and livelihoods-resulting in some men reimagining and seeking to create alternative career paths for their children. There is pressing need for labour reforms on the employment conditions of low-paid mine workers to enable them to reinforce their livelihoods and secure better futures for their families. Gender-transformative interventions which aim to transform ideas of masculinity that emphasize providing rather than emotional involvement with children are also needed.
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Affiliation(s)
- Yandisa Sikweyiya
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Sebenzile Nkosi
- Alcohol, Tobacco, and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Malose Langa
- School of Community and Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | - Mark N. Lurie
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America
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Smith J, Blom P. Those Who Don't Return: Improving Efforts to Address Tuberculosis Among Former Miners in Southern Africa. New Solut 2019; 29:76-104. [PMID: 30791826 DOI: 10.1177/1048291119832082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite increasing awareness regarding the role of oscillating migration in the mining industry as a major driving force in the spread of tuberculosis (TB) throughout southern Africa, very little work has focused on the historical and contextual factors which may contribute to former migrant miners' present-day risk of TB. Most research regarding migration-related and occupational influences on TB has been done on current miners still employed by the mining industry. Through both a historical and contemporary lens, this paper explores and elucidates the need to address the TB epidemic among former migrant mine workers and provides considerations to improve current interventions among this critical population.
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Affiliation(s)
- Jonathan Smith
- 1 Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | - Paul Blom
- 2 University of North Carolina at Chapel Hill, NC, USA
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3
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Sweileh WM. A bibliometric analysis of global research output on health and human rights (1900-2017). Glob Health Res Policy 2018; 3:30. [PMID: 30377667 PMCID: PMC6196451 DOI: 10.1186/s41256-018-0085-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/08/2018] [Indexed: 01/08/2023] Open
Abstract
Background Baseline data on global research activity on health and human rights (HHR) needs to be assessed and analyzed to identify research gaps and to prioritize funding and research agendas. Therefore, the aim of this study was to assess the growth of publications and research pattern on HHR. Methods A bibliometric methodology was used. Literature on HHR was retrieved using SciVerse Scopus for the study period from 1900 to 2017. Nine different search scenarios with different keyword combinations were used to retrieve the required documents. All types of documents published in peer-reviewed journals, including editorials, were included. The search strategy was validated. Results In total 6513 documents were retrieved with an h-index of 88 and an average of 9.8 citations per document. Publications on HHR field started as early as 1950 but showed a steep rise in the past two decades. Visualization of author keywords revealed that HIV/ AIDS, mental health, maternal and reproductive health, violence, ethics, torture, and refugees were most commonly encountered keywords. The journal "Health and Human Rights" was most active (n = 467; 7.2%) in this field. However, documents that appeared in The Lancet received the highest impact (29.5 citations per document). The United States of America produced the most in this field (n = 1817; 27.9%). Researchers in the region of Americas participated in approximately 45% of the retrieved documents while researchers in the Eastern Mediterranean region had the least contribution (2.5%). Researchers in high-income countries contributed to approximately 78% of the retrieved documents while researchers in low-income countries contributed to less than 5% of the retrieved documents. When data were standardized by population size, the research output from high-income countries was approximately four documents per one million inhabitants. For middle-income countries, the research output was 0.3 document per one million inhabitants. For low-income countries, the research output was 0.5 document per one million inhabitants. Conclusions Differential research productivity on HHR was seen among scholars in different world regions. World countries need to encourage and strengthen research on HHR in order to achieve the goals set in international agreements of human rights.
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology, Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Mashaphu S, Burns JK, Wyatt GE, Vawda NB. Psychosocial and behavioural interventions towards HIV risk reduction for serodiscordant couples in Africa: A systematic review. S Afr J Psychiatr 2018; 24:1136. [PMID: 30263215 PMCID: PMC6138108 DOI: 10.4102/sajpsychiatry.v24i0.1136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 04/19/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Sexual transmission of HIV frequently occurs in the context of a primary relationship between two partners; however, HIV prevention interventions generally focus on individuals at risk, rather than specifying couples as a unit of change and analysis, neglecting the crucial role that partners may play in sexual behaviour. This article reviews published scientific literature addressing couple-oriented HIV counselling and testing and other behavioural interventions using an online search for peer-reviewed papers. METHODS A systematic review was conducted to evaluate what has been published on psychosocial interventions in HIV serodiscordant couples in Africa. Electronic databases were searched from January 1990 to December 2015. Quality assessment of included studies was conducted using the Systematic Appraisal of Quality in Observational Research tool. RESULTS The electronic database searches initially retrieved 493 records; after cross-referencing, removing duplicates and applying strict inclusion and exclusion criteria, only eight papers were included in this review. All the studies under review showed that couples-focused counselling and educational programmes were associated with positive outcomes including reduced HIV transmission, reduced unprotected sex, increased rates of status disclosure and high levels of treatment adherence. CONCLUSIONS The literature on interventions for HIV serodiscordant couples is sparse. However, most interventions indicate that couples-focused interventions are effective in HIV risk reduction. In spite of the limited available data and repeated recommendations by different health authorities, couple-centred approaches to HIV prevention have not been implemented on a large scale.
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Affiliation(s)
| | | | - Gail E. Wyatt
- Department of Psychiatry and Bio-behavioural Sciences, University of California Los Angeles, United States
| | - Naseema B. Vawda
- Department of Behavioural Medicine, University of KwaZulu-Natal, South Africa
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5
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Wilches-Gutierrez J, Documet P. What is known about sexual and reproductive health in Latin American and Caribbean mining contexts? A systematic scoping review. Public Health Rev 2018; 39:1. [PMID: 29450102 PMCID: PMC5809854 DOI: 10.1186/s40985-017-0078-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/19/2017] [Indexed: 11/17/2022] Open
Abstract
Background Latin America and the Caribbean (LAC) has experienced an unprecedented mining boom since the mid-2000s with unknown effects on sexual and reproductive health (SRH). This study takes the essential first steps of summarizing the available literature regarding SRH in mining contexts in LAC, identifying critical gaps in knowledge, and discussing main implications for future research. Methods We conducted a scoping review with a systematic search of health literature in four databases, reference lists of selected papers, and citations in Google Scholar. Results The systematic search yielded 592 primary references and 16 articles from LAC. The 11 papers finally selected were conducted in gold-mining contexts in Brazil, Venezuela, Guyana, Peru, and Colombia, between 1995 and 2016. Ten studies centered on measuring HIV/STD prevalence among mineworkers and other populations; few examined associated risk factors. Eight studies reported high HIV/STD prevalence in the study population. None of the studies explored broader SRH issues. Conclusions Available research is scarce and provides limited evidence on SRH in LAC mining contexts. Critical gaps include little knowledge on (1) broader SRH impacts besides HIV/STDs, (2) SRH in settings different from gold-mining contexts in Amazon countries, (3) mechanisms shaping SRH in LAC mining contexts, and (4) effective interventions in these scenarios. Future research must consider the distinctive demographic, environmental, socioeconomic, and gender dynamics triggered by the mining economy in the analysis of the relationship between mining and SRH, particularly in a period of extractive boom.
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Affiliation(s)
- Jose Wilches-Gutierrez
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261 USA
| | - Patricia Documet
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261 USA
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6
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Martins-Fonteyn E, Loquiha O, Baltazar C, Thapa S, Boothe M, Raimundo I, Hens N, Aerts M, Meulemans H, Degomme O, Wouters E. Factors influencing risky sexual behaviour among Mozambican miners: a socio-epidemiological contribution for HIV prevention framework in Mozambique. Int J Equity Health 2017; 16:179. [PMID: 29017564 PMCID: PMC5634827 DOI: 10.1186/s12939-017-0674-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 09/26/2017] [Indexed: 11/25/2022] Open
Abstract
Background Information dealing with social and behavioural risk factors as well as their mechanisms among Mozambican migrants working in South African mines remains undocumented. This study aims to understand the various factors influencing HIV-related risk behaviours and the resulting HIV positive status of Mozambican miners employed by South African mines. This analysis was undertaken in order to inform a broader and more effective HIV preventive framework in Mozambique. Method This study relied upon data sourced from the first Integrated Biological and Behavioural Survey among Mozambican miners earning their living in South African mines. It employs quantitative techniques using standard statistical tools to substantiate the laid-down objectives. The primary technique applied in this paper is the multivariable statistical method used in the formulation and application of a proximate determinants framework. Results The odds of reporting one sexual partner were roughly three times higher for miners working as perforators as opposed to other types of occupation. As well, the odds of condom use – always or sometimes – for miners in the 31-40 age group were three times higher than the odds of condom use in the 51+ age group. Miners with lower education levels were less likely to use condoms. The odds of being HIV positive when the miner reports use of alcohol or drugs (sometimes/always) is 0.32 times lower than the odds for those reporting never use of alcohol or drugs. And finally, the odds of HIV positive status for those using condoms were 2.16 times that of miners who never used condoms, controlling for biological and other proximate determinants. Conclusion In Mozambique, behavioural theory emphasising personal behavioural changes is the main strategy to combat HIV among miners. Our findings suggest there is a need to change thinking processes about how to influence safer sexual behaviour. This is viewed to be the result of a person’s individual decision, due to of the complexity of social and contextual factors that may also influence sexual behaviours. This only stresses the need for HIV prevention strategies to exclusively transcend individual factors while considering the broader social and contextual phenomena influencing HIV risk among Mozambican miners.
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Affiliation(s)
- Emilia Martins-Fonteyn
- Research Centre for Longitudinal and Life Course Studies and Department of Sociology, University of Antwerp, City Campus, Prinsstraat 13, BE-2000, Antwerp, Belgium.
| | - Osvaldo Loquiha
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, University of Hasselt, Hasselt, Belgium.,Department of Mathematics and Informatics, University Eduardo Mondlane, Maputo, Mozambique
| | - Cynthia Baltazar
- Surveillance Department at National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Subash Thapa
- Department of Public Health, KU Leuven, Leuven, Belgium.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Makini Boothe
- University of California, San Francisco - USA, of Global Health Sciences, Maputo, Mozambique
| | - Ines Raimundo
- Faculty of Social Sciences, University Eduardo Mondlane, Maputo, Mozambique
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, University of Hasselt, Hasselt, Belgium.,Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Marc Aerts
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, University of Hasselt, Hasselt, Belgium
| | - Herman Meulemans
- Research Centre for Longitudinal and Life Course Studies and Department of Sociology, University of Antwerp, City Campus, Prinsstraat 13, BE-2000, Antwerp, Belgium
| | - Olivier Degomme
- International Centre for Reproductive Health (ICRH), University of Gent, Gent, Belgium
| | - Edwin Wouters
- Research Centre for Longitudinal and Life Course Studies and Department of Sociology, University of Antwerp, City Campus, Prinsstraat 13, BE-2000, Antwerp, Belgium
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7
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MacPhail C, Campbell C. Evaluating HIV/STD Interventions in Developing Countries: Do Current Indicators Do Justice to Advances in Intervention Approaches? SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1177/008124639902900401] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
HIV continues to spread unabated in many developing countries. Here we consider the interventions that are currently in place and critically discuss the methods that are being used to evaluate them as reported in the published literature. In recent years there has been a move away from highly individual-oriented interventions towards more participatory approaches that emphasise techniques such as community-led peer education and group discussions. However, this move towards more community orientated intervention techniques has not been matched by the development of evaluation methods with which to capture and explain the community and social changes which are often necessary preconditions for health-enhancing behaviour change. Evaluation research continues to rely on quantitative methodologies that fail to elucidate the complex changes that the newer interventions seek to promote within target communities. In addition, these methods of evaluation tend to rely on the use of highly individualistic and quantitative biomedical indicators such as HIV/STD rates, or knowledge, attitude, perception and behaviour (KAPB) survey questionnaires. We argue that such approaches are inadequate for the task of tracking and measuring important determinants of programme success such as psycho-social changes, features of the community-intervention interface and the degree of trust and identification with which members of target communities regard particular interventions. Rigorously conducted qualitative process evaluations taking account of the above factors could make a key contribution to the development of more successful HIV-prevention interventions.
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Affiliation(s)
- Catherine MacPhail
- CSIR Mining Technology, P.O. Box 91230, Auckland Park 2006, South Africa
| | - Catherine Campbell
- Department of Social Psychology, London School of Economics, Houghton Street, London WC2A 2AE, Britain
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8
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Deane KD, Samwell Ngalya P, Boniface L, Bulugu G, Urassa M. Exploring the relationship between population mobility and HIV risk: Evidence from Tanzania. Glob Public Health 2016; 13:173-188. [PMID: 27230067 DOI: 10.1080/17441692.2016.1178318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Migration and population mobility has long been regarded as an important structural driver of HIV. Following initial concerns regarding the spatial spread of the disease, mobile populations are viewed to engage in higher levels of risky sexual behaviours than non-mobile groups. However, beyond the case studies of mineworkers and truck drivers, the statistical evidence is inconclusive, suggesting that the relationship between mobility and risk is not well understood. This study investigated how engaging in specific livelihoods that involve mobility influences sexual behaviour and HIV risk. A qualitative research project, including focus groups and in-depth interviews with key mobile groups, was conducted in Northern Tanzania. The findings show that the patterns and conditions of moving related to the requirements of each different economic activity influence the nature of relationships that mobile groups have whilst away, how and where local sexual networks are accessed, and the practicalities of having sex. This has further implications for condom use. Risk behaviours are also shaped by local sexual norms related to transactional sex, emphasising that the roles of mobility and gender are interrelated, overlapping and difficult to disentangle.
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Affiliation(s)
- Kevin D Deane
- a Northampton Business School , University of Northampton , Northampton , UK
| | | | - Lucas Boniface
- b National Institute of Medical Research , Mwanza , Tanzania
| | - Grace Bulugu
- b National Institute of Medical Research , Mwanza , Tanzania
| | - Mark Urassa
- b National Institute of Medical Research , Mwanza , Tanzania
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9
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A cross-national analysis of the effects of methadone maintenance and needle and syringe program implementation on incidence rates of HIV in Europe from 1995 to 2011. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 32:3-10. [PMID: 27212656 DOI: 10.1016/j.drugpo.2016.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 02/02/2016] [Accepted: 02/06/2016] [Indexed: 11/23/2022]
Abstract
Although many studies have found an association between harm reduction interventions and reductions in incidence rates of Human Immunodeficiency Virus (HIV) infection, scant research explores the effects of harm reduction cross-nationally. This study used a year- and country-level fixed effects model to estimate the potential effects of needle-and-syringe programs (NSPs) and methadone maintenance therapy (MMT) on incidence rates of HIV in the general population and among people who inject drugs (PWID), in a sample of 28 European nations. After adjusting for Gross Domestic Product (GDP) and total expenditures on healthcare, we identified significant associations between years of MMT and NSP implementation and lower incidence rates of HIV among PWID and the general population. In addition to years of implementation of NSP and MMT, the greater proportion of GDP spent on healthcare was associated with a decrease in logged incidence rates of HIV. The findings of this study suggest that MMT and NSP may reduce incidence rates of HIV among PWID cross-nationally. The current study opens a new avenue of exploration, which allows for a focus on countrywide policies and economic drivers of the epidemic. Moreover, it highlights the immense importance of the adoption of harm reduction programs as empirically-based health policy as well as the direct benefits that are accrued from public spending on healthcare on incidence rates of HIV within the general population and among subpopulations of PWID.
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10
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Bulled NL. Social models of HIV risk among young adults in Lesotho. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 14:239-54. [PMID: 26284999 DOI: 10.2989/16085906.2015.1054295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Extensive research over the past 30 years has revealed that individual and social determinants impact HIV risk. Even so, prevention efforts focus primarily on individual behaviour change, with little recognition of the dynamic interplay of individual and social environment factors that further exacerbate risk engagement. Drawing on long-term research with young adults in Lesotho, I examine how social environment factors contribute to HIV risk. During preliminary ethnographic analysis, I developed novel scales to measure social control, adoption of modernity, and HIV knowledge. In survey research, I examined the effects of individual characteristics (i.e., socioeconomic status, HIV knowledge, adoption of modernity) and social environment (i.e., social control) on HIV risk behaviours. In addition, I measured the impact of altered environments by taking advantage of an existing situation whereby young adults attending a national college are assigned to either a main campus in a metropolitan setting or a satellite campus in a remote setting, irrespective of the environment in which they were socialised as youth. This arbitrary assignment process generates four distinct groups of young adults with altered or constant environments. Regression models show that lower levels of perceived social control and greater adoption of modernity are associated with HIV risk, controlling for other factors. The impact of social control and modernity varies with environment dynamics.
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Affiliation(s)
- Nicola L Bulled
- a Center for Global Health , University of Virginia , Charlottesville , Virginia , USA
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11
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Gow J, George G, Govender K. A comparison of quality of life between HIV positive and negative diamond miners in South Africa. SAHARA J 2014; 10:89-95. [PMID: 24405284 PMCID: PMC3914423 DOI: 10.1080/17290376.2013.870066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objective To analyse the health-related quality of life (HR-QOL) in two groups of diamond miners (HIV negative and positive) in South Africa using three instruments. Two hypotheses were to be tested. One, was that the HR-QOL of HIV positive miners would be lower than that of HIV negative miners; and two, the selected instruments would behave consistently and thus all would confirm hypothesis one. Methods In our study, workers were recruited during a voluntary counselling and testing programme for HIV. HR-QOL were estimated using the Assessment of Quality of Life (AQOL) Mark 2, EQ-5D (EuroQOL), and Health Utilities Index 3 (HUI3) instruments. The data were analysed for utility values and for correlations between variables of interest (in particular HIV status). Goodness of fit, Pearson's r coefficient and t-tests were the statistical tests applied to the data. Results Just over 1100 respondents were included in the analysis. HIV positive workers scored significantly lower on quality of life on the HUI3 as compared to HIV negative workers but this relationship did not (surprisingly) hold for the AQOL or EQ-5D. There was a significant positive correlation between all three instruments. Conclusion There was inconsistency among the instruments in measuring quality of life differences according to HIV status. The HUI3 confirmed the a priori expectation that the HR-QOL of HIV positive miners would be lower than HIV negative miners. There was no statistical difference for the AQOL and a confounding result was found for the EQ5D.
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Affiliation(s)
- Jeff Gow
- a PhD, Associate Professor, is affiliated to the School of Accounting, Economics and Finance , University of Southern Queensland , Toowoomba , Australia
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12
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Babu GR, Mahapatra T, Mahapatra S, Detels R. Sexual behavior and job stress in software professionals, Bengaluru - India. Indian J Occup Environ Med 2014; 17:58-65. [PMID: 24421592 PMCID: PMC3877448 DOI: 10.4103/0019-5278.123165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Sexually transmitted diseases are now gradually affecting the general population groups increasingly. Our earlier observations from qualitative research called for an effort to understand the sexual exposure, activity and behavior of the workers in these software professionals in Bengaluru, India. Aim: The current study is explored to understand the association of the sexual behaviors with Job. Materials and Methods: The study design employed was a cross-sectional study using a mixed sampling method. A total of 1071 subjects from software sector in Bengaluru, the capital city of Karnataka completed the self-administered questionnaire. The source population comprised all information technology/information technology enabled services (IT/ITES) professionals aged 20-59 years working in “technical functions” in 21 selected worksites (units) of the software industry. The exposure of interest was job stressors and the outcome measures were sexual behaviors in the form of having multiple sexual partners, paid sex in last 3 months and frequency of intercourse with irregular sexual partners and condom use with regular partners during last sexual act. Results: Among the study population, 74.3% reported not using a condom during their last vaginal intercourse with their regular partner. Regression estimates indicated that workers with high physical stressors had 6 times odds of having paid for sex in last 3 months and those with a moderate level of income related stress had 2.4 times likelihood of not using a condom during the last sexual intercourse with their regular partner. Conclusion: There is scope for starting prevention programs among young professionals in the IT/ITES sector to mitigate their possible risk behaviors.
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Affiliation(s)
- Giridhara R Babu
- Department of Epidemiology, Public Health Foundation of India, IIPH-H, Bangalore Campus, Bengaluru, Karnataka, India
| | - Tanmay Mahapatra
- Department of Epidemiology, University of California, Los Angeles, California, USA
| | - Sanchita Mahapatra
- Department of Epidemiology, University of California, Los Angeles, California, USA
| | - Roger Detels
- Department of Epidemiology, University of California, Los Angeles, California, USA
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13
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Hirsch JS. Labor migration, externalities and ethics: theorizing the meso-level determinants of HIV vulnerability. Soc Sci Med 2014; 100:38-45. [PMID: 24444837 PMCID: PMC4001245 DOI: 10.1016/j.socscimed.2013.10.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 10/18/2013] [Accepted: 10/21/2013] [Indexed: 11/16/2022]
Abstract
This paper discusses labor migration as an example of how focusing on the meso-level highlights the social processes through which structural factors produce HIV risk. Situating that argument in relation to existing work on economic organization and HIV risk as well as research on labor migration and HIV vulnerabilities, the paper demonstrates how analyzing the processes through which labor migration creates vulnerability can shift attention away from the proximate behavioral determinants of HIV risk and toward the community and policy levels. Further, it presents the concepts of externalities and the ethics of consumption, which underline how both producers and consumers benefit from low-waged migrant labor, and thus are responsible for the externalization of HIV risk characteristic of supply chains that rely on migrant labor. These concepts point to strategies through which researchers and advocates could press the public and private sectors to improve the conditions in which migrants live and work, with implications for HIV as well as other health outcomes.
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Affiliation(s)
- Jennifer S Hirsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, United States.
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Zhuang K, McQuaide S. AIDS/other STIs prevention in China: the effect of sex worker migration and the organization of the sex industry. Anthropol Med 2013; 20:36-47. [PMID: 23514622 DOI: 10.1080/13648470.2013.774935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
HIV/AIDS prevention projects that pay special attention to the socio-cultural context of a community have been implemented in a number of Asian and African countries recently. Such projects integrate scientific approaches, such as condom promotion, with cultural approaches that focus on regional social norms. This paper explores effective intervention strategies in the context of sex workers' mobility patterns, and the sex industry's internal organization in China. It argues that a social network based on quasi-familial relations and regional ties recruits young women into the business, helps them move vertically as well as horizontally within the business, and facilitates the smooth operation of the business. A sound understanding of the specific characteristics of sex work in China, therefore, is instrumental in formulating effective intervention tactics.
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Affiliation(s)
- Kongshao Zhuang
- aInstitute of Anthropology, Zhejiang University, 310007 China
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15
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Gupta I, Joe W, Rudra S. HIV prevention: Towards a “structural-plus” approach. Health (London) 2013. [DOI: 10.4236/health.2013.51014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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HIV prevention, structural change and social values: the need for an explicit normative approach. J Int AIDS Soc 2012; 15 Suppl 1:1-10. [PMID: 22713355 PMCID: PMC3499876 DOI: 10.7448/ias.15.3.17367] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 04/01/2012] [Accepted: 04/29/2012] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The fact that HIV prevention often deals with politicised sexual and drug taking behaviour is well known, but structural HIV prevention interventions in particular can involve alteration of social arrangements over which there may be further contested values at stake. As such, normative frameworks are required to inform HIV prevention decisions and avoid conflicts between social goals. METHODS This paper provides a conceptual review and discussion of the normative issues surrounding structural HIV prevention strategies. It applies political and ethical concepts to explore the contested nature of HIV planning and suggests conceptual frameworks to inform future structural HIV responses. RESULTS HIV prevention is an activity that cannot be pursued without making value judgements; it is inherently political. Appeals to health outcomes alone are insufficient when intervention strategies have broader social impacts, or when incidence reduction can be achieved at the expense of other social values such as freedom, equality, or economic growth. This is illustrated by the widespread unacceptability of forced isolation which may be efficacious in preventing spread of infectious agents, but conflicts with other social values. CONCLUSIONS While no universal value system exists, the capability approach provides one potential framework to help overcome seeming contradictions or value trade-offs in structural HIV prevention approaches. However, even within the capability approach, valuations must still be made. Making normative values explicit in decision making processes is required to ensure transparency, accountability, and representativeness of the public interest, while ensuring structural HIV prevention efforts align with broader social development goals as well.
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Abstract
Mobility is a key determinant of HIV/sexually transmitted infection (STI) transmission dynamics in Asia and Africa. Scant data exist regarding its dynamic impacts on HIV/STI risk in Central America and Mexico. Our objective was to critically review the epidemiology and social and structural context of HIV/STI risk among mobile populations in Central America and Mexico. Eligible articles were published in English or Spanish between January 1, 2000 and August 31, 2010; conducted in Central America or Mexico; specified the mobile population included; and described primary research. 2045 records were screened, 275 articles reviewed, and 22 studies included. Mobility is associated with increased HIV risk behaviors, though it also may increase preventive behaviors. Among mobile groups in Central America and Mexico, social isolation, the socio-economic impacts of displacement, gender inequalities, and stigma/discrimination shape HIV risk. Epidemiologic research and multi-level interventions that target and engage vulnerable groups in transit stations are recommended.
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Eves R. Resisting Global AIDS Knowledges: Born-Again Christian Narratives of the Epidemic from Papua New Guinea. Med Anthropol 2012; 31:61-76. [DOI: 10.1080/01459740.2011.594122] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Auerbach JD, Parkhurst JO, Cáceres CF. Addressing social drivers of HIV/AIDS for the long-term response: Conceptual and methodological considerations. Glob Public Health 2011; 6 Suppl 3:S293-309. [DOI: 10.1080/17441692.2011.594451] [Citation(s) in RCA: 225] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rispel LC, Peltzer K, Nkomo N, Molomo B. Evaluating an HIV and AIDS Community Training Partnership Program in five diamond mining communities in South Africa. EVALUATION AND PROGRAM PLANNING 2010; 33:394-402. [PMID: 20185178 DOI: 10.1016/j.evalprogplan.2010.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 01/26/2010] [Accepted: 02/01/2010] [Indexed: 05/28/2023]
Abstract
In 2006, De Beers Consolidated Diamond Mines in South Africa entered into a partnership with the Soul City Institute for Health and Development Communications to implement an HIV and AIDS Community Training Partnership Program (CTPP), initially in five diamond mining areas in three provinces of South Africa. The aim of CTPP was to improve HIV knowledge and to contribute to positive behavior changes in the targeted populations. This paper describes the evaluation of the CTPP, one year after implementation. The evaluation combined qualitative interviews with key informants and trainers and a post-intervention survey of 142 community members. The successes of the CTPP included capacity building of trainers through an innovative training approach and HIV and AIDS knowledge transfer to community trainers and targeted communities in remote mining towns. The Soul City edutainment brand is popular and emerged as a major reason for success. Challenges included insufficient attention paid to contextual factors, resource constraints and the lack of a monitoring and evaluation framework. Independent evaluations are useful to strengthen program implementation. In remote areas and resource constraint settings, partnerships between non-governmental organisations and corporations may be required for successful community HIV and AIDS initiatives.
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Affiliation(s)
- L C Rispel
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Enoch Sontonga Avenue, 2050 Braamfontein, Johannesburg, South Africa.
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Lewycka S, Mwansambo C, Kazembe P, Phiri T, Mganga A, Rosato M, Chapota H, Malamba F, Vergnano S, Newell ML, Osrin D, Costello A. A cluster randomised controlled trial of the community effectiveness of two interventions in rural Malawi to improve health care and to reduce maternal, newborn and infant mortality. Trials 2010; 11:88. [PMID: 20849613 PMCID: PMC2949851 DOI: 10.1186/1745-6215-11-88] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 09/17/2010] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The UN Millennium Development Goals call for substantial reductions in maternal and child mortality, to be achieved through reductions in morbidity and mortality during pregnancy, delivery, postpartum and early childhood. The MaiMwana Project aims to test community-based interventions that tackle maternal and child health problems through increasing awareness and local action. METHODS/DESIGN This study uses a two-by-two factorial cluster-randomised controlled trial design to test the impact of two interventions. The impact of a community mobilisation intervention run through women's groups, on home care, health care-seeking behaviours and maternal and infant mortality, will be tested. The impact of a volunteer-led infant feeding and care support intervention, on rates of exclusive breastfeeding, uptake of HIV-prevention services and infant mortality, will also be tested. The women's group intervention will employ local female facilitators to guide women's groups through a four-phase cycle of problem identification and prioritisation, strategy identification, implementation and evaluation. Meetings will be held monthly at village level. The infant feeding intervention will select local volunteers to provide advice and support for breastfeeding, birth preparedness, newborn care and immunisation. They will visit pregnant and new mothers in their homes five times during and after pregnancy.The unit of intervention allocation will be clusters of rural villages of 2500-4000 population. 48 clusters have been defined and randomly allocated to either women's groups only, infant feeding support only, both interventions, or no intervention. Study villages are surrounded by 'buffer areas' of non-study villages to reduce contamination between intervention and control areas. Outcome indicators will be measured through a demographic surveillance system. Primary outcomes will be maternal, infant, neonatal and perinatal mortality for the women's group intervention, and exclusive breastfeeding rates and infant mortality for the infant feeding intervention.Structured interviews will be conducted with mothers one-month and six-months after birth to collect detailed quantitative data on care practices and health-care-seeking. Further qualitative, quantitative and economic data will be collected for process and economic evaluations. TRIAL REGISTRATION ISRCTN06477126.
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Affiliation(s)
- Sonia Lewycka
- Centre for International Health and Development, UCL Institute of Child Health, London, UK.
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Cohen R, Lynch S, Bygrave H, Eggers E, Vlahakis N, Hilderbrand K, Knight L, Pillay P, Saranchuk P, Goemaere E, Makakole L, Ford N. Antiretroviral treatment outcomes from a nurse-driven, community-supported HIV/AIDS treatment programme in rural Lesotho: observational cohort assessment at two years. J Int AIDS Soc 2009; 12:23. [PMID: 19814814 PMCID: PMC2768674 DOI: 10.1186/1758-2652-12-23] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 10/08/2009] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Lesotho has the third highest HIV prevalence in the world (an adult prevalence of 23.2%). Despite a lack of resources for health, the country has implemented state-of-the-art antiretroviral treatment guidelines, including early initiation of treatment (<350 cells/mm3), tenofovir in first line, and nurse-initiated and managed HIV care, including antiretroviral therapy (ART), at primary health care level. PROGRAMME APPROACH: We describe two-year outcomes of a decentralized HIV/AIDS care programme run by Doctors Without Borders/Médecins Sans Frontières, the Ministry of Health and Social Welfare, and the Christian Health Association of Lesotho in Scott catchment area, a rural health zone covering 14 clinics and one district hospital. Outcome data are described through a retrospective cohort analysis of adults and children initiated on ART between 2006 and 2008. DISCUSSION AND EVALUATION Overall, 13,243 people have been enrolled in HIV care (5% children), and 5376 initiated on ART (6.5% children), 80% at primary care level. Between 2006 and 2008, annual enrolment more than doubled for adults and children, with no major external increase in human resources. The proportion of adults arriving sick (CD4 <50 cells/mm3) decreased from 22.2% in 2006 to 11.9% in 2008. Twelve-month outcomes are satisfactory in terms of mortality (11% for adults; 9% for children) and loss to follow up (8.8%). At 12 months, 80% of adults and 89% of children were alive and in care, meaning they were still taking their treatment; at 24 months, 77% of adults remained in care. CONCLUSION Despite major resource constraints, Lesotho is comparing favourably with its better resourced neighbour, using the latest international ART recommendations. The successful two-year outcomes are further evidence that HIV/AIDS care and treatment can be provided effectively at the primary care level. The programme highlights how improving HIV care strengthened the primary health care system, and validates several critical areas for task shifting that are being considered by other countries in the region, including nurse-driven ART for adults and children, and lay counsellor-supported testing and counselling, adherence and case management.
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Assessing HIV Risk in Workplaces for Prioritizing HIV Preventive Interventions in Karnataka State, India. Sex Transm Dis 2009; 36:556-63. [DOI: 10.1097/olq.0b013e3181a8cdcf] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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"They (ARVs) are my life, without them I'm nothing"--experiences of patients attending a HIV/AIDS clinic in Johannesburg, South Africa. Health Place 2009; 15:1123-9. [PMID: 19596603 DOI: 10.1016/j.healthplace.2009.06.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 05/12/2009] [Accepted: 06/16/2009] [Indexed: 11/20/2022]
Abstract
This paper is a part of a larger study that explores the "social complexity" of antiretroviral therapy (ART), in resource-limited environments. Drawing on in-depth interviews with a sample of 44 patients in an urban HIV/AIDS clinic in Johannesburg, South Africa, this paper examines how people with HIV/AIDS conceptualize their illness and its treatment in this context. The paper concludes that the fear of stigma plays a significant role in patients' experiences throughout the disease trajectory. Yet, demonstrates that there are indications that ARVs are transforming the experience of living with HIV/AIDS and a process of normalisation is taking place. Despite the resource-limited context and, often, lack of family and community support, patients see the ARVs as 'life saving' and express their long-term commitment to adhere to the drug regimen as well as their trust in health professionals.
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Goldenberg S, Shoveller J, Koehoorn M, Ostry A. Barriers to STI testing among youth in a Canadian oil and gas community. Health Place 2008; 14:718-29. [DOI: 10.1016/j.healthplace.2007.11.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 11/14/2007] [Accepted: 11/21/2007] [Indexed: 10/22/2022]
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Sexually transmitted infection (STI) testing among young oil and gas workers: the need for innovative, place-based approaches to STI control. Canadian Journal of Public Health 2008. [PMID: 18767285 DOI: 10.1007/bf03403770] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Northeastern British Columbia is undergoing rapid in-migration of young, primarily male workers in response to the "boom" in the oil/gas industries. Accompanying the boom is a rise in Chlamydia rates among youth, which exceed the provincial average by 22%. STI testing reduces the disease burden, contributing to STI prevention. OBJECTIVES 1) To document youths' perceptions regarding the socio-cultural and structural forces that affect young oil/gas workers' access to STI testing; 2) to gather service providers' perspectives on sexual health service delivery for workers; and 3) to develop recommendations to improve the accessibility of STI testing. METHODS We conducted ethnographic fieldwork (8 weeks) in a remote oil/gas community, including in-depth interviews with 25 young people (ages 15-25) and 14 health and social service providers. RESULTS Participants identified limited opportunities to access testing, geographic isolation, and 'rigger' culture as three key categories inhibiting STI testing among oil/gas Workers. DISCUSSION These results suggest the need for place-based approaches to STI control. Innovative outreach strategies are suggested to address oil/gas workers' needs, including a locally tailored STI awareness campaign, condom distribution, expanded clinic hours, and onsite STI testing.
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Abstract
Recognition that social, economic, political, and environmental factors directly affect HIV risk and vulnerability has stimulated interest in structural approaches to HIV prevention. Progress in the use of structural approaches has been limited for several reasons: absence of a clear definition; lack of operational guidance; and limited data on the effectiveness of structural approaches to the reduction of HIV incidence. In this paper we build on evidence and experience to address these gaps. We begin by defining structural factors and approaches. We describe the available evidence on their effectiveness and discuss methodological challenges to the assessment of these often complex efforts to reduce HIV risk and vulnerability. We identify core principles for implementing this kind of work. We also provide recommendations for ensuring the integration of structural approaches as part of combined prevention strategies.
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Affiliation(s)
- Geeta Rao Gupta
- International Center for Research on Women, Washington, DC, USA
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Furin J, Behforouz H, Shin S, Mukherjee J, Bayona J, Farmer P, Kim J, Keshavjee S. Expanding Global HIV Treatment. Ann N Y Acad Sci 2008; 1136:12-20. [DOI: 10.1196/annals.1425.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Assisting or compromising intervention? The concept of 'culture' in biomedical and social research on HIV/AIDS. Soc Sci Med 2006; 64:965-75. [PMID: 17126464 DOI: 10.1016/j.socscimed.2006.10.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Indexed: 10/23/2022]
Abstract
This paper addresses how the notion of 'culture' has been understood and employed by both epidemiologists and anthropologists with respect to the literature on HIV/AIDS in Sub-Saharan Africa. It examines the shift towards non-biomedical understandings of the epidemic. The concept of 'culture' has been 'bandied about' [Schoepf, B.G. (2004). AIDS, history and struggles over meaning. In E. Kalipeni, S. Craddock, J.R. Oppong, & J. Ghosh (Eds.), HIV and AIDS in Africa: Beyond epidemiology. Oxford: Blackwell.], and yet no authors in the literature reviewed here attempt a more systematic account of the 'bandying about' itself. This paper thus attempts to address and close this gap. For biomedical researchers and epidemiologists, broadly speaking, 'culture' appears to compromise intervention, whilst for medical anthropologists, 'culture' is often seen as having the potential to assist intervention. 'Culture' comes to be multifaceted and laden with varying assumptions, which range from 'culture' being bounded and timeless, to 'culture' being linked to macro-processes, historically shaped, and contested. In turn, 'culture' has variously been understood as both the cause of, and solution to, the epidemic. It is also understood as having structured local interpretations of, and responses to, the epidemic. At the same time as noting the apparent dichotomy between the biomedical and social approaches, however, the models may inadvertently share certain assumptions about 'culture' as an essentializing signifier of difference. To this extent HIV/AIDS research could be improved by incorporating wider anthropological debates about the problems of the 'culture' concept.
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Vickerman P, Terris-Prestholt F, Delany S, Kumaranayake L, Rees H, Watts C. Are targeted HIV prevention activities cost-effective in high prevalence settings? Results from a sexually transmitted infection treatment project for sex workers in Johannesburg, South Africa. Sex Transm Dis 2006; 33:S122-32. [PMID: 16735954 DOI: 10.1097/01.olq.0000221351.55097.36] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to estimate the cost-effectiveness of syndromic management, with and without periodic presumptive treatment (PPT), in averting sexually transmitted infections (STIs) and HIV in female sex workers (FSWs) participating in a hotel-based intervention in Johannesburg. STUDY DESIGN Financial and economic providers' costs were estimated. A mathematical model, fitted to epidemiologic data, projected the HIV and STIs averted by the intervention. Cost per HIV infection and DALY averted were estimated for different general population HIV prevalences. RESULTS Projections suggest 53 HIV infections were averted (July 2000-June 2001) and a 3.1% decrease in the FSW HIV incidence. Cost-effectiveness was US dollars 78 per DALY averted. Incremental cost of PPT was US dollars 31 per disability-adjusted life year (DALY) averted. Initiating the intervention at 15% general HIV prevalence would have improved cost-effectiveness by 35%. Expanding PPT coverage to mass-treat all FSWs (instead of <17%) and their clients could increase impact 14-fold. CONCLUSION The results highlight targeted interventions can be cost-effective at all stages of HIV epidemics and suggests PPT could improve the cost-effectiveness of targeted STI interventions.
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Affiliation(s)
- Peter Vickerman
- HIVTools Research Group, Health Policy Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, United Kingdom.
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Coast E. Local understandings of, and responses to, HIV: rural-urban migrants in Tanzania. Soc Sci Med 2006; 63:1000-10. [PMID: 16713053 DOI: 10.1016/j.socscimed.2006.03.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Indexed: 11/16/2022]
Abstract
Migration is an important process of change for rural populations in developing countries. Migration is a primary cause of behaviour change-by their very act of migrating, migrants are different from those who do not migrate. The focus of the current study is male rural-urban migration in Tanzania and its interaction with sexual behaviour. The analysis presents results from a comparison with individual-level analyses of two populations, one (composed of recent rural-urban migrants) in an urban area and one made up of residents in a rural area. Detailed migration histories (n=96 rural-urban migrants) and in-depth interviews form the basis of the analysis. Three key research questions are addressed: How does the sexual behaviour of migrants differ from that of rural residents? How do HIV knowledge levels vary between rural-urban migrants and rural residents? What factors are associated with either intentions of behaviour change or reported behaviour? The results are counter-intuitive: rural-urban migrants-both married and unmarried-are not having sex in town. Despite limited understanding of the nature of HIV, the migrant population studied here regulates its behaviour in a way that reflects local understandings of the disease. This finding is important, not least because it challenges the view that HIV in sub-Saharan Africa is largely transmitted to rural areas by return migrants. Maasai rural-urban migrants in Tanzania-both married and unmarried-are not having sex in town. The policy and service provision implications of the results are explored.
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Desmond N, Allen CF, Clift S, Justine B, Mzugu J, Plummer ML, Watson-Jones D, Ross DA. A typology of groups at risk of HIV/STI in a gold mining town in north-western Tanzania. Soc Sci Med 2005; 60:1739-49. [PMID: 15686806 DOI: 10.1016/j.socscimed.2004.08.027] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Mining communities with migrant populations are high-risk locations for human immunodeficiency virus (HIV)/sexually transmitted infection transmission in Sub-Saharan Africa. Interventions presupposing certain groups to be at high risk, such as those working exclusively as commercial sex workers, may divert attention from other high-risk groups. Qualitative research was conducted in a small town adjacent to a large-scale commercial gold mine in north-western Tanzania. Objectives were to identify populations at high risk of HIV and suggest suitable behavioural interventions by gaining an understanding of sexual behaviour patterns in the town. Rapid assessment procedures were employed comprising participant observation, informal questioning and in-depth interviews. Epidemiological categories of "core", "bridging" and "general" populations may not be adequate to the understanding of risk. Many types of women were found to receive payment for sex, distinguished by permanency of residence, age, relationship status, accommodation and income-earning activity. Paying for sex and having multiple partners was common among most men. The town was a high-risk environment as a result of the economic opportunities available there (in contrast to the poverty of surrounding areas), which were often accessed by offering sex in exchange for money or gifts. In this environment, the potential for spread of HIV infection between sub-populations was high and identification of distinct high- and low-risk groups not possible. However, the methodology enabled the identification of different social circumstances of risk, such as residential arrangements, employment status and venues for recreation, associated with different types of people. Targeted interventions may be oriented to specific circumstances in order to address risk practices in a culturally appropriate manner. It is useful to think of risk environments rather than attributing risk to types of people, and to target interventions to these environments. The methodology also enabled an approach to interventions sensitive to different circumstances associated with risk within the town while identifying structural factors affecting risk at the level of the town as a whole.
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Affiliation(s)
- Nicola Desmond
- National Institute for Medical Research, NIMR/AMREF/LSHTM Collaborative Projects, PO Box 11936, Mwanza, Tanzania.
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Parkhurst JO, Lush L. The political environment of HIV: lessons from a comparison of Uganda and South Africa. Soc Sci Med 2004; 59:1913-24. [PMID: 15312925 DOI: 10.1016/j.socscimed.2004.02.026] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Considerable interest has arisen in the role of governance or political commitment in determining the success or failure of HIV/AIDS policies in sub-Saharan Africa. During the 1990s, Uganda and South Africa both faced dramatic HIV/AIDS epidemics and also saw transformations to new political systems. However, their responses to the disease differed in many ways. This paper compares and contrasts the ways in which policy environments, particularly government structures, can impede or expedite implementation of effective HIV prevention. Four elements of these environments are discussed--the role of political leadership, the existing bureaucratic system, the health care infrastructure, and the roles assigned to non-state actors. Two common international strategies for HIV prevention, syndromic management of sexually transmitted infections and sexual behaviour change interventions, are examined in relation to these elements in Uganda and South Africa during the mid-to-late 1990s. During this period, Uganda's political system succeeded in promoting behaviour change interventions, while South Africa was more successful in syndromic management efforts. Interactions between the four elements of the policy environment were found to be conducive to such results. These elements are relatively static features of the socio-political environments, so lessons can be drawn for current HIV/AIDS policy, both in these two countries and for a wider audience addressing the epidemic.
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Affiliation(s)
- Justin O Parkhurst
- Health Policy Unit, Health Systems Development Programme, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Pfeiffer J. Condom social marketing, Pentecostalism, and structural adjustment in Mozambique: a clash of AIDS prevention messages. Med Anthropol Q 2004; 18:77-103. [PMID: 15098428 DOI: 10.1525/maq.2004.18.1.77] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite significant debate about the efficacy, ideology, and ethics of the method, condom social marketing (CSM) has become the dominant approach to AIDS education in many sub-Saharan African countries. However, critics have charged that social marketing (SM) distracts from the structural determinants of health-related behavior and excludes genuine community participation. This article argues that the diffusion of SM techniques in Africa is not driven by demonstrated efficacy but is attributable to the promotion of privatization and free markets in the structural adjustment era across the region. The CSM experience in a central Mozambican community reveals the dangers of using the method at the expense of community dialogue and participation to confront the AIDS epidemic. The advertising campaign developed to sell condoms has clashed with Pentecostal and Independent Churches, now a majority of the population, that have expanded rapidly across the region spreading a contrasting message about sexuality and risky behavior.
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Affiliation(s)
- James Pfeiffer
- Department of Anthropology, Case Western Reserve University, USA
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Fassin D. The embodiment of inequality. AIDS as a social condition and the historical experience in South Africa. EMBO Rep 2003; 4 Spec No:S4-9. [PMID: 12789397 PMCID: PMC1326443 DOI: 10.1038/sj.embor.embor856] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIDS as a social condition and the historical experience in South Africa
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Affiliation(s)
- Didier Fassin
- University of Paris North, Director of Studies at the Ecole des Hautes Etudes en Sciences Sociales in Paris, France.
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Soskolne V, Shtarkshall RA. Migration and HIV prevention programmes: linking structural factors, culture, and individual behaviour--an Israeli experience. Soc Sci Med 2002; 55:1297-1307. [PMID: 12231010 DOI: 10.1016/s0277-9536(01)00282-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Migration is one of the structural factors associated with HIV infections, but the dynamic and complex role of migrant situations as determinants of HIV-related vulnerability is still a major issue for social science research. Moreover, interventions to address the specific structural and contextual factors inherent in this association are limited and many do not take into account the cultural components. This paper presents a multi-level framework for analysis of the links between migration and HIV. It includes the association of migration with structural macro factors-lower socio-economic status and limited power in the new society; intermediate structural factors-limited social capital and bi-directional interaction of cultural norms; and individual-level factors-stressors unique to the migration context, depleted psychosocial resources, loss of cultural beliefs and low use of health services. All these factors affect risky sexual behaviour and transmission of HIV. The paper utilises those elements of the framework that are relevant to the specific needs of immigrant populations from the former Soviet Union and from Ethiopia in Israel. We demonstrate their application to integrated, multi-level HIV prevention interventions and propose several special principles for development of migration-related HIV prevention programmes.
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Affiliation(s)
- Varda Soskolne
- Department of Social Medicine, Hadassah Medical Organization, POB 12000, Jerusalem 91120, Israel.
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Kaufmann GR, Smith D, Bucher HC, Phanuphak P, Sendi PP, Mbidde EK, Cooper DA, Battegay M. Potential benefit and limitations of a broad access to potent antiretroviral therapy in developing countries. Expert Opin Investig Drugs 2002; 11:1303-13. [PMID: 12225251 DOI: 10.1517/13543784.11.9.1303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In industrialised countries, highly active antiretroviral therapy (HAART) has drastically reduced HIV mortality. Only few developing countries have introduced HAART on a large scale, leaving millions of HIV-infected individuals without life-saving therapy. Although HAART appears to be economically viable for middle income countries, it remains unaffordable for many of the poorest and worst affected nations. In response, significant discounts for antiretrovirals and debt relief have been granted. Apart from economic problems, other important issues need to be addressed before antiretroviral therapy can be optimally utilised, including the logistics of drug supply, HIV education for hospital staff and patients, and laboratory facilities that allow clinicians to assess the efficacy of HAART.
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Affiliation(s)
- Gilbert R Kaufmann
- Basel Center for HIV Research, Division of Infectious Diseases, University Hospital Basel, Switzerland
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Peterse I, Swartz L. Primary health care in the era of HIV/AIDS. some implications for health systems reform. Soc Sci Med 2002; 55:1005-13. [PMID: 12220085 DOI: 10.1016/s0277-9536(01)00231-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this article it is argued that the current emphasis on third generation reforms to health systems places at risk the empowering comprehensive agenda of second generation reforms. Using the HIV/AIDS epidemic in South Africa as an exemplar, the authors demonstrate the importance of retaining this agenda. They suggest that the emphasis on 'packaged' priority programmes with measurable outcomes, which characterizes third generation reforms, needs to be accompanied by the reorientation of primary health care providers towards an empowering comprehensive approach to care. In addition, using psychodynamic principles, they also show how certain aspects of the health care system need restructuring to provide containment and support for such care.
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Affiliation(s)
- Inge Peterse
- Psychology Department, University of Durban-Westville, South Africa.
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40
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Abstract
There is now an acknowledged burden of AIDS and the HIV in Nigeria. In treatment centres, AIDS-related disorders account for up to 40% of admissions, while many communities have recorded regular losses within the last five years. In December 1999, the federal government announced that 2.9 million people (or 5.4% of the Nigerian population) were already infected by HIV. An important aspect of HIV/AIDS programmes is the care of persons living with AIDS (PLWA), both in curative centres and in communities. Based on operations research of a STD/AIDS Management Project, this paper examines acceptance of PLWA in communities in Southern Benue State, an area of high prevalence. From interviews with PLWA, their family members and others in the communities, it was found that the level of stigmatization is high and acceptance of PLWA is low. These reactions stem mainly from the fear of contracting 'the disease that has no cure', believed to be transmittable through any form of physical contact. Based on beliefs, which are further reinforced by the local terms for AIDS, some suggested that PLWA be eliminated before they infect others. These findings suggest that the challenges of AIDS control programmes include coming to terms with the epidemic and fostering more acceptance for PLWA and, above all, changing the current perception of HIV/AIDS from a personal to public health problem. The challenges are daunting but urgent, particularly because Nigeria's HIV/AIDS epidemic is reaching an explosion phase and more care will be provided at home.
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Affiliation(s)
- O Alubo
- Department of Sociology, University of Jos, Nigeria
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Campbell C, Mzaidume Y. How can HIV be prevented in South Africa? A social perspective. BMJ (CLINICAL RESEARCH ED.) 2002; 324:229-32. [PMID: 11809649 PMCID: PMC1122138 DOI: 10.1136/bmj.324.7331.229] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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London L. Human rights and public health: dichotomies or synergies in developing countries? Examining the case of HIV in South Africa. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2002; 30:677-691. [PMID: 12561273 DOI: 10.1111/j.1748-720x.2002.tb00435.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Despite growing advances in medical technologies, health status inequalities continue to increase across the globe. Developing countries have been faced with declining expenditures in health and social services, increasing burdens posed by both communicable and non-communicable diseases, and economic systems poorly geared to fostering sustainable development for the poorest and most marginalized. Under such circumstances, the challenges facing health practitioners in countries in transition are complex and diverse, and require the balancing of many conflicting imperatives. This is particularly so in relation to the development of public health policy, where equity, redress of past inequalities, and the god of social justice may seemingly be pitted against macroeconomic adjustments required for national economic development in an increasingly globalized economic order.For example, pressures to deregulate as part of a market-oriented development philosophy will increase the risks from occupational hazards in populations desperate for paid employment.
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Campbell C, Mzaidume Z. Grassroots participation, peer education, and HIV prevention by sex workers in South Africa. Am J Public Health 2001; 91:1978-86. [PMID: 11726380 PMCID: PMC1446919 DOI: 10.2105/ajph.91.12.1978] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This microqualitative case study of a community-based peer education program led by sex workers at a South African mine examined the role of grassroots participation in sexual health promotion. METHODS The study involved in-depth interviews with 30 members of the target community. The interviews were analyzed in terms of social capital, empowerment, and identity. RESULTS The study yielded a detailed analysis of the way in which community dynamics have shaped the peer education program's development in a deprived, violent community where existing norms and networks are inconsistent with ideal criteria for participatory health promotion. CONCLUSIONS Much remains to be learned about the complexities of translating theoretically and politically vital notions of "community participation" into practice among hard-to-reach groups. The fabric of local community life is shaped by nonlocal structural conditions of poverty and sexual inequality in ways that challenge those seeking to theorize the role of social capital in community development in general and in sexual health promotion in particular.
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Affiliation(s)
- C Campbell
- London School of Economics, London, England.
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44
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Campbell C. Selling sex in the time of AIDS: the psycho-social context of condom use by sex workers on a Southern African mine. Soc Sci Med 2000; 50:479-94. [PMID: 10641801 DOI: 10.1016/s0277-9536(99)00317-2] [Citation(s) in RCA: 167] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper provides a detailed account of the social organisation of commercial sex work in a squatter camp in a South African gold mining community. On the basis of in-depth interviews with 21 women, living in conditions of poverty and violence, the paper examines factors which might serve to help or hinder a newly implemented community-based peer education and condom distribution project aimed at vulnerable single women. Attention is given to the way in which the routine organisation of sex workers' everyday working and living conditions, as well as the strategies they use to construct positive social identities despite working in the most stigmatised of professions, serve to undermine their confidence in their ability to insist on condom use in sexual encounters with reluctant clients. However, even amongst this disadvantaged group of women, the interviews suggest that the tendency to speak of women's 'powerlessness' (as is the case in many studies of African women in the context of the HIV epidemic) is unduly simplistic and fails to take account of the range of coping strategies and social support networks that women have constructed to deal with their day to day life challenges. These strategies and networks could serve as potentially strong resources for community-based sexual health promotion programmes.
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Affiliation(s)
- C Campbell
- Social Psychology, London School of Economics and Political Science, UK.
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