Browsing by Subject "South Africa"

Background: South African adolescents living with HIV (ALWH) experience elevated risk for poor HIV-related outcomes due to challenges associated with HIV disease management. While previous research suggests that social support may mitigate poor HIV-related outcomes, we know little about the specific types of family social support that help ALWH achieve better health outcomes or how this support might be better facilitated. This study aimed to address this gap by characterizing the types of social support provided by family members to assist ALWH in their HIV care management.Methods: We conducted fifty-nine in-depth, semi-structured interviews with ALWH (n=20), their caregivers (n=19), and community stakeholders (n=20) in Cape Town, South Africa. Using deductive and then inductive thematic methods, we triangulated data from these three groups in NVivo to qualitatively analyze family social support. Results: We identified four types of family social support: instrumental support, appraisal support, emotional support, and informational support. Families provided crucial instrumental support through treatment reminders and attending clinic appointments with ALWH. Families also acted as strong sources of appraisal support to help ALWH reflect upon the importance of medication adherence by promoting future orientation and HIV normalization. Similarly, families facilitated adherence through emotional support, such as motivating ALWH and demonstrating interest in their health. Lastly, families offered informational assistance to educate adolescents about managing HIV treatment challenges, such as side effects. Conclusion: In characterizing family social support, our findings highlight sources of struggle and possible solutions to the challenges that ALWH face in their HIV care. Our results suggest that ALWH and providers rely heavily on families to distribute these four types of support in HIV care, emphasizing the importance of exploring how to better facilitate and replicate this support. Understanding these types of social support is a crucial step to identifying potential gaps in care and possible intervention strategies. As such, future research should inquire about the efficacy of incorporating these types of social support into interventions to assist ALWH in their HIV care management.

Drug-resistant tuberculosis (DR-TB) is a threat to TB control globally. South Africa has the third highest epidemic of DR-TB – following only Russia and China, two much more populous countries. South Africa has stringent guidelines for treating DR-TB; however, little is known about adherence to these guidelines. Additionally, little is known about age appropriate treatment, particularly in youth (13-24 years) who may have differing needs than adults with DR-TB. South Africa also has the world’s largest HIV epidemic – nearly 18% of the population is infected with HIV. Individuals with HIV are 26 to 31 times more likely to become infected with TB than individuals without HIV. Among individuals in South Africa with TB, there is a 57-68% HIV coinfection rate.

This dissertation includes a systematic literature review (Chapter 2) exploring barriers to TB treatment initiation in sub-Saharan Africa with an emphasis on children and youth. Additionally, time to treatment was assessed per South African guidelines (i.e. initiating treatment within five days of diagnosis) and total days from DR-TB diagnosis to DR-TB treatment initiation. This analysis included multi-level modeling with fixed patient- (sex, history of TB, HIV coinfection) and system-characteristics (urban-rural location, province) and random effects of treatment site. Guidelines were further evaluated, by assessing through descriptive statistics and logistic regression, receipt of guideline recommended care in terms of correct medications prescribed, correct dosage prescribed, and correct frequency prescribed at treatment initiation (correct regimen).

Barriers exist for all individuals with TB to initiate treatment regardless of age. These barriers are at the patient- and system-level and include: costs, health seeking behaviors, and infrastructure. More research is needed to identify barriers specifically among children and youth, as only four articles reviewed focused on these vulnerable populations. The time to DR-TB treatment is delayed for 84% of South Africans, and age did not predict delays. Seventeen percent of individuals coinfected with HIV receive care per guidelines compared to 12% of those without coinfection. Additionally, receipt of correct medications was prescribed to 88% of patients, yet only 33% received correct medications and doses, and still, only 30% received the full correct regimen. Age was not a strong predictor for receipt of correct guideline based treatment. In conclusion, more research must be focused on younger individuals with TB, particularly DR-TB. More research investigating guideline recommended care is essential to improve patient outcomes, prevent the transmission of DR-TB in communities, and to prevent further drug resistance.

Background: The Western Cape Province of South Africa has one of the highest documented rates of FASD globally. In order to establish FASD prevention interventions that can effectively reach women in this high-risk population, it is important to understand the attitudes that women hold towards alcohol use during pregnancy and examine reasons why positive attitudes may not necessarily translate to behavior in this setting. Study aims: The aims of this secondary analysis were to: describe the attitudes towards alcohol use during pregnancy, compare attitudes with alcohol use behaviors during past pregnancies, and build a logistic regression model to examine predictors of harmful attitudes toward alcohol use during pregnancy. These quantitative aims then set the stage for a qualitative exploration of reasons for harmful behaviors, in spite of attitudes that would support drinking cessation during pregnancy. Methods: This study is based on cross-sectional data from 200 women who were recruited from alcohol-serving venues in a single township in Cape Town, South Africa. A sub-set of 24 was selected to participate in-depth qualitative interviews. Measures of interest included: demographics, attitudes about alcohol use during pregnancy, history of abuse, depression, current drinking behavior, drinking during past pregnancy, and pregnancy intentions and attitudes. Quantitative analysis was conducted in three steps. First, descriptive statistics were used to describe the sample. Second, drinking behaviors in past pregnancies and attitudes toward alcohol use during pregnancy were examined separately and then together in order to describe any potential attitude/behavior gap in this population. Third, logistic regression models were built to examine predictors of attitudes toward alcohol use during pregnancy. Interviews were reviewed and coded for emergent themes under categories that were identified a priori: knowledge about risks of alcohol use during pregnancy, contributors to alcohol use during pregnancy, and contributors to resiliency against alcohol use during pregnancy. Results: The sample of 200 women ranged in age from 18 to 43, were all of Coloured (mixed-race) ancestry, and most had not completed secondary school. Most were not intending to become pregnant and most reported a history of abuse. Though approximately 83% (n=164) of women with a history of pregnancy did not report having harmful attitudes toward alcohol use during pregnancy, more than half of these women (n=84, 51.2%) still reported alcohol use during a previous pregnancy. This discrepancy revealed the existence of a stark attitude-behavior gap in which the holding of harmful attitudes toward alcohol use during pregnancy is not entirely predictive of alcohol use during pregnancy. The strongest predictors of holding harmful attitudes were a history of abuse (AOR=3.33, 95% CI 1.06-10.50) and drinking during a previous pregnancy (AOR=6.87, 95% CI 1.79-26.33). Qualitative data analysis revealed several factors that contributed to alcohol use during pregnancy: 1) Having an unplanned pregnancy; 2) Drinking because of stress or to cope; 3) History of abuse or trauma; 4) Reliance on the venue space for solace; 5) Recreation; and 6) Feelings of invincibility. Conclusions: These data further define the existence of an attitude-behavior gap in this population and highlight that in this setting, having non-harmful attitudes might not be enough to elicit healthy behavior. This points to a need for identification and implementation of policies or interventions that go beyond education to build intrinsic motivation to refrain from alcohol use during pregnancy.

This paper is focusing on the relationship between China’s aid to South Africa and people’s perception of inequality in recipient areas, and its mechanism. South Africa is African’s largest economy and second largest China’s aid recipient. However, in the meantime, South Africa is a country with high inequality and a large amount of people are living under the poverty line. This paper is focusing on subjective inequality. This paper proposes that China’s aid can reduce people’s perception of inequality by promoting employment therefore increases people’s prospect of upward mobility. AidData’s China’s aid dataset and South Africa Social Attitude Survey are used to test this theory. The result is that China’s aid decreases perception of inequality in recipient areas, however, the result varies among ethnic groups. To avoid endogenous, this paper also uses China’s steel production as an instrument variable. This paper also uses different measurement of aid, different methods, different attitudes and different instruments to test the robustness. The result is robust. However, the effect of mechanism—employment is weak.

Introduction: South Africa has witnessed a tremendous rise in methamphetamine consumption since the year 2000. Sex trading is a phenomenon that has been observed in active drug users, globally and within South Africa, and has been associated with risks for HIV infection and violence. This paper is a secondary analysis examining sex trading among active methamphetamine users in Cape Town, South Africa. Methods: Respondent driven sampling was used to recruit 360 active methamphetamine users in a peri-urban township in Cape Town. A structured clinical interview and computerized survey were used to assess history of sex trading, demographics, drug use, sexual risk behaviors, history of violence, and mental health. Logistic regression models were used to examine predictors of sex trading, separately for men and women. Results: In a total sample of 201 men and 159 women, 40% of men and 33% of women endorsed trading sex for tik or money in the past 3 months. Those who traded sex were more likely to meet the criteria for ICD-10 amphetamine dependence among both men (OR=4.59, 95% CI=1.31-16.13) and women (OR=8.00, 95% CI: 1.02-62.59). Men who were concurrent heroin users were also more likely to exchange sex (OR=2.58, 95% CI: 1.06-6.28). Sexual risk behaviors were significantly associated with sex trading. Notably, unprotected sex with a casual partner was correlated with sex trading in men (OR=3.57, 95% CI:1.66-7.69) and women (OR=3.68, 95% CI:1.63-8.29). Among women, those who experienced childhood sexual trauma (OR=3.79, 95% CI: 1.89-7.59) and had the symptoms of post-traumatic stress disorder (OR=2.95, 95% CI: 1.45-5.99) were also more likely to trade sex. Discussion: This study offers insight into the interventions needed for this high-risk population in a LMIC (low and/or middle income countries) context. The results stress a need for linkage to drug treatment, as addiction may be fueling sex trading. The risky sexual practices illustrate how targeted interventions geared toward safe sex practices may help this population. More research is needed to explore the experiences of men who have sex with men given their particularly high rates of sex trading behavior. In a context of high rates of trauma and violence, women need interventions that are attuned to their particular vulnerabilities and offer empowerment through counseling.

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Patients and methods

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South Africa has a substantial HIV epidemic as well as a rising methamphetamine use problem, particularly in Cape Town. Respondent driven sampling (RDS) may be a useful tool for engaging vulnerable and hard-to-reach populations in HIV research, although its effectiveness has not yet been examined among South African methamphetamine users. The aim of the current study was to describe the effectiveness of RDS as a method for engaging methamphetamine users in Cape Town into a HIV behavioral research study. RDS procedures were used to screen 374 potential participants from a peri-urban township in Cape Town. Measures of homophily, equilibrium and RDS-1 estimators were computed for key demographic and social variables.

Beginning with 8 seeds, 345 methamphetamine users were enrolled over a 6 month period, with a coupon return rate of 67%. The sample included 197 men and 148 women who were ethnically diverse (73% Coloured, 27% Black African) and had a mean age of 28.8 years (SD=7.2). Social networks were adequate (mean network size >5) and mainly comprised of close social ties. Equilibrium on race was reached after 11 waves of recruitment, and after ≤3 waves for all other variables of interest. There was little to moderate preference for either in- or out-group recruiting in all subgroups.

Results suggest that RDS is an effective method for engaging methamphetamine users into HIV prevention research in South Africa. RDS may be a useful strategy for seeking high risk methamphetamine users for HIV testing and linkage to HIV care in this and other low resource settings. We also discuss future directions for RDS studies.

This study was conducted using data that was collected as part of the National Income Dynamic Study(NIDS). We hypothesized that in the NIDS study conducted in South Africa this phenomenon would be observed as a rise in the first blood pressure and a drop to normal on the second reading. We then set out to investigate whether this phenomenon would be more pronounced among those with limited access to medical services such as those in the rural areas, those from low-income homes, the population with little or no education and lastly the black or colored population. Our analysis revealed that the white coat effect did indeed exist significantly among black races and the colored race but was not dependent on sex, education level, or income level. Based on the inaccuracies that come from the white coat effect and the resulting preference for home or ambulatory blood pressure readings we then set out to investigate whether those with home blood pressure monitors would have better blood pressure control than those individuals without home blood pressure monitors. This investigation was carried out in Zimbabwe for 10 weeks and will go on for a year. From the 10week results, it would seem those individuals with home blood pressure monitors achieved better blood pressure control than individuals without home blood pressure monitors. It seems this was a function of a higher number of clinic visits that were made by those with home blood pressure monitors compared to individuals who did not have home blood pressure monitors.

The needs of South African men with HIV are often overlooked in providing healthcare for people living with HIV/AIDS, leading to unique needs and experiences for men seeking HIV/AIDS healthcare. Compounding this phenomenon are norms of masculinity guiding these men's behaviors as they navigate health and healthcare systems. The aim of this study is to provide new insight on which components of masculinity interplay with healthcare access in South Africa. The study took place at one primary health care clinic in a peri-urban township in rural KwaZulu-Natal, South Africa. In-depth individual interviews were conducted with 21 HIV-positive men recruited from the clinic. Direct observations of the HIV clinic waiting area were also conducted. Data was analyzed using a grounded theory-informed memo-writing approach. Participants expressed a range of ways in which masculine ideals and identity both promoted and inhibited their willingness and ability to engage in HIV care. Notions of masculinity and social identity were often directly tied to behaviors influencing care engagement. Such engagement fostered the reshaping of identity around a novel sense of clinic advocacy in the face of HIV. Our findings suggested that masculinities are complex, and are subject to changes and reprioritization in the context of HIV. Interventions focusing on reframing hegemonic masculinities and initiating treatment early may have success in bringing more men to the clinic.

Disease metaphors dominate Christian theological discourses that equate sex with sin. When Christianity is imagined to “cure” sexuality, religious communities push out those members who are perceived to threaten the health of the social body. Progressive policy might give the impression that sexual liberation is best realized when disentangled from religion. Post-apartheid, democratic South Africa serves as a test case because it boasts having implemented some of the most progressive policies on sexuality. However, its groundbreaking laws have not curbed the country’s high rate of hate crimes, which largely target LGBTIQ citizens. In order to account for this dissonance, I elucidate the shortcomings of both progressive policy and theology before offering a constructive alternative. This project requires a transnational, interdisciplinary methodology that integrates Christian theology, critical theory, biblical theology, and fieldwork. The first three chapters critique theological and political attempts to “cure” sexuality in exchange for salvation and citizenship. These include the rhetoric of “cure” in hate crimes in present day South Africa, the coerced aversion therapy and sex reassignment surgeries performed to “cure” conscripts during apartheid, and the legalization of same-sex marriage during the transition to democracy. In conclusion, I propose that a decolonial theology based on the notion of Christ as contagion displays the meaning and purpose of baptism for costly discipleship and intimate life together.

Background: Limpopo Province has the highest rates of intimate partner violence (IPV) in South Africa, with data suggesting that over half of women experience IPV in their lifetimes. However, data among young, university-attending women in this province is lacking. This study aimed to estimate the prevalence of IPV victimization among university women and examine factors associated with IPV history. The study also aimed to explore how university women recognize IPV, suggest ways victims seek help, and identify a victim’s coping strategies using qualitative methods.

Methods: This study utilized a mixed methods approach and was conducted at the University of Venda (UNIVEN), a rural-based university in Vhembe district. Convenience sampling was used to recruit female participants who were currently enrolled at the university, aged 18 to 31 years, and currently in a relationship or in a relationship within the past year. 113 females were enrolled in the study. After obtaining written informed consent, we conducted a self-administered cross-sectional survey. IPV was measured using the Revised Conflict Tactics Scale (CTS2), which assessed for both past year and lifetime IPV experiences. To explore the association between IPV and other factors, other measures included an alcohol use screening tool (AUDIT-C) and a measure assessing attitudes toward gender roles. Descriptive statistics and Fisher’s exact tests were performed to assess the relationship between potential risk factors and IPV. Logistic regression analyses examined the associations between exposure variables and lifetime IPV victimization. Short explanatory model interviews (SEMI) examining women’s perceptions of IPV-related issues using a custom vignette were administered directly following the survey. The interviews were recorded and later analyzed using thematic analysis.

Results: 92.23% of participants reported being victims of any form of IPV in their lifetime. Psychological aggression (82.52%) was the most prevalent type of lifetime violence, followed by sexual coercion (73.79%), physical assault (37.86%), and injury (15.53%). The joint frequency distribution of IPV victimization by subscale reveals that 9.71% of participants reported being victims of all four forms of IPV at least once in their lifetime, while most respondents reported experiencing two types of IPV (35.9%). Compared to having no sexual partners in the past year, having two or more sexual partners was significantly associated with higher odds of being a lifetime victim of sexual coercion (p = 0.031; OR: 4.41; 95% CI 1.14 - 17.02). Study findings support an increased odds of lifetime IPV (p = 0.030; OR: 7.04; 95% CI 1.21 – 40.97) and physical assault (p = 0.010; OR: 3.77; 95% CI 1.37 – 10.40) for participants who personally knew an IPV victim at UNIVEN compared to women who did not personally know a victim. Participants who disagreed or strongly disagreed that IPV should be viewed as a crime were 11.37 times more likely to be victims of lifetime sexual coercion than those who agreed (p = 0.027; OR: 11.37; 95% CI 1.32 - 97.82). The SEMI revealed most women recognized IPV in the vignette, and the recommended help-seeking behaviors included seeking informal and formal help, leaving the relationship, and changing behavior.

Conclusions: IPV prevalence among the study sample was reported nearly universally. Number of sexual partners, personally knowing a victim of IPV at the university, and attitudes toward gender roles were significantly associated with having a history of IPV. University commitment and multi-sectoral collaboration at all levels are critical for the provision of resources, services, and violence prevention efforts. Future research is needed to inform evidence-based interventions that will reduce victimization by addressing risk factors, under-reporting, and barriers to seeking help.

Background: Autism spectrum disorder (ASD) is a major public health challenge worldwide. Early intensive intervention services have been shown to reduce core ASD symptomatology, but there are many barriers to implementing these services in low resource settings. Training caregivers to deliver intensive early ASD intervention may help to overcome many of the implementation barriers, but there is limited research about the feasibility of delivering a caregiver-mediated early ASD intervention in low resource settings and the compatibility of such interventions with existing platforms of care. Study Aims: This study explored key stakeholder perspectives on the feasibility of implementing early ASD intervention services in the Western Cape Province of South Africa. Methods: Eight in-depth interviews with District and Provincial representatives from the Department of Health, the Department of Education, the Department of Social Development, and two non-governmental organizations were conducted. Results: Stakeholders identified 20 current policies relevant to ASD in South Africa, future directions for ASD policy, and perceived barriers to ASD early intervention services. All participants reported a strong desire for early intervention services and identified key potential facilitators to early intervention. Conclusion: Caregiver mediated early ASD intervention may address barriers to ASD services in the Western. This study identified perceived barriers to such interventions as well as facilitators to delivering a caregiver mediated intervention. Adaptions of caregiver-mediated early ASD interventions in the Western Cape must be affordable, simplified to be delivered by paraprofessionals, and adapted to include local cultural components such as language.