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This paper presents empirical and methodological findings from an art-based, participatory process with a group (n  = 16) of adolescent and young advisors in the Western Cape Province of South Africa. In a weekend workshop, participants reflected on their participation in 12 years of health and development-related research through theatre, song, visual methodologies and semi-structured interviews. Empirical findings suggest that participants interpreted the group research encounter as a site of empowerment, social support and as a socio-political endeavour. Through song, theatre and a mural illustration, they demonstrated that they value 'unity' in research, with the aim of ameliorating the conditions of adolescents and young people in other parts of South Africa and the continent. Methodological findings document how participants deployed art-based approaches from South Africa's powerful history of activism, including the struggle against apartheid, the fight for anti-retroviral therapy and more recent social movements towards decolonization. [ABSTRACT FROM AUTHOR]

Pre‐abortion counselling may play a key role in abortion seekers' understanding of their decision to terminate a pregnancy and the subsequent emotions that they feel. In this paper, we report on a study conducted in the Eastern Cape province of South Africa concerning womxn's experiences of the pre‐abortion counselling offered as part of the implementation of the Choice of Termination Act that governs the provision of legal abortion in the country. Using a narrative‐discursive lens, the analysis revealed four micro‐narratives in which participants appreciated non‐directive and empathic counselling, as well as being provided with information. They also indicated that the counselling was upsetting and hurtful, particularly when providers drew on the awfulisation of abortion discourse to suggest that abortion leads to terrible consequences, and foetal personhood discourse to intimate that terminating the pregnancy is wrong and other alternatives (adoption, parenting) are better. The connection between these broadly positive and negative responses may lie in the dominance of anti‐abortion discourses coupled with the powerful positioning of healthcare providers as experts. The attendant disempowerment of clients within the health clinic setting may constrain pregnant people's ability to question such 'expert' information. The implications for feminist client‐centred pre‐abortion counselling are discussed. [ABSTRACT FROM AUTHOR]

South African adolescents experience a high prevalence of violence victimization alongside the health and economic burdens of HIV/AIDS and poverty. Polyvictimization is a useful theory and framework that allows for a nuanced understanding of lived adolescent experience patterns. Polyvictimization examinations are further enriched by person-centered analytical approaches. This study used latent class analysis to differentiate a sample of South African adolescents from highly deprived communities by their polyvictimization profiles and contextual violence risk and protective factors. Adolescents were sampled twice (2010/2011; 2011/2012), and data reflected their lifetime (sexual abuse) or recent (all other forms of assessed abuse/violence) violence victimizations, as well as individual, household, and community characteristics. Model fit indices supported a seven-class model with adolescents in high, moderate, and low polyvictimization classes. Adolescents in the high polyvictimization classes experienced a heavy burden of poverty and multiple forms of violence across contexts and were distinguished by HIV/AIDS and disability. Adolescents in the low polyvictimization class experienced relatively little violence, despite living in violent communities, and low household and individual burdens of HIV/AIDS and disability. Findings emphasize the importance of considering adolescent violence through a contextually sensitive polyvictimization lens to understand the complex web of violence that adolescents experience. This work supports previous research in low-resource South African settings highlighting the interconnected nature of violence, poverty, disability, and HIV/AIDS. Future research should explore these complex violence patterns and their effects, while program and policy actions must target and prevent adolescent violence especially for those impacted by poverty, disability, and HIV/AIDS. [ABSTRACT FROM AUTHOR]

Introduction: Multipurpose prevention technologies (MPTs) simultaneously prevent HIV, other sexually transmitted infections, and/or unintended pregnancy. Key gatekeepers, [healthcare providers (HCPs) and key stakeholders] require proactive engagement before product implementation. This manuscript identifies HCP demand creation strategies, key stakeholder considerations for the adoption of MPTs in South Africa. Methods: Formative research was conducted in three districts in three South African provinces (July to November 2022). Nurses initiating oral PrEP at facility and mobile study sites participated in 4-hour participatory workshops, exploring HIV prevention, including MPTs, demand creation strategies, and preferred MPTs training packages. Activities were observed, transcribed, and thematically analysed. Five online in-depth interviews (IDIs) with Key informants (KIs) (National/district programme implementers and technical leads) and one in person, exploring key programmatic and policy considerations for MPT adoption. IDIs were approximately 40 min long, audio recorded, transcribed, and thematically analysed. Results: Twenty-one Professional Nurses completed workshops: 19 female. Six IDIs were conducted with 4 Facility Managers, 1 NDoH representative and 1 DoH Provincial Deputy Director. All participants were females, aged 30-60+ years with >10 years' in SRH/HIV policy/advocacy/research. Community conversations and information at the clinic were the best MPT demand creation methods among HCPs. KIs identified five considerations for future MPT implementation: HCP training; demand creation and messaging; existing PrEP policy amendments; preparing users for additional choice; and sustaining MPT provision. Conclusion: Contraceptive implant and oral PrEP implementation lessons learned should be proactively considered when preparing for MPT introduction. HCP training and demand creation are of particular importance before MPT introduction. [ABSTRACT FROM AUTHOR]

This paper investigates the relationship between socio-economic status and emotional well-being of orphans in Mangaung, South Africa. Five hundred orphans aged 7-11 years participated in the cross-sectional study between 2009 and 2012. Data was collected by trained fieldworkers, who conducted face-to-face interviews and questionnaires with the orphans, their teachers and caregivers, and the heads of the households where the orphans resided. The caregivers, children and teachers all completed the Strengths and Difficulties Questionnaire in order to measure the orphans' mental health, while heads of household provided information about socio-economic indicators. STATA version 12 was used to perform multivariate data analyses to identify socio-economic factors associated with the mental health of orphans. Food security, access to medical services and a male caregiver were factors associated with better emotional well-being of orphans, whereas other variables such as household asset index and monthly household expenditure were not linked with the orphans' mental health. Two of the three variables (food security and access to medical services) associated with better emotional well-being of orphans are also government interventions to assist orphans. Further research is needed to determine whether other government programs also impact the emotional well-being of orphans. [ABSTRACT FROM AUTHOR]

Men and women living with HIV with access to ARVs are living longer, healthier lives that can and often do include bearing children. Children occupy a key space in men and women's personal and social lives and often play a fundamental role in maintaining these relationships, irrespective of illness concerns. Couples living with HIV need to balance prevention needs and ill-health while trying to maintain healthy relationships. Health-care providers serving the reproductive needs of HIV-affected couples need to consider the social and relational factors shaping reproductive decisions associated with periconception risk behaviors. This paper based on qualitative research at three hospital sites in eThekwini District, South Africa, investigates the childbearing intentions and needs of people living with HIV (PLHIV), and the attitudes and experiences of health-care providers serving the reproductive needs of PLHIV, and client and provider views and knowledge of safer conception. This research revealed that personal, social, and relationship dynamics shape the reproductive decisions of PLHIV, and “unplanned” pregnancies are not always unintended. Additionally, conception desires are not driven by the number of living children; rather clients are motivated by whether or not they have had any children with their current partner/spouse. Providers should consider the relationship status of clients in discussions about childbearing desires and intentions. Although many providers recognize the complex social realities shaping their clients' reproductive decisions, they have outdated information on serving their reproductive needs. Appropriate training to enable providers to better understand the relationship and social realities surrounding their clients' childbearing intentions is required and should be used as a platform for couples to work together with providers toward safer conception. The adoption of a more participatory approach should be employed to equalize client–provider power dynamics and to ensure clients are more involved in decision-making about reproduction and conception. [ABSTRACT FROM AUTHOR]

Ubuntu was recently adopted as the first theme for the 2020–2030 global agenda for social work, and yet little research is available to explore how it is transmitted and implemented in communities. The authors present findings of a qualitative study conducted in an academic setting in South Africa, where the transmission of Ubuntu was discussed among 30 young adult 'born frees'. Students seemed to embrace principles of Ubuntu as a whole; however, economic, social and cultural strains are documented as obstacles to its pragmatic application. Implications of community engagement through service learning as a means of strengthening Ubuntu are discussed. [ABSTRACT FROM AUTHOR]

Background: Preterm birth (PTB) is a global health epidemic, sub-Saharan Africa is severely impacted due to its limited healthcare resources. Pregnancy knowledge, cultural beliefs and practices play a role in the identification of risk and management of PTB. This study explored knowledge, understandings, cultural beliefs and attitudes to pregnancy and PTB, as well as cultural considerations for the introduction of an intravaginal device which could be used to identify PTB risk. Methods: Qualitative research was conducted in South Africa and Kenya. In-depth interviews were conducted using semi-structured guides with women with a history of PTB (n = 10), healthcare providers (n = 16) and health systems experts (n = 10); and 26 focus group discussions with pregnant women seeking antenatal care (n = 132) and community male partners/fathers (n = 54). Interviews/discussions were transcribed, translated, and analysed thematically. Results: Pregnancy knowledge, especially for first time pregnancies was poor, with many reporting late entry to antenatal care. Knowledge about PTB was understood in terms of gestational age, weight or small size of baby, with concerns about long term health and stigma. Various risk factors for PTB were described, including those related to traditions and beliefs of witchcraft/curses. Cultural practices, such as the use of traditional medicines and pica, and religion and its impact on health seeking behaviour were also viewed as risk factors. Although insertion of intravaginal devices was not widely acceptable in traditional communities, especially during pregnancy, it was felt that the use of one to detect risk of PTB would be accepted if proven effective in reducing PTB risk. Conclusions: Various culturally-informed beliefs exist which explain understandings of and attitudes toward pregnancy, pregnancy risk, and PTB. An inclusive exploratory process is critical to facilitate an understanding of the beliefs and traditions which could impact the introduction and design of a product to detect the risk of PTB. [ABSTRACT FROM AUTHOR]

Men are less vulnerable to HIV acquisition than women, but have poorer HIV-related health outcomes. They access HIV services less, and are more likely to die on antiretroviral therapy. The adolescent epidemic presents further challenges, and AIDS-related illness is the leading cause of death among adolescents in sub-Saharan Africa. We explored the health practices of adolescent boys and young men (aged 13–22) living with perinatally-acquired HIV and the processes through which these practices are formed and sustained. We engaged health-focused life history narratives (n = 35), semi-structured interviews (n = 32) and analysis of health facility files (n = 41), alongside semi-structured interviews with traditional and biomedical health practitioners (n = 14) in the Eastern Cape, South Africa. Participants did not access traditional products and services for HIV, a finding that deviates from much of the literature. Findings suggest that health practices are mediated not only by gender and culture, but also childhood experiences of growing up deeply embedded in the biomedical health system. [ABSTRACT FROM AUTHOR]

Background: Cross-border movements, especially from a malaria-endemic neighbour, contribute to importation of malaria, as they provide favourable conditions for malaria transmission in the receiving country. In the KwaZulu-Natal (KZN) province of South Africa (SA), the uMkhanyakude district is one of the endemic malaria areas where the borders are characterised by frequent cross-border movements of travellers coming into the province, mostly from Mozambique. Many studies have suggested that regional efforts through the implementation of cross-border measures are needed in both the high- and low-endemic countries to effectively address imported malaria. The implementation of cross-border measures to prevent imported malaria has led to a significant decline in malaria cases in KZN and SA; however, those measures are subjected to various challenges. Objective: This study sought to determine the health system challenges of implementing cross-border preventive measures for imported malaria at the Kosi Bay, Kwaphuza and Golela ports of entry in KZN. Methods: This inquiry consisted of a mixed methods approach, of which the qualitative component is reported here. In-depth interviews were conducted with four purposively selected health officers working at the legal and illegal ports of entry of the KZN province. Data were coded manually and then analysed using thematic data and descriptive analyses. Results: This study identified operational and prevention challenges. The related operational challenges included travellers' non-disclosure and refusal, uncontrolled cross-border movements and poor coverage as well as shortage of staff. The prevention challenges included lack of novelty in the existing cross-border preventive measures, insecurity and illegal migration. Concerning travellers' non-disclosure and refusal to cooperate, these issues occur at the legal ports of entry of Kosi Bay and Golela, where travellers were less cooperative in disclosing their health-related information to health border officers. They were more eager to cross and attend to their business. The findings revealed a lack of new ideas in the existing cross-border measures for the prevention of imported malaria, which some scientists considered as the reason for the failure of the elimination efforts in SA. Because of the porous borders and the shortage of staff to cover all the uncontrolled entries, travellers constantly crossed without any hindrances. Porous borders exposed the people living at the border areas and travellers to insecurity, promoted criminal activities and encouraged illegal migration. Conclusion: Cross-border malaria preventive measures are meant to contribute to decreased travel-related disease. Failure to attain this purpose must be carefully examined and mitigation strategies implemented. The study revealed the challenges of implementing cross-border measures at the KZN ports of entry of Kosi Bay, Kwaphuza and Golela. The challenges occurred at the operational and prevention levels, which, if not effectively addressed, could impede the decrease of imported malaria in the malaria-endemic district of KZN and SA in general. [ABSTRACT FROM AUTHOR]

Despite policy on adolescent sexual and reproductive health (SRH) services and education, teen pregnancies remain common in South Africa. Social norms and cultural resistance are a well-documented challenge for SRH program implementation in South Africa, and beyond. To gain insight on the complex picture of adolescents' access to SRH information and services in a peri-urban township, we explored this topic from a diversity of perspectives, carrying out 86 interviews to capture perceptions of adolescents, their parents, community members, and health professionals. Our research shows that despite the taboo nature of the issue of adolescent SRH, individual positions on adolescent access to SRH services and information are shifting and diverse, and are influenced by factors other than cultural norms. This research serves as a reminder to avoid simplistic reference to "culture" as a way of explaining health-related behaviors and people's responses to health challenges. [ABSTRACT FROM AUTHOR]

Despite HIV testing having improved globally, men remain disproportionately less likely to test for HIV. While violence against women (VAW) and HIV risk have a strong association among women, few studies explore men around VAW perpetration, risky-sexual behaviour, and HIV testing. Males aged 18–42 years were recruited from a peri-urban settlement near Johannesburg, South Africa. Data were from an endline of a trial. We used logistic regression to assess odds of non-HIV testing using STATA 13. At endline, 1508 men participated in the study. Of these nearly one-third (31.6%, n = 475) had not tested for HIV in the past year. HIV non-testing was significantly lower among men who were single, older, did not complete high school and were less food secure. VAW perpetration retained a significant association with HIV non-testing after controlling for socio-demographics (AOR = 0.73, 95%CI = 0.58–0.93). In multivariate models, HIV non-testing was also associated with inconsistent condom use (AOR = 0.64, 95%CI = 0.48–0.85), problem drinking (AOR = 0.72, 95%CI = 0.55–0.94) and reporting of all four risky sexual behaviours (AOR = 0.70, 95%CI = 0.49–1.01). Data suggests that one-third of men who never test for HIV in this setting may represent a high-risk group. Future campaigns could consider behaviour change around non-violence, relationship quality, and gender norms alongside HIV testing. [ABSTRACT FROM AUTHOR]

The global HIV/AIDS scientific community has begun to hail the dawn of 'the End of AIDS' with widespread anti-retroviral therapy (ART) and dramatic declines in AIDS-related mortality. Drawing on community focus groups and in-depth individual interviews conducted in rural South Africa, we examine the complex unfolding of the end of AIDS in a hard-hit setting. We find that while widespread ART has led to declines in AIDS-related deaths, stigma persists and is now freshly motivated. We argue that the shifting landscape of illness in the community has produced a new interpretive lens through which to view living with HIV and dying from AIDS. Most adults have one or more chronic illnesses, and ART-managed HIV is now considered a preferred diagnosis because it is seen as easier to manage, more responsive to medication, and less dangerous compared to diseases like cancer, hypertension, and diabetes. Viewed through this comparative lens, dying from AIDS elicits stigmatising individual blame. We find that blame persists despite community acknowledgement of structural barriers to ART adherence. Setting the ending of AIDS within its wider health context sheds light on the complexities of the epidemiological and health transitions underway in much of the developing world. [ABSTRACT FROM AUTHOR]

Child well-being is particularly relevant to South African social workers given the country's high rates of violence, poverty, inequality, unemployment, HIV/AIDS, and poor schooling outcomes. Guided by a social constructivist theoretical lens, and located within an interpretive qualitative research design, the aim of the study was to determine whether children's drawings and teacher interviews can differentiate qualitatively between children with positive well-being and those with compromised well-being. Children aged 6–8 years whose parents/caregivers were recipients of Child Support Grants (CSGs) were asked to draw a picture of themselves and their families and teachers were asked about the children's functioning. Findings from triangulation of drawings and interviews suggested that while a firm diagnosis of emotional, behavioral, or cognitive disorder could not be reached, it was possible to differentiate between children with positive well-being and those whose well-being appeared to be compromised by developmental delay, learning difficulties, emotional problems, behavioral problems, and/or social issues. It is therefore recommended that social workers make greater use of children's drawings and educator interviews as assessment tools. However, one should not rely solely on children's drawings, but should rather combine drawings with child and educator interviews. Findings also highlight the need for South African social workers to develop indicators that are culturally and ecologically applicable to African children. [ABSTRACT FROM AUTHOR]

Inadequate toilet facilities may increase women's risk of experiencing non-partner sexual violence. We sought to assess the association between young (18–24 year-olds) women's access to toilets and past year non-partner rape experience, in deprived communities in South Africa. Data came from cross-sectional, population-based survey from poor communities from four health districts in two provinces, namely, City of Johannesburg, and Ekurhuleni in Gauteng, and eThekwini and uMgungundlovu, in KwaZulu-Natal. Descriptive, unadjusted and adjusted associations, were estimated in STATA/IC16, accounting for study design. In total, 10,635 young women provided data on toilet access. Past year non-partner rape prevalence was 5.7%. In adjusted analyses, those reporting a shared toilet were more likely to report past year experience of non-partner rape (adjusted odds ratio: 1.45, 95% confidence intervals [1.17, 1.80]), compared to those with their own toilet indoors. Improving access to private, secure toilets is an important component for the prevention of non-partner sexual violence. [ABSTRACT FROM AUTHOR]

Among men in South Africa, the prevalence of tobacco smoking is as high as 33%. Although smoking is responsible for most lung cancer in South Africa, occupational and environmental exposures contribute greatly to risk. We conducted a tobacco and lung cancer screening needs assessment and administered surveys to adults who smoked >100 cigarettes in their lifetime in Johannesburg (urban) and Kimberley (rural). We compared tobacco use, risk exposure, attitudes toward and knowledge of, and receptivity to cessation and screening, by site. Of 324 smokers, nearly 85% of current smokers had a <30 pack-year history of smoking; 58.7% had tried to stop smoking ≥1 time, and 78.9% wanted to quit. Kimberley smokers more often reported being advised by a healthcare provider to stop smoking (56.5% vs. 37.3%, p=0.001) than smokers in Johannesburg but smokers in Johannesburg were more willing to stop smoking if advised by their doctor (72.9% vs. 41.7%, p<0.001). Findings indicate that tobacco smokers in two geographic areas of South Africa are motivated to stop smoking but receive no healthcare support to do so. Developing high risk criteria for lung cancer screening and creating tobacco cessation infrastructure may reduce tobacco use and decrease lung cancer mortality in South Africa. [ABSTRACT FROM AUTHOR]

Purpose: Health should be a universal phenomenon. However, little is known about the relationship between disability status and health issues – particularly in rural areas. This study looks at health issues of persons with disabilities in Madwaleni, a rural impoverished area in South Africa in 2011, and compares them to persons with no disabilities. Materials and Methods: Standardized questionnaires were used in the survey to assess disability and health status. The sample comprised of 773 individuals – 322 persons with disability and 451 comparisons (without disability) – covering 527 households. Children under the age of five were excluded from the sample. We used purposive sampling. Results and Conclusion: This study found that persons with disabilities have poorer reported health outcomes than persons with no disabilities. There is also an association between disability severity and mental health issues as assessed by the GHQ-12. A significantly higher percentage of persons with disability did not get health care when needed. Persons with disabilities also have less favorable attitudes toward competence of health care workers. This study has shown greater health needs and less satisfaction with services, which strongly indicates insufficient access for persons with disabilities in a rural impoverished are within South Africa. Persons with disabilities in rural South Africa have poorer reported health outcomes. Persons with disabilities have less favorable attitudes towards competence of health care workers in rural South Africa. Better access to health care for persons with disabilities is needed in rural South Africa. [ABSTRACT FROM AUTHOR]

Introduction: The burden of HIV is increasing among adults aged over 50, who generally experience increased risk of cormorbid illnesses and poorer financial protection. We compared patterns of health utilisation and expenditure among HIV-positive and HIV-negative adults over 50.Methods: Data were drawn from the Study on global AGEing and adult health in South Africa with analysis focusing on individual and household-level data of 147 HIV-positive and 2725 HIV-negative respondents.Results: HIV-positive respondents reported lower utilisation of private health-care facilities (11.8%) than HIV-negative respondents (25.0%) (p = .03) and generally had more negative attitudes towards health system responsiveness than HIV-negative counterparts. Less than 10% of HIV-positive and HIV-negative respondents experienced catastrophic health expenditure (CHE). Women (OR 1.8;p < .001) and respondents from rural settings (OR 2.9;p < .01) had higher odds of CHE than men or respondents in urban settings. Over half the respondents in both groups indicated that they had received free health care.Conclusions: These findings suggest that although HIV-positive and HIV-negative older adults in South Africa are protected to some extent from CHE, inequalities still exist in access to and quality of care available at health-care services – which can inform South Africa’s development of a national health insurance scheme. [ABSTRACT FROM AUTHOR]

South Africa's refugee population has grown considerably over the last decade. Both food insecurity and mental illness are common in developing countries, but this relationship remains unexamined in an African refugee population. 335 adult refugees in Durban, South Africa were interviewed using a self-report of food insecurity and the Hopkins Symptom Checklist-25. The proportion of those who responded 'often true' to not having enough food and eating less was 23.1 and 54.3 %, respectively. The proportion of individuals with a significant level of anxiety and depressive symptomatology was 49.4 and 54.6 %, respectively. The adjusted logistic regression indicated that not eating enough was significantly associated with anxiety (aOR = 4.52, 95 % CI: 2.09-9.80) and depression (aOR = 4.51, 95 % CI: 2.01-10.09). Similarly, eating less was significantly associated with anxiety (aOR = 2.88, 95 % CI: 1.56-5.31) and depression (aOR = 2.88, 95 % CI: 1.54-5.39). The high prevalence of food insecurity, and its relationship to mental illness, highlight the importance of addressing basic needs among this population. [ABSTRACT FROM AUTHOR]

Urban South Africa is a major destination for refugees across sub-Saharan Africa. Based on interviews with urban refugees, this study identified significant barriers to achieving livelihood security for this population, including community violence, crowding, fear of xenophobia, exploitation from officials and oversaturated markets for small businesses. Nevertheless, refugees identified several aspects of service provision from a non-governmental organization which proved helpful, especially through material assistance in helping establish viable, profit-generating small businesses. Recommendations for service delivery to this population include assessing refugees’ level of environmental vulnerability and providing a package of supports that address a clients’ particular living situation. [ABSTRACT FROM AUTHOR]

Maternal adherence to antiretroviral therapy (ART) is a concern and monitoring adherence presents a significant challenge in low-resource settings. We investigated the association between self-reported adherence, measured using a simple three-item scale, and elevated viral load (VL) among HIV-infected pregnant and postpartum women on ART in Cape Town, South Africa. This is the first reported use of this scale in a non-English speaking setting and it achieved good psychometric characteristics (Cronbach α = 0.79). Among 452 women included in the analysis, only 12 % reported perfect adherence on the self-report scale, while 92 % had a VL <1000 copies/mL. Having a raised VL was consistently associated with lower median adherence scores and the area under the curve for the scale was 0.599, 0.656 and 0.642 using a VL cut-off of ≥50, ≥1000 and ≥10000 copies/mL, respectively. This simple self-report adherence scale shows potential as a first-stage adherence screener in this setting. Maternal adherence monitoring in low resource settings requires attention in the era of universal ART, and the value of this simple adherence scale in routine ART care settings warrants further investigation. [ABSTRACT FROM AUTHOR]

HIV counseling and testing (HCT) is critical for children in generalized epidemic settings, but significant shortfalls in coverage persist, notably among orphans and others at disproportionate risk of infection. This study investigates the impact of a home visiting program in South Africa on orphaned and vulnerable children’s uptake of HCT. Using propensity score matching, survey data for children receiving home visits from trained community-based care workers were compared to data from children living in similar households that had not yet received home visits (n = 1324). Home visits by community-based care workers increased the odds of a child being tested by 97% (OR = 1.97, 95% CI = 1.34–2.92). The home visitation program had an especially pronounced effect on orphans, more than doubling their odds of being tested (OR = 2.12, 95% CI = 1.00–4.47) compared to orphans living in similar households that did not receive home visits. Orphan status alone had no effect on HCT independent of program exposure, suggesting that the program was uniquely able to increase testing in this subgroup. Results highlight the potential for increasing HCT access among children at high risk through targeted community-based initiatives. [ABSTRACT FROM PUBLISHER]

Life-course persistent offending contributes greatly to violent offending in any country. South Africa has high rates of violence; this study investigated what proportion of young South African offenders might be identified as life-course persistent, and what risk factors identified this group. Offenders aged 12 to 25 years (N = 395) were selected from eight different correctional facilities in four provinces of South Africa. Latent class analysis identified 164 offenders (41.5%) with distinctly earlier starts and more serious offending. These (probably life-course persistent) offenders were distinguished from others by male gender, violence at home, other victimization, familial crime, school performance, violence at school, and alcohol abuse and gang membership. Correctional services should be specifically targeted at this large subgroup of offenders to prevent recidivism. Primary prevention efforts should be targeted at preventing violence at home and school, at promoting school attachment, at substance abuse treatment, and at gang membership. [ABSTRACT FROM AUTHOR]

Evidence-based approaches are needed to address the high levels of sexual risk behavior and associated HIV infection among orphaned and vulnerable adolescents. This study recruited adolescents from a support program for HIV-affected families and randomly assigned them by cluster to receive one of the following: (1) a structured group-based behavioral health intervention; (2) interpersonal psychotherapy group sessions; (3) both interventions; or (4) no new interventions. With 95% retention, 1014 adolescents were interviewed three times over a 22-month period. Intent-to-treat analyses, applying multivariate difference-in-difference probit regressions, were performed separately for boys and girls to assess intervention impacts on sexual risk behaviors. Exposure to a single intervention did not impact behaviors. Exposure to both interventions was associated with risk-reduction behaviors, but the outcomes varied by gender: boys reported fewer risky sexual partnerships (β = −.48,p = .05) and girls reported more consistent condom (β = 1.37,p = .02). There was no difference in the likelihood of sexual debut for either gender. Providing both psychological and behavioral interventions resulted in long-term changes in sexual behavior that were not present when either intervention was provided in isolation. Multifaceted approaches for reducing sexual risk behaviors among vulnerable adolescents hold significant promise for mitigating the HIV epidemic among this priority population. [ABSTRACT FROM PUBLISHER]

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HIV-infected men and women who choose to conceive risk infecting their partners. To inform safer conception programs we surveyed HIV risk behavior prior to recent pregnancy amongst South African, HIV-infected women (N = 209) and men (N = 82) recruited from antenatal and antiretroviral clinics, respectively, and reporting an uninfected or unknown-HIV-serostatus pregnancy partner. All participants knew their HIV-positive serostatus prior to the referent pregnancy. Only 11 % of women and 5 % of men had planned the pregnancy; 40 % of women and 27 % of men reported serostatus disclosure to their partner before conception. Knowledge of safer conception strategies was low. Around two-thirds reported consistent condom use, 41 % of women and 88 % of men reported antiretroviral therapy, and a third of women reported male partner circumcision prior to the referent pregnancy. Seven women (3 %) and two men (2 %) reported limiting sex without condoms to peak fertility. None reported sperm washing or manual insemination. Safer conception behaviors including HIV-serostatus disclosure, condom use, and ART at the time of conception were not associated with desired pregnancy. In light of low pregnancy planning and HIV-serostatus disclosure, interventions to improve understandings of serodiscordance and motivate mutual HIV-serostatus disclosure and pregnancy planning are necessary first steps before couples or individuals can implement specific safer conception strategies. [ABSTRACT FROM AUTHOR]

Scholars have documented the emergence of apparently race-neutral discourses that serve to entrench racial stratification following the elimination of de jure segregation. These discourses deny the existence of both present-day racism and the contemporary effects of histories of racial oppression. Researchers posit that individuals are socialized into these views, but little empirical attention has been paid to the processes through which such socialization occurs. Focusing on the South African case study, I draw on five months of daily observations in seventeen 9th-grade history classrooms, content analysis of notes distributed in class, and 170 in-depth interviews with teachers and students to document how and why students are taught not to attend to the effects of apartheid on their society. To mitigate race-based conflict in their local school context, teachers told “both sides of the story,” highlighting that not all whites were perpetrators and not all blacks were victims. By decoupling the racialized coding of victims and perpetrators, and sidelining discussions of beneficiaries, teachers hindered students’ abilities to make connections to the present. In outlining how and why individuals are taught about the irrelevance of the past, this study contributes to literatures on race, education, collective memory, and transition to democracy. [ABSTRACT FROM AUTHOR]

HIV-positive adolescents who engage in unsafe sex are at heightened risk for transmitting or re-acquiring HIV. Disclosure of HIV-status to sexual partners may impact on condom use, but no study has explored the effects of (i) adolescent knowledge of one's HIV-status, (ii) knowledge of partner status and (iii) disclosure to partners, on safer sex behaviour. This study aimed to identify whether knowledge of HIV-status by HIV-positive adolescents and partners was associated with safer sex. Eight fifty eight HIV-positive adolescents (10–19 years old, 52% female, 68.1% vertically infected) who had ever initiated antiretroviral treatment in 41 health facilities in the Eastern Cape, South Africa, were interviewed using standardised questionnaires. Quantitative analyses used multivariate logistic regressions, controlling for confounders. Qualitative research included interviews, focus group discussions and observations with 43 HIV-positive teenagers and their healthcare workers.N = 128 (14.9%) of the total sample had ever had sex, whileN = 109 (85.1%) of sexually active adolescents had boy/girlfriend. In total, 68.1% of the sample knew their status, 41.5% of those who were sexually active and in relationships knew their partner's status, and 35.5% had disclosed to their partners. For adolescents, knowing one's status was associated with safer sex (OR = 4.355, CI 1.085–17.474,p = .038). Neither knowing their partner's status, nor disclosing one's HIV-status to a partner, were associated with safer sex. HIV-positive adolescents feared rejection, stigma and public exposure if disclosing to sexual and romantic partners. Counselling by healthcare workers for HIV-positive adolescents focused on benefits of disclosure, but did not address the fears and risks associated with disclosure. These findings challenge assumptions that disclosure is automatically protective in sexual and romantic relationships for HIV-positive adolescents, who may be ill-equipped to negotiate safer sex. There is a pressing need for effective interventions that mitigate the risks of disclosure and provide HIV-positive adolescents with skills to engage in safe sex. [ABSTRACT FROM AUTHOR]

While older people live in developing countries, little is known about the relative importance of features of their communities in influencing their liveability. We examine components of home and neighbourhood among older South Africans. Linear regression analyses revealed that features of home (basic amenities, household composition, financial status and safety) and neighbourhood (ability to shop for groceries, participate in organizations and feel safe from crime) are significantly associated with life satisfaction. Approaches to liveability that are person-centred and also set within contexts beyond home and neighbourhood are needed to address boundaries between home and neighbourhood; incorporate personal resources into liveability models and import broader environmental contexts such as health and social policy. [ABSTRACT FROM AUTHOR]

Intended conception likely contributes to a significant proportion of new HIV infections in South Africa. Safer conception strategies require healthcare provider-client communication about fertility intentions, periconception risks, and options to modify those risks. We conducted in-depth interviews with 35 HIV-infected men and women accessing care in South Africa to explore barriers and promoters to patient-provider communication around fertility desires and intentions. Few participants had discussed personal fertility goals with providers. Discussions about pregnancy focused on maternal and child health, not sexual HIV transmission; no participants had received tailored safer conception advice. Although participants welcomed safer conception counseling, barriers to client-initiated discussions included narrowly focused prevention messages and perceptions that periconception transmission risk is not modifiable. Supporting providers to assess clients' fertility intentions and offer appropriate advice, and public health campaigns that address sexual HIV transmission in the context of conception may improve awareness of and access to safer conception strategies. [ABSTRACT FROM AUTHOR]

To explore the barriers and facilitators of linkage to and retention in care amongst persons who tested positive for HIV, qualitative research was conducted in a home-based HIV counselling and testing (HBCT) project with interventions to facilitate linkages to HIV care in rural KwaZulu-Natal, South Africa. The intervention tested 1272 adults for HIV in Vulindlela of whom 32% were HIV positive, received point-of-care (POC) CD4 testing and referral to local HIV clinics. Those testing positive also received follow-up visits from a counsellor to evaluate linkages to care. The study employed a qualitative methodology collecting data through in-depth semi-structured interviews. Respondents included 25 HIV-positive persons who had tested as part of HBCT project, 4 intervention research counsellors who delivered the HBCT intervention and 9 government clinic staff who received referrals for care. The results show that HBCT helped to facilitate linkage to care through providing education and support to help overcome fears of stigma and discrimination. The results show the perceived value of receiving a POC CD4 result during post-test counselling, both for those newly diagnosed and those previously diagnosed as HIV positive. The results also demonstrate that in-depth counselling creates an “educated consumer” facilitating engagement with clinical services. The study provides qualitative insights into the acceptability of confidential HBCT with same day POC CD4 testing and counselling as factors that influenced HIV-positive persons’ decisions to link to care. This model warrants further evaluation in non-research settings to determine impact and cost-effectiveness relative to other HIV testing and referral strategies. [ABSTRACT FROM AUTHOR]

Background: Effective use of proven treatments for high blood pressure, a preventable health risk, is challenging for many patients. Prompts via mobile phone SMS-text messaging may improve adherence to clinic visits and treatment, though more research is needed on impact and patient perceptions of such support interventions, especially in low-resource settings. Method: An individually-randomised controlled trial in a primary care clinic in Cape Town (2012-14), tested the effect of an adherence support intervention delivered via SMS-texts, on blood pressure control and adherence to medication, for hypertensive patients. (Trial registration: ClinicalTrials.gov NCT02019823). We report on a qualitative evaluation that explored the trial participants' experiences and responses to the SMS-text messages, and identified barriers and facilitators to delivering adherence support via patients' own mobile phones. Two focus groups and fifteen individual interviews were conducted. We used comparative and thematic analysis approaches to identify themes and triangulated our analysis amongst three researchers. Results: Most participants were comfortable with the technology of using SMS-text messages. Messages were experienced as acceptable, relevant and useful to a broad range of participants. The SMS-content, the respectful tone and the delivery (timing of reminders and frequency) and the relational aspect of trial participation (feeling cared for) were all highly valued. A subgroup who benefitted the most, were those who had been struggling with adherence due to high levels of personal stress. The intervention appeared to coincide with their readiness for change, and provided practical and emotional support for improving adherence behaviour. Change may have been facilitated through increased acknowledgement of their health status and attitudinal change towards greater self-responsibility. Complex interaction of psycho-social stressors and health service problems were reported as broader challenges to adherence behaviours. Conclusion: Adherence support for treatment of raised blood pressure, delivered via SMS-text message on the patient's own phone, was found to be acceptable, relevant and helpful, even for those who already had their own reminder systems in place. Our findings begin to identify for whom and what core elements of the SMS-text message intervention appear to work best in a low-resource operational setting, issues that future research should explore in greater depth. [ABSTRACT FROM AUTHOR]

Escalation of non-communicable diseases (NCDs) among urban South African populations disproportionately afflicted by HIV/AIDS presents not only medical challenges but also new ways in which people understand and experience sickness. In Soweto, the psychological imprints of political violence of the Apartheid era and structural violence of HIV/AIDS have shaped social and health discourses. Yet, as NCDs increasingly become part of social and biomedical discussions in South African townships, new frames for elucidating sickness are emerging. This article employs the concept of syndemic suffering to critically examine how 27 women living with Type 2 diabetes in Soweto, a township adjacent to Johannesburg known for socio-economic mobility as well as inequality, experience and understand syndemic social and health problems. For example, women described how reconstructing families and raising grandchildren after losing children to AIDS was not only socially challenging but also affected how they ate, and how they accepted and managed their diabetes. Although previously diagnosed with diabetes, women illustrated how a myriad of social and health concerns shaped sickness. Many related diabetes treatment to shared AIDS nosologies, referring to diabetes as ‘the same’ or ‘worse’. These narratives demonstrate how suffering weaves a social history where HIV becomes ordinary, and diabetes new. [ABSTRACT FROM PUBLISHER]

Although there is a high prevalence of anxiety and depression amongst people receiving antiretroviral treatment (ART), many patients are not screened, diagnosed or referred for mental health problems. This study aims to determine whether public sector health care workers in South Africa observe, screen, diagnose and refer ART patients that show symptoms of common mental disorders. It also aims to ascertain the extent of mental health training received by public sector health care workers working in ART. The study was cross-sectional in design. Self-administered questionnaires were completed by 40 nurses and structured interviews were conducted with 23 lay workers across the five districts in the Free State between July 2009 and October 2009. STATA version 12 was used to perform statistical data analysis. The health care workers reported observing a high frequency of symptoms of common mental disorders among public sector ART patients. While 70% of nurses screened and diagnosed, only 40% of lay workers screened and diagnosed patients on ART for a mental disorder. Health care workers who had received training in mental health were more likely to screen or diagnose a mental disorder, but only 14% of the workers had received such training. We recommend that health care workers should receive task-specific training to screen and/or diagnose patients on ART for common mental disorders using the guidelines of the South African HIV Clinicians Society. A positive diagnosis should be referred to a health care practitioner for appropriate evidence-based treatment in the form of medication or psychotherapy. [ABSTRACT FROM PUBLISHER]

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The article discusses a study which looked at experience of recovery from first-episode psychosis in schizophrenia among various patients. Topics mentioned include the use of interpretative phenomenological analysis in data analysis, the role of patient support and having to care for another as contributors to patient recovery, and the increasing view of patients with schizophrenia as active agents in their own treatment.

Depression and other health problems are common co-morbidities among persons living with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS). The aim of this study was to investigate depression, health status, and substance use in relation to HIV-infected and uninfected individuals in South Africa. Using a cross-sectional case-control design, we compared depression, physical health, mental health, problem alcohol use, and tobacco use in a sample of HIV-infected (N= 143) and HIV-uninfected (N= 199) respondents who had known their HIV status for two months. We found that depression was higher, and physical health and mental health were lower in HIV-positive than HIV-negative individuals. Poor physical health also moderated the effect of HIV infection on depression; HIV-positive individuals were significantly more depressed than HIV-negative controls, but only when general physical health was also poor. We did not find an association between alcohol or tobacco use and HIV status. These results suggest the importance of incorporating the management of psychological health in the treatment of HIV. [ABSTRACT FROM AUTHOR]

The primary mode of HIV transmission in South Africa is heterosexual sexual behavior. HIV prevention research specifically focusing on men in South Africa is limited. We assessed self-reported HIV risk behaviors in 1,181 men ages 18 to 45 years in randomly selected neighborhoods in Eastern Cape Province, South Africa. Older men were less likely to report having multiple partners. Religiosity was a protective factor for condom use and unprotected sex with steady partners. Discussing using condoms was a protective factor for condom use and unprotected sex with both steady and casual partners. Having a child was associated with decreased condom use with steady partners and employment was associated with decreased condom use with casual partners. The findings suggest the need for HIV risk-reduction behavioral interventions tailored for South African men with regard to age, religiosity, and types of sexual partners. Implications for the development of such interventions are discussed. [ABSTRACT FROM AUTHOR]

Alcohol use is associated with compromised antiretroviral therapy (ART) adherence. We aimed to identify patterns and predictors of ART use among alcohol drinkers. Using purposive sampling, we recruited 304 male and female patients from two ART clinics in Tshwane, South Africa. Interviews were conducted using a structured questionnaire comprising measures of demographic factors, psychosocial factors (i.e., ART adherence, self-efficacy beliefs, alcohol and ART interactions beliefs, ART-alcohol outcome expectancy, attitude towards drinking alcohol and taking ART and HIV stigma) and alcohol use (AUDIT). Data were analysed using descriptive statistics and three multivariate linear regressions. Forty percent of the sample reported drinking alcohol. Half of the drinkers endorsed one of three unique patterns of ART use: (1) dosing ART earlier than required (2) taking ART while drinking alcohol and (3) skipping ART doses. The other half endorsed combinations of ART use on drinking days, for example, earlier ART dosing and taking ART while drinking alcohol was the most common combination. High adherence perseverance (a self-efficacy subscale) and a non-favourable attitude towards drinking alcohol and taking ART predicted the unique pattern of taking ART early when planning to drink alcohol. The unique pattern of taking ART despite drinking alcohol was predicted by higher levels of education (marginal significance) and experiencing low HIV stigma. A high score on the AUDIT and experience of high stigma predicted the unique pattern of skipping ART doses when drinking alcohol. Patterns of ART taking in alcohol drinkers in this sample are varied, and not always mutually exclusive. This apparent complexity of medication taking patterns among alcohol drinkers warrants further exploration. Furthermore, the finding that different psychosocial factors predict different ART-taking patterns suggests a need for programmes to improve alcohol-related non-adherence to ART to be multifaceted. [ABSTRACT FROM PUBLISHER]