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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]

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]

The uptake of and adherence to HIV prevention products in South Africa has not achieved widespread success. This study aimed to develop a holistic understanding of the psychographics of adolescent girls and young women in South Africa, a primary audience for HIV prevention products, in order to inform market segmentation and marketing strategies. Extensive ethnographic analyses were complemented with a survey (n = 1,500) centered on personal care product journeys. Clustering and qualitative methods yielded six segments with measurable differences, and revealed common themes surrounding empowerment and self-determination, patriarchy, and misinformation risk. The findings enable targeted approaches for HIV prevention product campaigns. [ABSTRACT FROM AUTHOR]

Background: Many communities in developing countries rely on ecosystem services (ESs) associated with wild and cultivated plant species. Plant resources provide numerous ESs and goods that support human well-being and survival. The aim of this study was to identify and characterize wild and tended plant species, and also investigate how local communities in the Eastern Cape Province in South Africa perceive ESs associated with plant resources. Methods: The study was conducted in six local municipalities in the Eastern Cape Province, between March 2016 and September 2021. Data on socio-economic characteristics of the participants, useful plants harvested from the wild and managed in home gardens were documented by means of questionnaires, observation and guided field walks with 196 participants. The ESs were identified using a free listing technique. Results: A total of 163 plant species were recorded which provided 26 cultural, regulating and provisioning ESs. Provisioning ESs were the most cited with at least 25 plant species contributing towards generation of cash income, food, traditional and ethnoveterinary medicines. Important species recorded in this study with relative frequency of citation (RFC) values > 0.3 included Alepidea amatymbica, Allium cepa, Aloe ferox, Artemisia afra, Brassica oleracea, Capsicum annuum, Cucurbita moschata, Hypoxis hemerocallidea, Opuntia ficus-indica, Spinacia oleracea, Vachellia karroo and Zea mays. Conclusion: Results of this study highlight the importance of plant resources to the well-being of local communities in the Eastern Cape within the context of provision of essential direct and indirect ESs such as food, medicinal products, construction materials, fodder, regulating, supporting and cultural services. The ESs are the basis for subsistence livelihoods in rural areas, particularly in developing countries such as South Africa. Therefore, such body of knowledge can be used as baseline data for provision of local support for natural resource management initiatives in the province and other areas of the country. [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]

When patient-reported measures are translated and cross-culturally adapted into any language, the process should conclude with cognitive interviewing during pretesting. This article reports on translation and cross-cultural adaptation of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire into Afrikaans (for the Western Cape). This qualitative component of a clinical measurement, longitudinal study was aimed at the pretesting and cognitive interviewing of the prefinal Afrikaans (for the Western Cape) DASH questionnaire highlighting the iterative nature thereof. Twenty-two females and eight males with upper limb conditions were recruited to participate at public health care facilities in the Western Cape of South Africa. Cognitive interviews were conducted as a reparative approach with an iterative process through retrospective verbal probing during a debriefing session with 30 participants once they answered all 30 items of the translated DASH questionnaire. The sample included Afrikaans-speaking persons from low socioeconomic backgrounds, with low levels of education and employment (24 of 30 were unemployed). Pragmatic factors and measurement issues were addressed during the interviews. This study provides confirmation that both pragmatic factors and measurement issues need consideration in an iterative process as part of a reparative methodology towards improving patient-reported measures and ensuring strong content validity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mine workers in South Africa face various health and safety risks, and socioeconomic challenges. OBJECTIVE: This study aimed to assess the associations between socio-demographic factors and health, safety and wellness in the South African mining industry. METHODS: Qualitative and quantitative data were collected from 64 interviews with mine management and labour representatives, 14 focus groups with mine workers, and 875 questionnaires completed by mine workers from three platinum, two gold, one coal, one diamond, and one manganese mine in South Africa. RESULTS: Health challenges included non-communicable diseases, HIV/AIDS, tuberculosis (TB), and respiratory diseases, while safety challenges included worker behaviour, stress and fatigue. Socio-demographic factors associated with disease, sick leave, fatigue, accidents and job satisfaction included age, length of service, race, nationality, education, mining sector, work status, income, housing, domestic crowding, sleep, exercise, alcohol use, and perceived quality of life. CONCLUSION: Socio-demographic factors should be taken into consideration when developing workplace health and safety programmes. [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]

Increasing numbers of perinatally HIV (PHIV+)-infected youth are surviving into adulthood with better access to treatment. However, few studies examine positive outcomes in the face of adversity (resilience) for PHIV+ youth. Social Action Theory (SAT) provided the theoretical framework for this study of PHIV + youth in South Africa (SA), allowing examination of contextual, social, and self-regulatory factors that influence behavioral health. Data were from youth and caregiver baseline interviews, simply pooled from a pilot (N=66) and larger (n=111) randomized control trial (RCT) of the VUKA Family program. For this analysis, outcomes included emotional and behavioral functioning (total difficulties), and prosocial behaviors. Potential SAT correlates included socio-demographics; caregiver health and mental health; parent-child relationship factors; stigma, and child coping, support; and self-esteem. Regression analyses adjusted for age, gender, and study revealed significant associations at the contextual, social, and self-regulation level. Lower total child difficulties scores were associated with lower caregiver depression (β = 3.906,p < .001), less caregiver-reported communication about difficult issues (β = 1.882, p = .009) and higher youth self-esteem (β =-0.119, p = .020). Greater prosocial behaviors were associated with greater caregiver-reported communication (β = 0.722, p = .020) and child use of wishful thinking for coping (β = 5.532, p = .009). Less youth depression was associated with higher caregiver education (β =−0.399, p = .010), greater caregiver supervision (β =−1.261, p = .012), more social support seeking (β =−0.453, p = .002), higher youth self-esteem (β =−0.067, p < .001), lower internalized stigma (β = 0.608, p = .040), and child use of resignation for coping (β = 1.152, p = .041). Our data support evidence-based family interventions that also promote youth self-regulation skills to enhance the health and mental health of PHIV+ youth. [ABSTRACT FROM PUBLISHER]

This study investigated how trilinguals fare on the cross-linguistic lexical tasks (CLT)-Afrikaans, -isiXhosa and -South African English (SAE) (cf. Haman et al., 2015) compared to monolingual controls, and whether the CLT-Afrikaans renders comparable results across socioeconomic status (SES) backgrounds. The LITMUS-CLTs were administered to 41 low SES 4-year-olds (11 trilinguals; 10 monolingual speakers of Afrikaans, isiXhosa and SAE) and the LITMUS-CLT-Afrikaans to 11 mid-SES 4-year-old monolinguals. Results (a) indicate that trilinguals’ proficiency in their exposure-dominant language did not differ significantly from monolinguals’ proficiency, but their proficiency in their additional two languages was significantly lower than monolinguals’ proficiency; (b) reflect the extent, but not current amount, of exposure trilinguals had had over time to each of their languages; and (c) show that low and mid-SES monolinguals differed significantly on noun-related, but not verb-related, CLT measures. Possible reasons for and the clinical implications of these results are discussed. [ABSTRACT FROM PUBLISHER]

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]

Background: In low-income settings, many women and girls face activity restrictions during menses, owing to lack of affordable menstrual products. The menstrual cup (MC) is a nonabsorbent reusable cup that collects menstrual blood. We assessed the acceptability and performance of the MPower® MC compared to pads or tampons among women in a low-resource setting. Methods: We conducted a randomized two-period crossover trial at one site in Durban, South Africa, between January and November 2013. Participants aged 18-45 years with regular menstrual cycles were eligible for inclusion if they had no intention of becoming pregnant, were using an effective contraceptive method, had water from the municipal system as their primary water source, and had no sexually transmitted infections. We used a computer-generated randomization sequence to assign participants to one of two sequences of menstrual product use, with allocation concealed only from the study investigators. Participants used each method over three menstrual cycles (total 6 months) and were interviewed at baseline and monthly follow-up visits. The product acceptability outcome compared product satisfaction question scores using an ordinal logistic regression model with individual random effects. This study is registered on the South African Clinical Trials database: number DOH-27-01134273. Results: Of 124 women assessed, 110 were eligible and randomly assigned to selected menstrual products. One hundred and five women completed all follow-up visits. By comparison to pads/tampons (usual product used), the MC was rated significantly better for comfort, quality, menstrual blood collection, appearance, and preference. Both of these comparative outcome measures, along with likelihood of continued use, recommending the product, and future purchase, increased for the MC over time. Conclusion: MC acceptance in a population of novice users, many with limited experience with tampons, indicates that there is a pool of potential users in low-resource settings. [ABSTRACT FROM AUTHOR]

Gender and HIV risk have been widely examined in southern Africa, generally with a focus on dynamics within sexual relationships. Yet the social construction of women's lives reflects their broader engagement with a gendered social system, which influences both individual-level risks and social and economic vulnerabilities to HIV/AIDS. Using qualitative data from Lesotho, we examine women's lived experiences of gender, family and HIV/AIDS through three domains: (1) marriage; (2) kinship and social motherhood, and (3) multigenerational dynamics. These data illustrate how women caregivers negotiate their roles as wives, mothers, and household heads, serving as the linchpins of a gendered family system that both affects, and is affected by, the HIV/AIDS epidemic. HIV/AIDS interventions are unlikely to succeed without attention to the larger context of women's lives, namely their kinship, caregiving, and family responsibilities, as it is the family and kinship system in which gender, economic vulnerability and HIV risk are embedded. [ABSTRACT FROM AUTHOR]

We examined whether alcohol use is associated with antiretroviral therapy (ART) adherence independently of structural and psychosocial factors among 304 male and female ART recipients in ART sites in Tshwane, South Africa. ART adherence was assessed by the CASE Adherence Index. Independent variables were demographic, structural, psycho-social, and alcohol use (AUDIT score) factors. In hierarchical multiple regression, demographic variables (Step 1) explained 4 % of variance in ART adherence ( p ≤ 0.01). Variance explained increased to 16 % ( p ≤ 0.001) after entering structural variables (Step 2); 19 % ( p ≤ 0.001) after entering psychosocial variables (Step 3); and 24 % ( p ≤ 0.001) after entering AUDIT score (Step 4). Alcohol use is independently associated with ART adherence. [ABSTRACT FROM AUTHOR]

Aims To conduct a quantitative investigation of stress and the relationship with burnout among AIDS care volunteers. Background Volunteer caregivers experience stress that could lead to burnout. Yet, very few studies quantify stress and its relationship with burnout among AIDS care volunteers. Design This study uses a cross-sectional, exploratory survey design. Methods Face-to-face interviews were conducted with 126 volunteer caregivers working in 13 semi-rural communities (townships) in Durban, South Africa in April 2009. All participants were women, Christian and with low levels of education. A 22-item instrument was drawn from Pearlin et al.'s role overload and role captivity scales, Van Dyk's stress factor scale and the Maslach Burnout Inventory. Results Most of the volunteers had moderate-to-high levels of stress. 'Role/work overload' 'lack of support' and 'overwhelming nature of the disease' explained most of the variance in stress. Volunteers' age and number of patients in their care were predictors of stress. Caring for only AIDS patients, lack of support, stress emanating from perceived stigma and lack of training; and the overwhelming nature of AIDS were predictors of burnout. Conclusion High levels of stress could negatively impact volunteers' health and well-being and on-the-job performance. Policy makers must develop and fund home-based care models that take into account the stressors associated with AIDS care, by reducing the work load, providing ongoing psychosocial support and recruiting nurses to assist volunteers. The small non-probability sample used in this study highlights the need to treat the findings with caution. [ABSTRACT FROM AUTHOR]

Efforts to prevent mother-to-child HIV transmission (PMTCT) in sub-Saharan Africa have focused overwhelmingly on women, to the unintended exclusion of their male partners. A cross-sectional study was conducted in Tshwane, South Africa, to determine barriers to male-partner participation during PMTCT. In-depth interviews were conducted with 124 men whose partners had recently been pregnant, and five focus group discussions were held with physicians, nurses, HIV counselors, and community representatives. Qualitative analysis revealed that while most fathers believed that HIV testing is an important part of preparing for fatherhood, there are formidable structural and psychosocial barriers: the perception of clinics as not 'male-friendly,' a narrow focus on HIV testing instead of general wellness, and a lack of expectations and opportunities for fathers to participate in health care. Coupled with more family-oriented approaches to PMTCT, measurable improvements in the way that male partners are invited to and engaged in HIV prevention during pregnancy can help PMTCT programs to achieve their full potential. [ABSTRACT FROM AUTHOR]

Background: Antiretroviral therapy (ART) roll-out is fraught with challenges, many with serious repercussions. We explored and described patient behaviour-related challenges from the perspective of health care providers from non-governmental organisations involved in ART programmes in KwaZulu-Natal, South Africa. Methods: A descriptive case study design using qualitative approach was applied during this study. Data was collected from nine key informants from the three biggest NGOs involved in ART roll-out using in-depth semistructured interviews. Transcribing and coding for emergent themes was done by two independent reviewers. Ethical approval for the study was granted by the UNISA research ethics committee of The Faculty of Health Sciences. Written consent was obtained from directors of the three NGOs involved and individual audio taped informed consent was obtained from all study participants prior to data collection. Results: Findings revealed six broad areas of patient behaviour challenges. These were patient behaviour related to socio-economic situation of patient (skipping of medication due to lack of food, or due to lack of transport fees), belief systems (traditional and religious), stigma (non- disclosure), sexual practices (non-acceptability of condoms, teenage pregnancies), escapism (drug and alcohol abuse) and opportunism (skipping medication in order to access disability grant, teenage pregnancies in order to access child grant). Conclusion: New programmes need to address patient behaviour as a complex phenomenon requiring a multipronged approach that also addresses social norms and institutions. In the face of continued ART scale up, this is further evidence for the need for multi-sectoral collaboration to ensure successful and sustainable ART roll-out. [ABSTRACT FROM AUTHOR]

This study examines levels and correlates of internalized homophobia among men who have sex with men (MSM) in Pretoria, South Africa. Using respondent-driven sampling, we recruited 324 MSM from February to August 2009. Results were adjusted using RDSAT analysis to yield population-based estimates. High levels of internalized homophobia exist among South African MSM: 10-15% reported 'often/very often' and over 20% reported 'sometimes' having feelings of internalized homophobia. A greater level of internalized homophobia was significantly associated with a lower level of education [Adjusted Odds Ratio = 2.2; 95% CI = 1.1-4.9], a higher level of HIV misinformation [AOR = 2.7; 95% CI: 1.3-5.3], bisexual identity (vs. homosexual) [AOR = 5.5; 95% CI: 2.5-12.0], and HIV-related conspiracy beliefs [AOR = 2.4; 95% CI: 1.02-5.8]. These findings contribute valuable information to our understanding of internalized homophobia in South Africa, highlighting the need to empower the gay community, promote self-acceptance of homosexual identity, and address conspiracy beliefs among MSM to reduce internalized homophobia and increase access to HIV prevention interventions. [ABSTRACT FROM AUTHOR]