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The article posits that imbalances in gender relations are influencing two distinctive yet connected crises for women in Lesotho: the HIV epidemic and spousal abuse. The overarching premise is that as spousal abuse is increasingly recognised and as HIV infections spread, responses to the phenomenon do not reflect the related risks and consequences in married women's lives. This article underscores the nexus of connections between HIV and spousal abuse in Lesotho, identifying potential areas for pragmatic state-led responses. Applying a rights-based approach, it assesses women's vulnerability to each problem at the individual, societal and programmatic levels, noting that there are both direct and underlying factors heightening risks for women. The article asks, what is the value added by a rights-based approach to the subject under discourse? And, how can a rights-based approach be translated into practical tools for planning, monitoring and evaluating projects and programmes aimed at tackling the multifaceted risks and challenges of HIV and spousal abuse confronting women in Lesotho? In response to these questions, the author identifies three trajectories of opportunities for an integrated, comprehensive response. The unmistakable anchor of the article's propositions is the rights-based approach. Although the discussion focuses on Lesotho, the implications for the broader African region cannot be overemphasised in light of commonly shared experiences pertaining to the severe difficulties posed by spousal abuse and HIV. [ABSTRACT FROM PUBLISHER]

The fisheries sector contributes significantly to Malawi's national economy and to the livelihoods of the poor as certain activities in the sector have relatively low barriers to entry. Various studies have shown that the fisheries sector suffers from high HIV prevalence in many low-income countries. In Malawi, HIV prevalence as well as the causes and impact of HIV infections among fisherfolk are yet to be assessed. Participatory action research was conducted in Mangochi District, in the southern part of Lake Malawi, between December 2007 and January 2008, to identify critical HIV-risk points along the value-chain for the Lake Sardine or usipa (Engraulicypris sardella) fishery. Data were collected through interviews with key informants and from focus group discussions at the community, institution, district and market levels. An analysis of vulnerability resulted in the formulation of mechanisms to redress HIV and AIDS prevention and mitigation at each point of vulnerability. The findings show that HIV and AIDS vulnerability in the fishery's market-chain is highest where fish processing and trading influence sexual relationships between fishermen and female fish traders. The period of high usipa catches (December to March) coincides with a period of food shortage and fishing offers income-generating opportunities for many food-insecure households. This increases competition in processing and trading fish, a socio-economic situation that may result in increased instances of transactional sex. The interactions along the usipa fishery's market-chain, from rural to urban settings, also favour the transmission of HIV from areas of high prevalence to areas with otherwise low HIV risk. [ABSTRACT FROM AUTHOR]

This paper presents a case study of wellness programme and health policy development based on an HIV/AIDS organisation's Khayelitsha site in the Western Cape Province, South Africa. The study examines the different challenges that the organisation faces in relation to its predominantly low-income staff, donor-driven structure, its limited resources and organisational capacity, and the highly stressful and demanding nature of HIV-related treatment and care. This case study also examines the significant and contentious challenges lying in the organisation's faith-based identity. Research began with a review of civil society organisations' responses to HIV in sub-Saharan Africa, as well as related topics, such as South Africa's public health system, and health-seeking attitudes, beliefs and behaviours in high-risk South African communities. The organisation's health policy was analysed and 'workshopped' with multiple employees. Focus groups were conducted with mid-management and fieldwork staff in the Khayelitsha office, while a comprehensive, anonymous, wellness questionnaire was distributed in order to collect quantitative data. Data acquired from the questionnaire responses and the focus group discussions indicated that wellness programme and health policy development faces its greatest challenges on two fronts, namely due to a critical lack of organisational development and capacity, and a host of practical, social and cultural challenges among the most vulnerable people whom the NGO intends to serve. The study's primary recommendations include: taking its employees' cultural and social norms into consideration; addressing issues related to capacity and organisational development with the major donors; broadening the scope of its health policy to extend beyond issues related to HIV; and examining and clarifying expectations of employee behaviour in light of its identity as a faith-based organisation. The study also issues a secondary list of recommendations for other resource-constrained NGOs that also wish to develop and implement wellness programmes and health policies in their workplace. [ABSTRACT FROM AUTHOR]

This paper is a response to a growing vision of schools as sites of care and support for vulnerable children in the context of HIV and AIDS. The aim is to interrogate this notion and to raise some key issues in considering the role of schools in the context of the epidemic. The paper is based on two research activities. The first was a desk review of projects working in the area of schools in the context of HIV/AIDS and poverty, including a review of the policies underlying these initiatives. The second was the documentation of a particular project in a province of South Africa. The paper begins by outlining some major education policies in South Africa related to the care and support of vulnerable children in the context of HIV and AIDS. The paper then offers three cautionary notes in relation to the thrust of these policies and those programmes attempting to implement them. The first suggests consideration of the context of implementation - the schooling system. The second recommends consideration for resourcing these policies, which is looked at through a case study. The third note considers the policy visions of schools and teachers: how schools and teachers are conceptualised both in policies and programmes is problematised. The misalignment between the policies around schools and vulnerable children, the resourcing of these policies, and their contexts of implementation is brought into relief, as well as the implications for thinking about expanded roles for schools and teachers. The paper offers possible ways forward in considering the role of schools in the context of HIV and AIDS. These include new ways of thinking about resourcing, proper monitoring and evaluation of projects, and a focus on quality teaching and learning. [ABSTRACT FROM AUTHOR]

Large-scale surveys have reported that about 55% of orphans worldwide are adolescents. In Kenya, the majority of HIV-infected adolescents are females. The current study used the anthropological methods of in-depth case studies to analyse how migratory life situations of individual female adolescent orphans in the Luo community of Western Kenya may increase their exposure to HIV. The study shows that the ability of the female adolescent orphans to adopt risk-preventive behaviour in relation to HIV is determined by a range of factors beyond their control of individual sexual behaviour. Although analysis of a single case study limits generalisation of the findings, the results provide insights into the reason for sex differentials in HIV infection rates among adolescents as reported in some large-scale surveys. The paper recommends that HIV prevention strategies for adolescents should examine the specific life situations of female orphans by focusing on the impacts of HIV and AIDS and poverty on the protective role of the family. It also recommends that keeping female adolescent orphans in school or in vocational training can be an effective HIV prevention strategy for them. [ABSTRACT FROM AUTHOR]

The end of apartheid in South Africa has led to political-economic transition, the deregulation of cities, and increased population mobility, with growing numbers of people living and working in sub-standard and 'informal' urban conditions. These processes have created a fertile terrain for the rapid spread of HIV, especially in the province of KwaZulu-Natal. Few studies have considered how the HIV epidemic's outcomes are interacting with other societal processes, such as globalisation and urbanisation, or how these processes collectively converge with place-specific conditions to expose, drive and compound vulnerabilities to HIV and AIDS. This paper links an analysis of the political economy of South Africa's HIV epidemic with findings from an ethnographic case study with street traders in Warwick Junction, the largest trading hub in Durban, KwaZulu-Natal. [ABSTRACT FROM AUTHOR]

This paper documents the evaluation of a 20-month project to provide voluntary counselling and testing (VCT) to a mobile population of youth surrounding the Agbogbloshie market in Accra, Ghana. The specific objectives of the evaluation were to determine: 1) to what extent targets for providing VCT services to the specified population were reached; 2) how HIV prevalence among clients compared to that of the general population; 3) to what extent former clients self-reported behaviour change; and 4) whether useful lessons could be drawn regarding fees, hours, and location of services, as well as use of peer educators to increase use of VCT services among the target population. Various methodologies, including questionnaires, focus group discussions, a review of the service statistics and an exit poll of clients were used to evaluate the project. The service statistics demonstrated that the project exceeded the life-of-project target for number of clients by nearly 40%. Prevalence for the VCT client population (aged 15-25) was higher than for the general population (aged 15-24), although the gender differentials were similar. Focus group data suggested that clients may have adopted behaviour changes as a result of VCT. Finally, focus group discussions and VCT service trends showed that the high number of clients was largely influenced by three factors: services being free, location and hours of services being convenient to the target population, and use of peer educators to promote the services. In addition, the evaluation highlighted the importance of the counselling component of VCT, even as counselling can get short-changed at the expense of HIV testing when large numbers of clients are involved. The evaluation stressed the need to appropriately remunerate peer educators for their work whenever possible. Finally, VCT programmes continue to face challenges such as: HIV stigma as a barrier to people coming to be counselled and tested; insufficient availability of medication, support and services for HIVpositive clients; and difficulty of ensuring the sustainability of VCT programmes. [ABSTRACT FROM AUTHOR]