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Mother-to-child transmission is a continuing source of new HIV infections in South Africa. The paper posits that insight into the socio-cultural, behavioural, environmental and economic factors that sustain the HIV epidemic is as important as understanding the biological causes of the disease when planning and implementing interventions to prevent and reduce perinatal transmission. Furthermore, understanding the pregnancy intentions of individuals in areas of endemic HIV/AIDS is vital for providing the best care for individuals who are HIV-positive. This paper suggests a model for types of support and interventions that are relative to the intention of HIV-positive women or couples to become pregnant. Included among these are interventions for prevention of unwanted pregnancy, prevention of transmission of HIV, protection of the infant, and protection of the mother. [ABSTRACT FROM AUTHOR]

Therapeutic interventions to address HIV in Africa mean that individuals are increasingly diagnosed with HIV prior to severe health crisis. This paper contributes to the anthropological literature on living with HIV by focusing on the creation and use of narrative and practical strategies for addressing HIV in a setting where such experiences have to date received little attention. Specifically, focus is on the discursive strategy of ‘living positively’, a forceful and much propagated orientation to life following an HIV diagnosis. In this paper the authors examine how this strategy is embraced not only by individuals living with HIV, but also by activists, HIV support organizations and public health agencies. The paper is based on fieldwork in and around Cape Town, South Africa in 2002 and draws on open-ended interviews with 12 women living with HIV and observations from support groups, activist events and public health meetings. The research indicates that the living positively dictum is imbued with a multiplicity of meanings and that it is used in diverse ways. For women living with HIV the practical and philosophical elements of positive living have social and political force in transforming personal and social attitudes about HIV, especially about HIV testing and treatment access. At the same time, however, the dictum poorly addresses the structural constraints of living with HIV and places the responsibility for positive living squarely on the individual. Despite this, the political context that prevailed in Cape Town at the time of the research created a particularly fertile juncture for embracing the living positively philosophy. [ABSTRACT FROM AUTHOR]

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

HIV-disclosure among childbearing women remains poorly understood, particularly in sub-Saharan Africa. This paper chronicles disclosure experiences of 31 women attending prevention of mother-to-child HIV transmission services in Johannesburg. Data collection entailed repeat in-depth interviews over a nine-month period. Virtually all women (93.5%) had told at least one person (usually a partner), most voluntarily and within a week of the test result. Secondary disclosure was most likely with female family members, through indirect means and involuntary. Confidentiality breach by primary targets likely contributed to the observed high rates of involuntary secondary disclosure and negative secondary disclosure experiences. For most mothers, voluntary disclosure was driven by the desire to ensure adequate infant care and avoid vertical HIV transmission. The impact of disclosure was not always clear-cut. While most primary disclosure experiences were ultimately constructive, secondary disclosure more likely led to rejection, stigmatization and the withholding of financial support. Our data illustrate the influence of social contextual factors on disclosure patterns and impact. For these mothers, socio-cultural norms, the current media and political environment surrounding HIV/AIDS, household composition and social networks and childbearing status shaped disclosure experiences; sometimes constraining disclosure circumstances and sometimes creating a safe space to disclose. Programmatic implications are also discussed. [ABSTRACT FROM AUTHOR]

Pregnancy decision-making is complicated for HIV-positive women because they have to contend with unpredictable symptoms, potential vertical transmission, and often a problematic life context including poverty, abuse, and stigma. The purpose of the study was to explore the views of HIV-positive women attending a support group at a clinic in the Mpumalanga Province, on becoming pregnant. A qualitative, descriptive, and phenomenological research design was adopted to conduct one-on-one interviews using a semi-structured interview guide. Purposive sampling aided the selection of fifteen HIV-positive women who were members of the HIV/AIDS support group at the clinic. Data saturation was reached at participant number 15. Lincoln and Guba's four criteria for ensuring the trustworthiness of data were applied. Data were analysed using the open coding technique. The following categories emerged: Mitigating fears of becoming pregnant through the prevention of mother-to-child transmission (PMTCT) programme; relationship between becoming pregnant and stigma attached to HIV/AIDS; cultural and social norms about becoming pregnant and the relationship between support groups and becoming pregnant. The study concluded that the desire to become pregnant amongst HIV-positive women is influenced by several aspects such as knowledge about the prevention of mother to child transmission, cultural values and social norms, and belonging to support groups where they were able to share experiences. Furthermore, becoming pregnant was viewed as an obligation to satisfy their partners/husbands and security to maintain marriages. [ABSTRACT FROM AUTHOR]

In a South African medical school in the late 2010s, future health-care professionals are told that young black women from rural areas are the drivers of HIV infection. Like AIDS narratives that have come before, this statement bluntly configures and constructs 'women' and reproduces, perhaps unknowingly, a patriarchal and uncritical engagement with the gendered nature of the AIDS epidemic in something akin to intellectual tunnel vision. The creation of this dominant and narrow vision began long before the AIDS epidemic; it was rooted in histories and discursive traditions of female forms repeatedly traumatised by elite medico-scientific communities. The strength of this intellectual tradition and its perpetuation is evident in articles about AIDS that appeared in the South African Medical Journal between 1980 and 1995, and are analysed in this article. In early AIDS narratives, certain women initially feature as silent sexual partners of men; 'black' women then appear as infecting prostitutes until attention shifts to the pregnant female form. Towards the mid 1990s, the narratives turned towards women and human rights, but, in all these representations, only certain categories of women are visible and many are completely ignored. The article reveals these silences in the medical record and explicitly notes which female forms are seen and which unseen. It explores the changing roles assigned to certain female forms as the AIDS narrative evolved and suggests that the focus on certain types of sexualities or sexual orientation were embedded in unchallenged racialised, sexist, heteronormative modes of research. Finally, the article considers how understanding the history and perpetuation of this tunnel vision could be beneficial to HIV and AIDS research and argues for the necessity of critically engaging with context and complexity in research. [ABSTRACT FROM AUTHOR]

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: The objectives of this study were to evaluate whether infants born to known HIV-positive mothers, but who were not themselves infected with HIV and who were fed a chemically acidified starter formula with prebiotics with or without nucleotides during their first six months, displayed growth rates equal to uninfected infants fed a chemically acidified starter formula without prebiotics or nucleotides. Design: The design was a multi-centre, double-blinded randomised controlled trial. Setting: The study was carried out in four academic hospitals, three in Johannesburg and one in Cape Town, South Africa. Subjects and intervention: The subjects were newborn infants born to consenting HIV-positive women who had previously decided not to breast feed. The infants were randomised to receive one of three milk formulas. The intervention comprised chemically acidified formula without prebiotics or nucleotides, with prebiotics only, or with prebiotics and nucleotides. Outcome measures: The outcome measures were the growth parameters through the first six months of life. Results: Of the 150 randomised infants, 50 did not complete the study and 16 (12.8% of those tested) were infected with HIV, leaving 84 infants available for analysis. All three formulas were tolerated well, with no differences in growth parameters seen with the addition of prebiotics and nucleotides. The growth rates of the study infants up to the age of six months were very good, showing an increase in Z-scores from negative values at the time of enrolment in the first week after birth to around zero for length and > 0.5 for weight. Conclusions: The three chemically acidified formulas were tolerated well and resulted in good growth over the first six months of life. No benefits were seen with the addition of prebiotics or nucleotides. The growth rates were similar to those found in previous studies of ours on biologically acidified formulas. The chemical acidification of infant formulas appears to be a realistic alternative to biological acidification should an acidified formula be required. [ABSTRACT FROM AUTHOR]

Informed consent has historically been a cornerstone to ensuring autonomy during HIV testing. However, recent changes to global guidance on HIV testing have led to substantial debate on what policy provisions are necessary to ensure that consent remains meaningful in the context of testing. Despite disproportionate rates of testing during pregnancy, pregnant women's perspectives on the HIV testing process are underrepresented in the testing discourse. This study explores women's experiences with HIV testing and the consent process in a public antenatal clinic in South Africa. Qualitative interviews with 25 women were conducted at the clinic at either an antenatal visit or an infant immunization visit that followed HIV testing. Interviews were transcribed, translated, and coded for analysis. Women were categorized into one of the three groups based on their perceptions of choice in consenting for an HIV test. Matrices were used to allow for cross-category and cross-case comparison. Half of the women described having a clear choice in their decision to test. Others were less clear about their choice. Some women felt they had no choice in testing for HIV. None of the women stated that they were tested without having signed a consent form. We found that half of the women's narratives illustrated direct and indirect ways in which providers coerced them into taking an HIV test while receiving antenatal care. As the new guidance on HIV testing is implemented in different settings, it is critical to monitor women's testing experiences to ensure that a woman's right to make an informed, voluntary choice is not violated. Furthermore, models of testing that allow us to meet broader public health goals while simultaneously respecting women's autonomy are needed. [ABSTRACT FROM AUTHOR]

Grandparents are increasingly becoming the primary carers of children orphaned by the HIV epidemic in South Africa. Traditional family roles are being reversed as aging family members take responsibility for the physical and psychosocial needs of children. This study uses qualitative research to explore the experiences of grandparents fostering children orphaned by AIDS in Richards Bay, KwaZulu-Natal Province, South Africa. The idea was born after a local HIV support organisation (Richards Bay Family Care) observed a trend within their organisation of grandparents increasingly becoming foster parents for orphans. An exploratory study was conducted in the organisation's three target areas (two rural villages and urban Richards Bay); the ultimate aim was to explore options for improving financial and emotional support for this group. The qualitative research methods included: four focus group discussions with foster-carers and community leaders (including two pocket-chart voting exercises); 12 in-depth interviews with grandparent foster-carers; and ten key-informant interviews, mostly with staff who provide support services. Data analysis was by thematic framework. The needs of the grandparent foster-carers varied: the rural participants were essentially concerned with meeting children's basic needs (housing, food and education), while those in urban areas more often felt pressure to provide emotional and psychological support for orphans. In both groups, women were at the forefront of foster care. Important problems identified by the grandparents were child discipline and a feeling of disharmony in the intergenerational relationship. Government foster care grants were identified as a regular source of income for especially the rural foster-carers. The findings may help programme managers better understand the differences in the needs of urban and rural foster parents. The experiences of grandparents as carers of orphans affected by HIV or AIDS are unique considering their age, frailty and poverty status. More research is needed on the role played by men in fostering children orphaned by AIDS. [ABSTRACT FROM AUTHOR]

The prevalence of HIV infection continues to increase among women in South Africa while there are few interventions specifically targeting condom use promotion in this population. We report the results of an experimental pilot study of a health education intervention aimed at enhancing coping skills and consistent condom use among HIV-positive women attending primary health clinics in the Western Cape province of South Africa. One hundred and twenty women were randomised into the intervention condition or a control condition. Both groups completed an interviewer administered questionnaire that included measures of self-esteem, attitude towards condom use, and self-efficacy towards condom use and negotiating condom use, and provided vaginal swab specimen at baseline and three months after the intervention. Tests for intervention effects at three months while controlling for baseline revealed that only self-esteem was significantly higher in the intervention group relative to the control group. No significant differences were found on measures of coping skills and condom use behaviour. Importantly, incidence for Chlamydia Trachomatis, Neisseria Gonorrhea and Trichomona vaginalis during the study period were significantly lower in the intervention group than the control group. These results are strong indications that this intervention could serve as a basis for the development of potentially effective interventions to reduce STI-related sexual risk behaviours among HIV-positive black women in South Africa. [ABSTRACT FROM AUTHOR]

HIV infection is high among South African youth but most report being unaware of their HIV status. We explored the correlates of HIV testing using data from youth aged 15-24 years old who reported being sexually experienced during a national survey conducted in South Africa in 2003 (N=7665). Among sexually experienced youth, 32.7% of females and 17.7% of males reported having been tested for HIV. In multivariable analysis, ever being pregnant (OR = 2.97; 95% CI 2.36-3.73), ever starting a conversation about HIV/AIDS (OR = 1.29; 95% CI 1.0-1.65) and urban residence (OR = 2.0; 95% CI 1.58-2.52) were independent correlates of HIV testing among sexually experienced females. Among sexually experienced males, HIV-positive status (OR = 1.76; 95% CI 1.14-2.73), personally knowing someone that died of AIDS (OR = 1.68; 95% CI 1.14-2.47), being aged 20-24 years (OR = 1.56; 95% CI 1.10-2.22) and having completed high school (OR = 1.58; 95% CI 1.17-2.12) were independent correlates of HIV testing. The following factors were significantly associated with HIV testing among both men and women; ever talking to parents about HIV/AIDS, ever participating in a loveLife programme, a higher frequency of visits to a clinic in the past 12 months and non-black race (p<0.05). There is a need to better understand the correlates of HIV testing to ensure that adolescent HIV prevention programmes actively promote HIV testing among this group. Specific attention needs to be paid to young women who do not access antenatal care and young men who are less regular users of routine clinical care. Communication is a significant predictor of having tested for HIV and should be encouraged with parents and through intervention programmes for adolescents. Finally, specific attention must be paid to increasing access to HIV testing for at-risk adolescents in rural communities. [ABSTRACT FROM AUTHOR]

HIV prevalence among women in South Africa continues to be high despite the availability of a comprehensive plan for the control of HIV/AIDS and a plethora of prevention programmes. Any explanation for the ongoing high HIV prevalence continues to be elusive. The objective of this study was to understand the relationship between HIV, gender, race and socioeconomic status among South African public sector educators in order to inform prevention programmes. A cross-sectional survey involving a probability sample of 1,766 schools out of 26,713 in the Department of Education Register of School Needs was selected. A sample of 24,200 respondents out of 356,749 public sector educators participated in the study. Nurses registered with the South African Nursing Council were recruited, trained to conduct interviews and to collect specimens for HIV testing. The study found an association between HIV, gender, race and socioeconomic status among educators. African educators showed a higher HIV prevalence than other race groups. Among females, the highest HIV prevalence was among educators aged 25-35 years and in males aged 36-49 years. Further, educators with a high income and educational qualifications had a lower HIV prevalence compared to educators with low income and low educational qualifications, regardless of sex. Migration and marital factors were also found to play a role in HIV infection. The results suggest that HIV prevention needs to take into account critical issues around empowerment of vulnerable groups such as women and certain race groups to be able to implement safe sexual practices and therefore reduce HIV infections. [ABSTRACT FROM AUTHOR]

Despite good intentions and commitment from providers, prevention-of-mother-to-child-transmission of HIV (PMTCT) services can be difficult for pregnant women to access, despite the provision of free health services for women and children. We examined the introduction of PMTCT services in a very poor rural area of the Eastern Cape, South Africa, to assess the context's impact on the provision of this service. Our approach involved 13 individual in-depth interviews and 26 focus group discussions, spread over six clinics in a single district, supplemented by situational observations. Our goal was to suggest how access to PMTCT services at the clinics may be improved. Poor roads, an underdeveloped transport system and poor telecommunications typify the pervasive poverty in the study area. Families have few resources for travel and most live a long distance from a clinic. Accessing emergency transport is especially difficult and expensive. Poor infrastructure also means that many families do not have access to clean water, which complicates the use of infant formula. PMTCT services had been recently added to several clinics that provide general services to the local population, but that were already understaffed and over-pressured. Since the PMTCT services were new, some elements of the intervention and staff training were delayed, thus inhibiting full implementation. New staff had not been added to ease accumulated pressures. Thus, socio-economic context can present a formidable barrier to the provision of PMTCT services. Improvement in services to rural areas will require creative thinking, perhaps including the use of mobile services and the development of community structures, such as contributions to community health education by traditional birth attendants and local volunteer groups. [ABSTRACT FROM AUTHOR]