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Objective: To end the AIDS epidemic by 2030, despite the increasing poverty and inequalities, policies should be designed to deal with population heterogeneity and environmental changes. Bottom-up designs, such as the Agent-Based Model (ABM), can model these features, dealing with such complexity. HIV/AIDS has a complex dynamic of structural factors, risk behaviors, biomedical characteristics and interventions. All embedded in unequal, stigmatized and heterogeneous social structure. To understand how ABMs can model this complexity, we performed a scoping review of HIV applications, highlighting their potentialities. Methods: We searched on PubMed, Web of Science, and Scopus repositories following the PRISMA extension for scoping reviews. Our inclusion criteria were HIV/AIDS studies with an ABM application. We identified the main articles using a local co-citation analysis and categorized the overall literature aims, (sub)populations, regions, and if the papers declared the use of ODD protocol and limitations. Results: We found 154 articles. We identified eleven main papers, and discussed them using the overall category results. Most studies model Transmission Dynamics (37/154), about Men who have sex with Men (MSM) (41/154), or individuals living in the US or South Africa (84/154). Recent studies applied ABM to model PrEP interventions (17/154) and Racial Disparities (12/154). Only six papers declared the use of ODD Protocol (6/154), and 34/154 didn't mention the study limitations. Conclusions: While ABM is among the most sophisticated techniques available to model HIV/AIDS complexity. Their applications are still restricted to some realities. However, researchers are challenged to think about social structure due model characteristics, the inclusion of these features is still restricted to case-specific. Data and computational power availability can enhance this feature providing insightful results. [ABSTRACT FROM AUTHOR]

Enhancing the quality of life (QOL) of people living with HIV and AIDS (PLWHA) has become a significant global health goal, as combination antiretroviral therapy has helped to transform HIV/AIDS from a fatal illness to chronic disease. In this study, we aim to comprehensively describe the growth of research publications and the development of research landscapes regarding interventions to improve QOL among PLWH, as well as to characterize interdisciplinary topics and emerging interests of the research community. English articles and reviews published from 1991 to 2018 concerning interventions to improve QOL among PLWHA were retrieved from the Web of Science. Collaboration among organizations sharing coauthorships and co-occurrence network of authors' keywords was illustrated through network graphs. Latent Dirichlet Allocation was used for classifying papers into corresponding topics. A total of 2304 publications were included in the study. The USA continues to lead in research productivity, followed by South Africa, China, and India. Emerging research themes were found to be the application of multilevel interventions and long-term care, rehabilitation, along with topics relating to mental health issues, behavioral therapy and social supports for patients receiving treatments, and application of e-health approaches in designing and implementing interventions. There has been, however, a modest appearance of topics covering local, cultural, and environmental contexts of interventions. The findings of the study suggest expanding the coverage of psychosocial, behavioral, and contextualized interventions, increasing the involvement of family and community, improving the effectiveness of technology-based and e-health interventions, and developing strategies for lifelong treatment of HIV/AIDS. [ABSTRACT FROM AUTHOR]

Reports on the defense of the paper 'A Critical Analysis of the Pharmacology of AZT and its Use in AIDS,' published in the periodical 'Current Medical Research and Opinion.' Its use by President Thabo Mbeki in the debate over the efficacy of AZT in South Africa; Comments by managing editor of the periodical Peter Clarke.

This paper co-authored by an artist/activist and a feminist art historian, will present a case study of a multi-disciplinary approach to implement an HIV/AIDS action intervention in targeted communities. The objectives of the training are to assist Phumani Paper projects to become sustainable and to enable participants to reduce the loss and trauma caused by HIV/AIDS affecting their community enterprises. Phumani Paper was set up initially as a government funded poverty alleviation program in seven provinces across South Africa, and presently 17 sites are challenged with survival as viable craft enterprises. Some of those sites have lost up to half their membership as a result the impact of HIV/AIDS. This paper will draw on fifteen years of activism and experience in South Africa. This most recent project is focussed on the use of the visual arts and "PhotoVoice" narratives as a strategy to reduce the impact of HIV/AIDS in impoverished community projects. We will examine the process and results of a pilot project funded by the Ford Foundation, and implemented by a multidisciplinary, multi-cultural team that was conducted in three Phumani Paper craft project sites in July 2006. Part of the success of the pilot can be attributed to the application of Participatory Action Research techniques, which encourage project participants to be co-developers of new knowledge about themselves that can serve to guide social transformation. We will suggest ways that visual and narrative materials when applied as a training intervention can systematically increase the achievement of social change. We argue that social transformation has the most potential when it integrates existing cultural reference points with multi-disciplinary approaches and practices. [ABSTRACT FROM AUTHOR]

This paper sets out a general framework for analysing long-term care (LTC) systems for older people in different countries and then applies this framework to a specific national setting. The paper considers the extent to which South Africa's emerging LTC system conforms to broader patterns observed across low- and middle-income countries and how far it has been shaped by more local effects. It finds that patterns of demand for LTC vary across different racial categories. Despite having lower rates of ageing that the white population, Africans account for the majority of LTC demand. Residential services cater primarily for older whites and there is a widespread perception that LTC for Africans should be a family responsibility. Across the sector there is evidence of gaps in service availability, limited state oversight and uneven service quality. In 2016 this led to a high-profile political scandal which may prompt more effective state responses to this growing societal challenge. [ABSTRACT FROM AUTHOR]

Deals with a review of the literature which covered several aspects of HIV/AIDS and related diseases in South Africa. Classes of people who have not acquired the HIV infection in 1987; Population classes cited in the estimated total of HIV-infected individuals in the country in 1991; HIV prevalence rates during the period of 1995-2000.

This paper analyses the lived experiences of people living with HIV in South Africa through the use of body mapping as a visual research method, by focusing on the physical and symbolic use of the body within the broader context of anthropology and medical anthropology. The study consists of an empirical analysis of the body maps themselves and the accompanied narratives of seven participants, six female and one male participant living with HIV in South Africa. Drawing upon theories and literature on theorising the body in medical anthropology and visual research, this study explores the significance of this practice as a visual research method in understanding the nuanced lived experiences of people living with HIV by highlighting the individuality of the body and emotions; embodied experiences: a bio-cultural approach; and the body politic: social injustice. The results of this study illustrate that body mapping is a unique visual research method, that explores the body as the vehicle in which we exist within the world, while containing a vast amount of layered interpretive and cultural meanings, which are key to understanding the lived experience of people from marginalised groups. [ABSTRACT FROM AUTHOR]

In 2003, the South African government shifted AIDS policy making HIV treatment available in the public healthcare sector. The antiretroviral roll out, while hailed as a success, has required continued activism to ensure genuine implementation. Women particularly the poor, traditionally bear the brunt of the impact of HIV/AIDS socially and economically. Very often they do this in most marginalised spaces. This paper draws on theories of participation and empowerment to understand female activism during the period of antiretroviral roll out in South Africa. The paper seeks to understand how processes of empowerment linked with the first stage - access to ARVs impacted on the second stage - ARV roll out. It also considers how female activists understand their empowerment in the context of their role. The focus is grassroots activism females in Lusikisiki and Khayelitsha. This paper draws from a qualitative study on bottom-up policy advocacy utilising participatory observation and in-depth interviews with activists and civil society organisations. The main findings are that during the roll out phase of the HIV/AIDS campaign women activists worked from transformed "ways of thinking and being" in terms of HIV/AIDS and in terms of their role in the struggle for health rights. Their contesting embedded notions of power contributed to the democratisation of HIV/AIDS services. The transformation also caused shifts in the ways women mobilised, framed their understanding of the struggle and accessed participation spaces. [ABSTRACT FROM AUTHOR]

The Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome, (HIV/AIDS) has been a cause for concern in the health sector for decades. However, a scientific cure for the condition is still at large. HIV/AIDS has been widely considered extremely deadly especially in South Africa where the prevalence rate is at approximately 12.6% of the population (Statistical Release 2017). In recent years, approaches to HIV/AIDS management shun discrimination and stigmatisation and reinforce support and acceptance of those living with the disease. As a result, health practitioners, activists, and other stakeholders such as non-profit organisations have used various discursive strategies to discourage stigmatisation of people living with HIV/AIDS. Considering the foregoing, this paper analyses some selected South African online newspaper adverts in terms of how they discourse the phenomenon of living with HIV/AIDS in South Africa. The objective is to analyse how selected HIV/AIDS adverts attempt to offset and dismantle long-held discriminatory beliefs and practices. The paper draws theoretical inspiration from Billig's (1996) rhetorical approach to social psychology and a range of rights-based approaches. The findings reveal that the discourse and rhetoric of advertising are instrumental in promoting HIV/AIDS awareness and eradicating discrimination and stigmatisation of people living with the disease. [ABSTRACT FROM AUTHOR]

The author comments on three papers in this issue that take very different approaches to uncovering how HIV/AIDS is affecting members of households in South Africa. Posel and colleagues explores local understandings of the disease and death. Schatz addresses the role of elderly women in caregiving. Collinson and Wittenberg look at the trends over time in household composition in Agincourt and nationally.

Over the past few years, the pivotal roles older women play in responding to the unprecedented HIV/AIDS epidemic in southern Africa has received increasing recognition by academics, governments, funding agencies, non-governmental organisations, and citizens around the world. Yet, discourses surrounding AIDS and 'grandmotherhood' are laden with a number of ungrounded assumptions that have important implications for researchers, advocates and decision-makers. Drawing on ethnographic and survey data predominantly from South Africa, this paper challenges seven such assumptions. The paper illustrates how certain prevailing 'wisdoms' about grandmothers and AIDS in southern Africa are not entirely accurate and may mask many women's struggles and vulnerabiities, perpetuate stereotypes and misguide well-meaning policies. It also suggests that the societal impacts of AIDS in the region are, at present, not as dramatic as often portrayed, largely because the strength and resilience of many older women have cushioned some of the negative consequences. The paper thus calls for more nuanced and forward-looking analyses and interventions - ones that recognise grandmothers as central to the society's thin safety net and that grapple with older women's complex and diverse vulnerabilities. [ABSTRACT FROM AUTHOR]

Pentecostalism is the fastest growing form of Christianity in developing countries. Paralleling Pentecostalism's growth has been the HIV/AIDS pandemic. This paper examines how post-apartheid South Africans are responding to the conflicts born of the HIV/AIDS crisis. Fieldwork conducted in 2005 shows that Pentecostals who were not involved in efforts to address HIV/AIDS saw the church's mission as almost exclusively spiritual in nature. Pentecostals who were engaged in HIV/AIDS-related work were more likely to have an integrated worldview and to see the church's mission as relevant to the physical world. Beliefs about removing racism from the church and sin as structural as well as individual were also associated with this integrated worldview. These insights lay the foundation for constructing a Pentecostal social ethic for addressing HIV/AIDS. [ABSTRACT FROM AUTHOR]

This paper emerges out of a larger qualitative study that aimed at mapping barriers to basic education experienced by children and adults in the context of the HIV and AIDS pandemic. The study was undertaken in Richmond district and involved a range of centres of learning (formal and informal) including three high schools, five primary schools, two adult basic education centres, a school for the deaf, two early childhood centres and their communities. The participants in the study were child and adult learners, parents and caregivers, school governing bodies, organizations working in the district, officials from the Departments of Health, Education and Social Welfare and members of a support group for people living with HIV or AIDS. The study attempted to capture the voices of participants and to obtain rich qualitative data through individual interviews and focus group interviews. In addition, various participatory research techniques such as transect walks, vulnerability matrices, ranking exercises, photo-voice and social mapping were used in the focus group interviews. This paper provides an understanding of a theme - that of oppression - that emerged from the data. The findings suggest that oppressions are systematically produced and reproduced in the processes of the everyday lives of learners, their families, teachers and the wider school community in this particular context. The paper juxtaposes Young's (1990) five categories of oppression: exploitation, marginalization, powerlessness, cultural imperialism and violence, with three post-structural constructs: discourse, hegemony and resistance to highlight the complex workings of oppression. These constructs are applied to the data from the study. The paper will provide examples of the forms of oppression and multiple ways in which oppression is played out in different situated spaces. [ABSTRACT FROM AUTHOR]

The inclusion of Men who have Sex with Men (MSM) in global health policies has resulted in significant resource prioritisations in order to treat and prevent the Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS). MSM policy inclusions and health prioritisations, however, are primarily motivated by an epidemiological understanding of male same‐sex sexual behaviours, based on biological risks associated with HIV infection. Owing to South Africa's high HIV rates and MSM policy prioritisations, we aimed to examine experiences of engagement in urban MSM‐targeted HIV interventions. Qualitative interviews were conducted with participants (n = 20) who previously engaged in MSM‐HIV interventions, across a variety of historically marginalised "township" spaces in Cape Town, South Africa. Interviews were audio‐recorded with the consent of all participants, transcribed verbatim, and verified, and anonymised using alpha‐numeric codes. Data were analysed for core themes and in this paper we describe interactions between biological and social risks that shape city life for MSM in diverse township spaces. When positioned against the background of the Neuropolis, a recent sociological intervention by Des Fitzgerald, Nikolas Rose and Ilina Singh, our results portray urban life among MSM as a form of biological citizenship: (1) constructed by experiences that are constitutive of biosocial stressors, based on (2) health‐seeking attitudes and behaviours, and (3) reinforced through socio‐spatial engagements in peer‐led and community‐based HIV interventions. We conclude by offering critical insight into recent calls for the development of comprehensive and localised peer‐led health programmes as a current void in the geographies of health and sexualities in the global south. In this paper we describe Men who have Sex with Men and their urban experiences associated with HIV/AIDS interventions, and socio‐economic and spatial health inequalities in "townships" across Cape Town, South Africa. MSM's engagement in HIV interventions was examined as a form of urban citizenship that is: (1) constructed by biological and social interactions, (2) based on health‐seeking attitudes and behaviours, and (3) reinforced through peer‐led socio‐spatial relations. We offer critical insights into recent calls for comprehensive urban interventions in Africa as a current void in the geographies of health and sexualities in the global south. [ABSTRACT FROM AUTHOR]

This paper examines two autobiographical responses to the HIV/AIDS epidemic in South Africa from the perspective of responsibility and rights. The analysis draws on interdisciplinary studies of the epidemic and its effects on South African communities. Memoirs by Edwin Cameron and Sister Abegail Ntleko address challenges in South Africa with regard to attitudes toward and treatment of HIV-infected people. Both writers use their texts to advocate for social and political responsibility and for the rights of those infected. Rian Malan's essays function as a counterpoint, bringing into focus controversial questions about the role of funding and reliable statistics for the epidemic. The topic is relevant in a South African context where antiretroviral treatment was met with skepticism in official political discourse. Representations of responsibilities and rights as well as official responses to the HIV/AIDS epidemic have been additionally reexamined in relation to the COVID-19 pandemic, giving the epidemic renewed relevance. [ABSTRACT FROM AUTHOR]

While it is well-established that poverty and disease are intimately connected, the nature of this connection and the role of poverty in disease causation remains contested in scientific and social studies of disease. Using the case of HIV/AIDS in South Africa and drawing on a theoretically grounded analysis, this paper reconceptualises disease and poverty as ontologically entangled. In the context of the South African HIV epidemic, this rethinking of the poverty-disease dynamic enables an account of how social forces such as poverty become embodied in the very substance of disease to produce ontologies of HIV/AIDS unique to South Africa. [ABSTRACT FROM AUTHOR]

We have only just begun to understand the long-term impact of living with chronic HIV on health and livelihood after a decade of widespread access to treatment in southern Africa. This paper explores health and well-being, disability, and livelihood dynamics among people living with HIV (PLHIV) in a public healthcare setting in South Africa. We undertook a cross-sectional survey among a cohort of 1042 people on ART and explored associations between socio-demographic characteristics, treatment adherence, measures of disability (functional and activity limitations), livelihood resources (capitals) and outcomes, including food security, and exposure to livelihood shocks. A range of dynamic relationships relevant for decision-makers is evident. Age, gender, and marital status all had significant associations with levels of livelihood capitals and outcomes. Those who had been on ART for longer periods of time also had significantly higher aggregate livelihood capital. This was particularly driven by social and financial capital. Livelihoods are built within specific social and health contexts. Of particular importance is that the resources drawn on to build a livelihood differ significantly between men and women, and that different forms of disability also have gender-specific pathways in influencing livelihood and livelihood outcomes. Our results support the need for a gender-sensitive approach to supporting the well-being and livelihoods of PLHIV. Of equal importance is an approach that considers more comprehensively the new experiences of comorbidities and disabilities that may occur with a long life on ART. [ABSTRACT FROM PUBLISHER]

Background: Sub Saharan Africa is confronted with a wide range of interlinked health and economic problems that include high levels of mortality and poor service delivery. The objective of the paper is to develop a spatial model for Sub-Saharan Africa that can quantify the mortality impact of (poor) service delivery at sub-district level in order to integrate related health and local level policy interventions. In this regard, an expanded composite service delivery index was developed, and the data were analysed using a Bayesian Poisson spatial model. Results: The results indicate significant differences in the risk of mortality and poor service delivery at sub-district level. In particular, the results indicate clusters of high mortality and poor service delivery in two of the bigger, poorer provinces with large rural communities. Conversely, two of the wealthier provinces have lower levels of mortality and higher levels of service delivery, but income inequality is more widespread. The bivariate and multivariate models, moreover, reflect significant positive linkages (p < 0.01) between increased mortality and poor service delivery after adjusting for HIV/AIDS, income inequality, population density and the protective influence of metropolitan areas. Finally, the hypothesized provision of a basket of services reduced the mortality rate in South Africa's 248 sub-districts by an average of 5.3 (0.3-15.4) deaths per 1000. Conclusion: The results indicate that the model can accurately plot mortality and service delivery "hotspots' at subdistrict level, as well as explain their associations and causality. A mortality reduction index shows that mortality in the highest risk sub-districts can be reduced by as much as 15.4 deaths per 1000 by providing a range of basic services. The ability to use the model in a wider SSA context and elsewhere is also feasible given the innovative use of available databases. Finally, the paper illustrates the importance of developing policy in SSA that can simultaneously solve both economic and health problems. [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.)

To date the international community has tended to direct HIV prevention programmes, treatment, care and supportive services to young adults and children, with little concern about the impact on older people. Since empirical evidence on the socioeconomic impact of HIV/AIDS on households with older persons is lacking, this paper attempts to fill this gap, using data from a household-based survey conducted in Bhambayi, a mixed formal and informal settlement north of eThekwini, KwaZulu-Natal. The findings highlight the links between the uptake of the South African old age pension, poverty and HIV/AIDS in households with older persons. The paper makes recommendations for both government and non-governmental organisations in respect of community-based support systems for such households affected by HIV/AIDS. [ABSTRACT FROM AUTHOR]

Cities in the South are faced with the double challenges of underdevelopment and poverty on the one hand and urbanisation on the other. As the developing regions of the South continue to urbanise at an incredible rate, it is clear that many cities do not have the necessary capacity to respond to the increasing needs and demands by urban residents. As a result, many new city residents have no other option but to settle in informal areas. These areas have long been associated with poor and unhealthy living conditions and, more recently, the links between these living conditions and HIV/AIDS have become increasingly clear. Research suggests that developmental factors like poverty, unemployment, gender inequality and inadequate shelter, water and sanitation all play a role in increasing vulnerability to HIV/AIDS. These conditions further affect the ability of HIV-positive individuals, households and communities to cope with the consequences of the epidemic. This in turn leads to further impoverishment and reduces the likelihood that people living in informal settlements will be able to improve their livelihoods. Yet, little attention has been paid by policy makers and planners to the relationship between HIV/AIDS and informality despite the challenge it provides for cities and the implications of the epidemic for government institutions and local government in particular. This paper argues that informality is complex and that its heterogeneous nature is not effectively understood and thus not given appropriate recognition and support. It looks at the effects of the HIV/AIDS epidemic within this context of informality and the inevitable wave of urbanisation. The paper suggests that the only way to deal effectively with HIV/AIDS (and informality) is through planning and building integrated and sustainable urban settlements that respond to the complexities of informality in cities of the developing world. [ABSTRACT FROM AUTHOR]

The paper compares the response of the South African Government to HIV and AIDS with the government's policy development concerning the use of tobacco. The high burden of disease from HIV and AIDS in South Africa and the morbidity and mortality from the use of tobacco are outlined. Using the framework of the Ottawa Charter for Health Promotion, the paper reviews and critiques the Government's different stance to building public policy, creating supportive environments, engaging community participation, developing personal skills and re-orienting the health services, for HIV/AIDS and tobacco. The result of these policy choices is described. The lack of adequate implementation of the key elements of the Ottawa Charter has resulted in high morbidity and mortality due to the spread of HIV infection in South Africa. This has also influenced the resurgence of tuberculosis, and the accompanying MDR and XDR TB epidemics. The high prevalence of HIV infection has also meant that the health system is unable to cope with the large numbers of patients requiring anti-retroviral treatment, and the early morbidity and mortality of young economically active people has had devastating social consequences, resulting in the large numbers of orphans. In contrast, South Africa is a signatory to the World Health Organizations' Framework Convention on Tobacco Control, and has successfully implemented many of the policies. [ABSTRACT FROM AUTHOR]

Background: An integrated chronic disease management (ICDM) model was introduced by the National Department of Health in South Africa to tackle the dual burden of HIV/AIDS and non-communicable diseases. One of the aims of the ICDM model is to reduce HIV-related stigma. This paper describes the viewpoints of service users and providers on HIV stigma in an ICDM model in rural South Africa. Materials and methods: A content analysis of HIV stigmatisation in seven primary health care (PHC) facilities and their catchment communities was conducted in 2013 in the rural Agincourt sub-district, South Africa. Eight Focus Group Discussions were used to obtain data from 61 purposively selected participants who were 18 years and above. Seven In-Depth Interviews were conducted with the nurses-in-charge of the facilities. The transcripts were inductively analysed using MAXQDA 2018 qualitative software. Results: The emerging themes were HIV stigma, HIV testing and reproductive health-related concerns. Both service providers and users perceived implementation of the ICDM model may have led to reduced HIV stigma in the facilities. On the other hand, service users and providers thought HIV stigma increased in the communities because community members thought that home-based carers visited the homes of People living with HIV. Service users thought that routine HIV testing, intended for pregnant women, was linked with unwanted pregnancies among adolescents who wanted to use contraceptives but refused to take an HIV test as a precondition for receiving contraceptives. Conclusions: Although the ICDM model was perceived to have contributed to reducing HIV stigma in the health facilities, it was linked with stigma in the communities. This has implications for practice in the community component of the ICDM model in the study setting and elsewhere in South Africa. [ABSTRACT FROM AUTHOR]

It is timely to have this kind of study in South Africa as the country has an increasing number of people living with HIV and AIDS. While an extensive literature has documented factors associated with HIV and AIDS, psychosocial variables associated with the health of persons living with HIV (PLH) have only begun to receive attention recently. The objective of this paper was to explore the views of a group of people living with HIV and AIDS regarding HIV and AIDS and Self-Forgiveness. Theoretical base: To examine the role of self-forgiveness in people living with HIV and AIDS, George Engel's Biopsychosocial Model was adopted. Methods: Individual In-depth Interviews were conducted with 10 purposefully-selected participants in Ekurhuleni. Outcomes: Results showed that self-forgiveness has a huge role in the lives of people living with HIV and AIDS. For instance, it has been found that self-forgiveness leads to acceptance of HIV status, promote infected people to seek medical care, and eventually gain the confidence to disclose to friends and families. Work implications: In conclusion, self-forgiveness has micro, messo and macro implications as it promotes good health of people living with HIV and AIDS; enhance HIV status self-disclosure and adherence to HIV treatment. [ABSTRACT FROM AUTHOR]

In this paper, I utilise the tools of analytic philosophy to amalgamate mono-causal and multi-causal theories of disease. My aim is to better integrate viral and socio-economic explanations of AIDS in particular, and to consider how the perceived divide between mono-causal and multi-causal theories played a role in the tragedy of AIDS denialism in South Africa in the early 2000s. Currently, there is conceptual ambiguity surrounding the relationship between mono-causal and multi-causal theories in biomedicine and epidemiology. Mono-causal theories focus on single, typically microbial, sources of illness and are most concerned with infectious diseases. By contrast, multi-causal theories allow for multiple factors to underpin a disease's aetiology, including socio-economic and behavioural factors, and they usually focus on chronic non-communicable diseases. However, if these theories are taken to be strictly distinct, this prevents the inclusion of both microbial and socio-economic factors in a single explanation of any particular disease. This strict distinction became a problem when trying to explain the disproportionate prevalence of AIDS in southern Africa and ultimately contributed to the tragedy of AIDS denialism in South Africa. In tandem with viewing how the perceived divide between multi-causal and mono-causal theories underpinned AIDS denialism, I examine Thabo Mbeki's specific role, while acknowledging that AIDS is being deprioritised on a broader international level. Overall, I will demonstrate that any long-term plan to eliminate AIDS will require viral and socio-economic factors to be considered simultaneously and that such a theoretical approach requires a clearer understanding of the underlying concepts of disease aetiology. [ABSTRACT FROM AUTHOR]

The Intervention with Microfinance for AIDS and Gender Equity (IMAGE) programme has been scaled up to three provinces in South Africa. This paper explores associations between women's engagement in the intervention, intimate partner violence (IPV) and factors associated with IPV and partner abuse. We enrolled women receiving group-based microfinance loans plus gender training into the scaled-up IMAGE cohort study (n = 860). We present cross-sectional analysis on participants' characteristics and intervention engagement and use multivariate logistic regression to explore associations. 17% of women reported lifetime (95% CI 15 to 20%) and 7% past year (95% CI 5 to 9%) IPV, 9% past-year economic (95% CI 7 to 11%) and 11% past-year emotional (95% CI 9 to 14%) abuse. Women under 35 years had higher levels of IPV and emotional abuse. 53% of women attended all the trainings, 83% continuously borrowed and 98% agreed the training had a major impact on their life. Attendance was associated with improved partner relationships (χ2p < 0.001), but not lower IPV risk. Odds of past-year IPV decreased the more types of support (e.g. advice) women received from group members (aOR 0.27, p < 0.001 among those reporting all support versus none or some). A similar pattern was seen for economic, but not emotional, abuse. The scaled-up IMAGE intervention is widely acceptable and may support improvements in partner relationships, but younger women need to be targeted. Group support appears to be a potentially important component of the intervention. [ABSTRACT FROM AUTHOR]

HIV/AIDS-related (HAR) stigma is an ongoing problem in Sub-Saharan Africa that is thought to impede HIV preventive and treatment interventions. This paper uses a systematic sample of households (Level 1) nested within near-neighbor clusters (Level 2) and communities (Level 3) to examine multilevel relationships of HAR stigma to health service barriers (HSBs) and HIV outcomes in KwaZulu-Natal, South Africa, thereby addressing methodological and conceptual gaps in the literature from this context. Findings suggest differential patterns of prediction at Level 1 when examining two different dimensions of stigma: more highly stigmatizing attitudes predicted more household health service barriers; and perceptions of greater levels of community normative HAR stigma predicted higher household HIV ratios. Level 2 findings were similarly dimension-differentiated. Cross-level analyses found that near-neighbor cluster-level (setting level) consensus about (standard deviation) and level of (mean) community normative HAR stigma significantly predicted household-level HSBs and HIV ratio, controlling for household-level community normative HAR stigma. These differential patterns of prediction suggest that HAR stigma is a multi-level construct with multiple dimensions that relate to important outcomes differently within and across multiple ecological levels. This has important implications for future research, and for developing interventions that address setting-level variation in stigma. [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.)

Livelihood insecurity, HIV and AIDS, and environmental change, including high climate variability, have negatively impacted the southern African region for the last decade. It is increasingly evident that there is a complex interplay of factors shaping rural livelihoods at various scales. Recognition of the varied impacts of HIV and AIDS has led to development of a conceptual framework that utilises the ‘AIDS Timeline’ or ‘Programming Matrix’, which enables differential intervention strategies to be adopted depending on the dominant impacts and trends on livelihoods. This paper presents this approach and links it to case study material from two districts in Malawi and South Africa. The evidence suggests that although there are some areas where HIV and AIDS are mainstreamed into livelihood security interventions, this is not sufficient, as holistic environmental and social approaches are not adopted. This paper reflects on the fieldwork findings to link to the AIDS Timeline in support of appropriate interventions. At the same time, we highlight the urgency in addressing the meso-scale and adopting a holistic framework that addresses livelihood security from a range of angles, including the implications for the chronically ill, interactions with environment and the capacity to implement change. [ABSTRACT FROM AUTHOR]

This paper focuses specifically on the needs and concerns of 'very young adolescents' who as defined by the Population Council are young people aged between 10 and 14 years. The title of this paper, 'Where Do We Start?', acknowledges that attitudes towards and knowledge of HIV and AIDS are best looked at in a situated way. We look at classes of sixth-grade students from four quite different cultural contexts within the province of KwaZulu-Natal: a deeply rural school made up of black students; a township school again made up exclusively of black students; and two more urban and affluent schools, one a public school made up primarily of white and Indian students, and one faith-based school which, while made up of various racial and ethnic groups, is predominantly white. The paper maps out ways of using arts-based approaches with young people so that they are positioned in engaging and participatory ways. It is argued that 'one size does not fit all' when it comes to planning HIV and AIDS interventions. [ABSTRACT FROM AUTHOR]

Aim: This paper examines financial, emotional, and physical responsibilities elderly women are being asked to take on due to the incapacity of their adult children to care for the next generation; such incapacity is likely to increase as the HIV/AIDS epidemic worsens. Methods: This paper combines quantitative and qualitative data. Census data from the Agincourt health and demographic surveillance system (AHDSS) describe the presence of the elderly (specifically women over the age of 60 and men over the age of 65) in households in the Agincourt study site. Semi-structured interviews with 30 female residents aged 60-75 complement the census data by exploring the roles that older women, in particular, are playing in their households. Results: An elderly man and/or woman lives in 27.6% of households; 86% of elders live with non-elders. Households with a woman over the age of 60 resident (as opposed to those without) are twice as likely to have a fostered child living in the household and three times as likely to have an orphaned child in the household. Elderly women face financial, physical, and emotional burdens related to the morbidity and mortality of their adult children, and to caring for grandchildren left behind due to adult children's mortality, migration, (re)marriage, and unemployment. Conclusions: Older women provide crucial financial, physical, and emotional support for ill adult children and fostered and orphaned grandchildren in their households. As more prime-aged adults suffer from HIV/AIDS-related morbidity and mortality, these obligations are likely to increase. [ABSTRACT FROM AUTHOR]

This paper examines young South African school children's understanding of HIV/AIDS. Based on ethnographic work in two schools in Greater Durban, it explores the impact of HIV/AIDS on the ways in which gender and sexuality are articulated against the backdrop of race and class specific contexts. The first part of the paper examines the children's discourses of sex, sexuality and HIV/AIDS. We show that young children's meanings of sex, sexuality and are not straightforward and are actively produced and defined through a range of social processes. These processes shape the extent to which young children experience sexuality within discourses of fear and pleasure. Young children's meanings of HIV/AIDS are explored in the second part of the paper. Here we show how their knowledge of HIV/AIDS is socially structured through class/race and gender and these forms of social relations provide the framing and reference points for children's constructions of meanings around HIV/AIDS. We finish the paper by raising some theoretical and practical/political questions about the implications of what we have found for HIV/AIDS education in South Africa. [ABSTRACT FROM AUTHOR]

In the face of international pressure and local concern regarding the repercussions of the AIDS epidemic for children in South Africa, as well as the review underway of children's legislation in the country, there is much debate regarding social security provision for children in the context of HIV/AIDS. To date, the State's social security response to the impact of AIDS on children has been to focus its attention on the provision of the Foster Child Grant for orphans. Draft Children's legislation introduces additional cash grants, some of which similarly target orphans. However, drawing on a combination of primary research and demographic projections, this paper argues against the provision of grants for orphans as a category of children distinct from other children. It argues that. given the pervasiveness of poverty across South Africa's child population, a social security system that directs interventions on the basis of children's orphanhood mistargets crucial resources; is inequitable; is located in questionable assumptions about children's circumstances; risks further overburdening the child protection system; and is not, as a whole, a cost-efficient way of adequately supporting the largest possible number of poor children who require assistance. The paper argues therefore that the most equitable, accessible and appropriate mechanism for supporting children in the context of the AIDS epidemic would be through the extension to all children of the Child Support Grant mechanism that is currently in place. Progressive implementation of a universal Child Support Grant should be based not on providing grants in the interim to particular categories of children (such as orphans) but rather on drawing more impoverished children -- irrespective of their parental circumstances -- into the social security 'safety net'. [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]

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Worldwide, researchers routinely study children indirectly through adults who act as proxies for such children. The call for researchers to rather study children directly and adopt less intrusive child-friendly methodologies has become louder. The draw-and-write technique is regarded as a less intrusive child-friendly method of collecting data that can be used for this purpose. This paper reports the findings of a qualitative study that sought to establish the feasibility of the draw-and-write technique in exploring the resilience of children orphaned by AIDS. This study involved a convenience sample of 23 IsiXhosa-speaking orphaned children aged from 13 to 17. The participants were in grades 6 to 10 and they resided in two child and youth care centres in the Eastern Cape province of South Africa. As part of the draw-and-write technique the participants were asked to make drawings of what enabled them to cope with their lives and to write short narratives in which they explained their drawings. Inductive content analysis was used to analyse the data and this process yielded two main themes, namely: personal protective resources and socio-ecological protective resources. The findings show that complex combinations of personal and socio-ecological resilience resources enabled the resilience of the orphaned children. The findings challenge researchers not to be oblivious to alternative child-friendly methods of research such as the draw-and-write technique when young people are the unit of analysis. The findings of this study have implications for research as well as practice in the field of education and psychology. [ABSTRACT FROM AUTHOR]

South Africa possesses the largest anti-retroviral therapy (ART) program in the world, but the path to this record was dramatic. There is scarce literature employing a comprehensive framework to explain this achievement and inform epidemic responses. This paper applies the Advocacy Coalition Framework (ACF) to analyse the interactions among diverse actors, institutions and networks that were associated with the AIDS policy change in South Africa. Post-apartheid, HIV/AIDS and AIDS-related mortality were serious public health problems. At the time, the discernible coalitions in the HIV/AIDS policy subsystem were the pro-science coalition and AIDS dissidents. In view of the availability of compelling scientific evidence on the pathogenesis of HIV/AIDS, the clinical usefulness of ART, the availability of funding for national ART roll-out, strong global advocacy to reduce the cost of ART, all of these in an era when access to adequate HIV treatment/care was increasingly considered a human right, the environment to establish an appropriate HIV/AIDS policy for the country was conducive. However, AIDS dissidents dominated the policy agenda via their control over key institutions, the use of various dimensions of power, biasing evidence to inform policy, and promoting the activities of strong interest groups that were not in support of ART. National ART roll-out finally emerged as a political priority because of external shocks (on the AIDS policy subsystem) which disfavoured the dominant coalition. As in this important experience in the history of HIV treatment, stakeholders involved in epidemic response tend to engage in intense ideological conflicts. An adequate appraisal of the outcomes of these conflicts in terms of population health gains and adopted public health and social measures to control epidemics would require the supplementation of complex system thinking with relevant public policy concepts, notably power dimensions, governance, emergence of global health networks and evidence use in policy. [ABSTRACT FROM AUTHOR]

Globally, in the last 20 years health has improved. In this generally optimistic setting HIV and AIDS accounts for the fastest growing burden of disease. The data show the bulk of this is experienced in Southern Africa. In this region, HIV and AIDS (and tuberculosis [TB]) peaks among young adults. Women carry the greater proportion of infections and provided most of the care. South Africa has the dubious distinction of having the largest number of people living with HIV in the world, 6.4 million. HIV began spreading from about 1990 and today the prevalence among antenatal clinic attendees is 29.5%. A similar situation exists in other nations of the region. It is an expensive disease, requiring more resources than are available, and it is slipping off the global agenda, both in terms of attention and international funding. Those halcyon days of the decade from 2000 to 2010 are over. This paper explores the concept of three transition points: economic, epidemiological and programmatic. The first two have been developed and written about by others. We add a third transition point, namely programmatic, argue this is an important concept, and show how it can become a powerful tool in the response to the epidemic. The economic transition point assesses HIV incidence and mortality of people infected with HIV. Until the number of newly infected people falls below the number of deaths of people living with HIV, the demand for treatment and costs will increase. This is a concern for the health sector, finance ministry and all working in the field of HIV. Once an economic transition occurs the treatment future is predictable and the number of people living with HIV and AIDS decreases. This paper plots two more lines. These are the number of new people from the HIV infected pool initiated on treatment and the number of people from the HIV infected pool requiring treatment. This introduces new transition points on the graph. The first when the number of people initiated on treatment exceeds the number of people needing treatment. The second when the number initiated on treatment exceeds the new infections. That is the theory. When we applied South African data from the ASSA2008 model, we were able to plot transition points marking progress in the national response. We argue these concepts can and should be applied to any country or HIV epidemic. [ABSTRACT FROM PUBLISHER]

With 3 million people receiving anti-retroviral therapies (ARV) in South Africa, it has the largest public ARV programme in the world. The implementation of this programme was made possible by the efforts of AIDS advocacy groups that lobbied the government to make ARV available. Chief among these was the Treatment Action Campaign (TAC). The group mobilised South Africans across socio-economic and racial lines against the AIDS denial of key members of the African National Congress (ANC). Through interviews with TAC members and ethnographic accounts of ©current activism, this paper examines song as a method of mobilisation against HIV/AIDS-related injustices. As instrumental components of the liberation struggle, songs have become ubiqioutus within protest action, as demonstrated by the recent hashtag student movements. By utilising similar forms of rights-based activism found in the country's liberation struggle, TAC is able to tap into reservoirs of emotional potential rooted in political struggle. [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.)

South Africa bears the brunt of HIV-AIDS with the highest incidence and disease prevalence in the world. UNAIDS estimates that, of the 36.7 million individuals infected with HIV-AIDS globally, 19.1 million reside in South Africa7. In addition, approximately 2.1 million new HIV infections occurred in 2015 with almost 960 000 of those occurring in South Africa signalling that the rates of infections are not dropping as expected6.Given the unrelenting nature of this disease burden, even greater efforts are now required to turn the tide on HIV-AIDS globally, but more so in South Africa. These efforts entail more effective HIV-AIDS service delivery with combination prevention modalities, access to HIV-AIDS treatment and care, harm reduction of HIV-AIDS stigma and discrimination together with HIV-AIDS education, awareness and advocacy. This has led to the development of many global and local Non-Governmental Organisations, Non Profit Organisations, Private and public organisations that have embarked upon the development of HIV-AIDS management and treatment programmes. However, these programmes currently exist in an unregulated environment but have the potential to run as cost effective, efficacious and successful programme aimed at attaining the optimal health for their patients should a standard exist. No current global or local standard or regulation exists to date governing HIV-AIDS Management Programmes in South Arica. The aim of this paper is to review the HIV-AIDS landscape to assess if any regulatory frameworks exist and to propose the development of a standard for HIV-AIDS management programmes with guidance for use in the multisector response to curb HIV-AIDS globally and locally. [ABSTRACT FROM AUTHOR]

Background: In much of the world, President George W. Bush was not admired for his foreign policy and diplomacy. It is therefore ironic that Bush's single most uncontested foreign policy triumph was an instance of what has now become known as "health diplomacy". In 2003 Bush launched the President's Emergency Plan for AIDS Relief, a five-year $15 billion initiative to fight HIV/AIDS, mostly in Africa. The president's pragmatic health diplomacy may well save his foreign policy legacy. This article argues that a middle power such as South Africa should consider a similar instrumental AIDS diplomatic strategy, to rehabilitate its public health as well as foreign policy images. Discussion: This article reflects on the emergence and contemporary practice of health diplomacy. In particular, it explores the potential of niche areas within health diplomacy to become constructive focal points of emerging middle powers' foreign policies. Middle powers often apply niche diplomacy to maximise their foreign policy impact, particularly by pursuing a multilateral agenda. The literature on middle powers indicates that such foreign policy ambitions and concomitant diplomacy mostly act to affirm the global status quo. Instead, this paper argues that there may well be niches within health diplomacy in particular that can be used to actually challenge the existing global order. Emerging middle powers in particular can use niche areas within health diplomacy in a critical theoretical manner, so that foreign policy and diplomacy become a project of emancipation and transformation, rather than an affirmation of the world as it is. Summary: The article first describes the emergence and contemporary practice of health diplomacy; this is followed by a discussion of niche diplomacy, in particular as it applies to the foreign policy agendas of emerging middle powers. It then reviews South African foreign policy and diplomacy, before situating these policies within the context of emerging mechanisms of south-south multilateralism. The article concludes by synthesizing these elements and advocating for a South African AIDS diplomacy, emphasizing its potential to galvanize a global project of emancipation. [ABSTRACT FROM AUTHOR]

Accessible summary The purpose of this study was to describe the role of inclusiveness in lessening the pain of parents death in adolescents orphaned by AIDS., Data were derived from 15 AIDS orphans between the ages of 14 and 18 years., The method used was focus groups with discourse analysis using four themes: grieving patterns, coping strategies, experience with loss and expectations., The participants believed that including them in the illnesses, dying and funeral preparations of their parents would have facilitated their healing., Abstract The purpose of this paper is to raise an argument that inclusiveness will lessen the pain of losing a parent among adolescents orphaned by AIDS and as a result, prevent future mental health problems that may occur because of inappropriate grieving and maladaptive coping strategies. Participation of adolescents orphaned by AIDS in decisions pertaining to their parents' illnesses and funeral arrangements, for example, may shorten the grieving process and allow for closure. The paper draws data from focus group discussions that were held with 15 adolescents orphaned by AIDS in urban South Africa. The focus group discussions that were structured around four themes: grieving patterns; coping strategies; experience with loss; and expectations. The results of the study demonstrate inclusiveness as an overarching factor in the healing process. The concept is thus a strong recommendation for mental health practice and further study. [ABSTRACT FROM AUTHOR]

This paper, based on a case study of a South African contract cleaning company in Durban, KwaZulu-Natal, adds to the recent literature on the management of the financial impact of the HIV/AIDS pandemic. After situating the research alongside recent contributions that have examined large enterprises, and small, medium and micro enterprises, the paper provides a profile of the company and its predominantly female workforce. The company's management of costs incurred due to HIV/AIDS is critically assessed from the perspective of financial sustainability, using an AIDS Projection Model developed by Matthews (2007). It was found that while continued employment of this workforce is economically sustainable, both from the perspective of the business and the associated provident fund, the costs to employees are far from equitable. The paper therefore recommends the implementation of a holistic HIV/AIDS management programme, including treatment and prevention activities. [ABSTRACT FROM PUBLISHER]