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Abstract: This paper is a part of a larger study that explores the “social complexity” of antiretroviral therapy (ART), in resource-limited environments. Drawing on in-depth interviews with a sample of 44 patients in an urban HIV/AIDS clinic in Johannesburg, South Africa, this paper examines how people with HIV/AIDS conceptualise their illness and its treatment in this context. The paper concludes that the fear of stigma plays a significant role in patients’ experiences throughout the disease trajectory. Yet, demonstrates that there are indications that ARVs are transforming the experience of living with HIV/AIDS and a process of normalisation is taking place. Despite the resource-limited context and, often, lack of family and community support, patients see the ARVs as ‘life saving’ and express their long-term commitment to adhere to the drug regimen as well as their trust in health professionals. [Copyright &y& Elsevier]

In the face of the extreme challenges posed by the South African HIV/AIDS epidemic, collaboration between public and private partners is often called for in an attempt to mobilise additional resources and generate synergies. This paper shows that the ability to successfully use public-private partnerships to address complex challenges, such as an HIV/AIDS epidemic, is influenced by the fabric of society, one important aspect being historical legacies. The first part of the article shows how South Africa's apartheid past affects the ability of public and private partners to collaborate in a response to HIV and AIDS today. It also takes into account how reconciliation and nation-building policies in the immediate post-transformation period have affected the ability to form and sustain partnerships concerning HIV/AIDS issues. The second part of the article analyses more recent developments regarding the information that these hold as to the feasibility of public-private partnerships and whether these continue to be affected by the legacies of the past. Two events with symbolic political value in South Africa, namely the 2010 FIFA World Cup soccer event and the recent changes in government, are systematically examined on the basis of three analytical queries, regarding: the impact of the event on nation-building and transcending cleavages in society; the event's impact on the ability to form public-private partnerships in general; and the role of HIV/AIDS in connection with the event. Conclusions are drawn a propos the influence of historic factors on the ability of South African society to effectively use public-private partnerships in the response to HIV and AIDS, and the continued dynamics and likely future directions of these partnerships. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre 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.)

This paper examines the principle of beneficence in the light of moral and epistemological concerns that have crystallized in the South African context around clinical care. Three examples from the South African experience affecting the development of bioethics are examined: medical colonialism, the death in detention of Steve Biko, and the HIV/AIDS epidemic. Michael Gelfand's book [(1948). The sick African: a clinical study. Cape Town: Stewart Printing Company.] on African medical conditions captures the ambiguous nature of colonial medicine that linked genuine medical treatment with the civilizing mission. Biko's death was a key historical event that deeply implicated the medical profession under apartheid. The present HIV/AIDS epidemic presents the gravest social and political crisis for South African society. All three experiences influence the meaning and relevance of beneficence as a bioethics principle in the South African context. This paper argues for a South African bioethics informed by a critical humanism that takes account of the colonial past, and that does not model itself on an “original wound” or negation, but on positive care-giving practices. [Copyright &y& Elsevier]

Aim. This paper is a report of a study exploring HIV/AIDS-related knowledge, attitudes, practices and perceptions of nurses in the largely black and rural Limpopo Province of South Africa. Background. Studies of HIV/AIDS knowledge, attitudes and practices among healthcare workers in developing countries have shown gaps in knowledge and fear of contagion, coupled with ambivalent attitudes in caring for patients with HIV/AIDS and inconsistent universal precautions adherence. Method. A cross-sectional study of a random sample of primary health care (PHC) ( n = 71) and hospital nurses ( n = 69) was carried out in 2005, using a questionnaire, focus groups and in-depth interviews. Findings. Hospital nurses reported a higher frequency of care for patients with HIV/AIDS ( P < 0·05), but less HIV/AIDS training when compared to PHC nurses ( P < 0·001). HIV/AIDS knowledge was moderately adequate and associated with professional rank, frequency of care and training ( P < 0·001). Attitudes towards patients with HIV/AIDS were mainly positive and were statistically significantly correlated with HIV/AIDS knowledge ( P < 0·01) and training ( P < 0·05). Three out of four nurses reported that they practised universal precautions (76·1%), but fear of occupational HIV transmission and lack of injection safety was found. Seven in 10 nurses reported previous needlestick injuries, but postexposure prophylaxis was not available in all healthcare facilities. Participants reported a higher workload because of HIV/AIDS, lack of training impacting negatively on their work, and stigma and shared confidentiality affecting them emotionally. Conclusion. There is a need for accelerated HIV/AIDS training of rural nurses and for wider implementation of universal precautions and postexposure prophylaxis availability in public health facilities in southern Africa. [ABSTRACT FROM AUTHOR]

In this paper I shall discuss my experience of convening a Masters programme in HIV/AIDS and Society. There are few, if any, courses in South Africa that focus on HIV/AIDS from a multidisciplinary perspective. Yet this is critically important. HIV/AIDS knows no disciplinary boundaries. Contributing to effective policy, which is part of the university's mission, means interrogating contemporary practice and conventional wisdom. This involves looking at old questions from new angles and drawing on diverse understandings as well as past experience to explore new issues. This process of critical reflection, informed by understandings from different disciplines, challenges some of the assumptions of the social sciences themselves. [ABSTRACT FROM AUTHOR]

Copyright of Politica y Sociedad is the property of Universidad Complutense de Madrid 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.)

This paper explores the organisational structures of traditional healers, outlines their explanations of HIV/AIDS, and discusses how they can be integrated with company programmes. The South African Traditional Health Practitioners Act seeks to register, regulate and promote traditional healers, but its ability to do this depends on strong, formalised associations of traditional healers. The different forms of traditional healer groupings in South Africa are described along with the implications that their organisational structure has for knowledge, competition and service standards. Traditional healers' diverse and fluid beliefs about HIV and AIDS are explained together with ways in which cooperation between companies, allopathic medicine and African traditional healing practices could be promoted in workplace responses to HIV/AIDS. It is suggested that such collaboration should focus on 'windows of compatibility' rather than on overall agreement. Moreover, it is argued that any response to HIV/AIDS must be embedded within a wider set of agreements, the most critical being a genuine process of referral between the traditional and allopathic healthcare systems. Companies are in a strong position to initiate such reforms, and this would support the professionalisation of traditional healers as well as help coordinate a wider and more effective response to the HIV epidemic in South Africa. [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 explores the gender dimensions of access to highly active antiretroviral therapy (HAART) in South Africa. It shows that women are more vulnerable to HIV infection than men, but that women access HAART in disproportionately large numbers. Regression analysis on data from the South African Demographic and Health Survey suggests that men in general access health services less readily than women. This 'masculinity factor' accounts for most of the difference between men and women when it comes to accessing HAART. Although men were more likely to favor traditional medicine than women, this was not a statistically significant factor, and it appears that visiting a traditional healer is complementary to, rather than a substitute for, accessing HAART. In short, it seems that gendered norms that make it difficult for men to admit weakness and seek medical attention are the main probable cause for the low proportions of men accessing HAART. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue, including the article about human immunodeficiency virus (HIV) and another on acquired immunodeficiency syndrome (AIDS) in South Africa.

The ongoing damage that the newer forms of HIV denialism are visiting upon our country is evidenced by the recent firing of Nozizwe Madlala-Routtedge, the South African Deputy Minister of Health. It is widely believed that the underlying reason for her dismissal was her support of orthodox HIV treatment and prevention strategies and her disdain for HIV denialism. This paper seeks to understand the origins, spread and metamorphosis of President Thabo Mbeki's HIV denialism in South Africa. Using the theory of cognitive dissonance, I argue that, given the structural beliefs of the African National Congress (ANC) and the pattern of emergence of HIV in the 1980s, a degree of scepticism around the putative science of HIV was probable in ANC circles. On assuming the Presidency in 1999, Mbeki tapped into this scepticism to formulate his initial biological version of HIV denialism, which claimed that 'a virus can't cause a syndrome.' The steady erosion of support for this flagrant HIV denialism, together with the rise of neoliberal thinking in the ANC, would lead to the evolution of this biological denialism into a form of treatment denialism. This ideology argued against the widespread provision and use of antiretroviral treatment. Empirical evidence is presented to demonstrate the extent to which ongoing HIV denial in the general population is continuing to fuel the spread of HIV. [ABSTRACT FROM AUTHOR]

Abstract: Households experience HIV and AIDS in a complex and changing set of environments. These include health and welfare treatment and support services, HIV-related stigma and discrimination, and individual and household social and economic circumstances. This paper documents the experiences of 12 households directly affected by HIV and AIDS in rural KwaZulu Natal, South Africa, between 2002 and 2004. The households were observed during repeated visits over a period of more than a year by ethnographically trained researchers. Field notes were analysed using thematic content analysis to identify themes and sub-themes. This paper focuses on three dimensions of household experience of HIV and AIDS that have received little attention in HIV and AIDS impact studies. First, that experience of HIV and AIDS is cumulative. In an area where population surveys report HIV prevalence rates of over 20% in adults, many households face multiple episodes of HIV-related illness and AIDS deaths. We describe how these challenges affect perceptions and responses within and outside households. Second, while over 50% of all adult deaths are due to AIDS, households continue to face other causes of illness and death. We show how these other causes compound the impact of AIDS, particularly where the deceased was the main income earner and/or primary carer for young children. Third, HIV-related illness and AIDS deaths of household members are only part of the households’ cumulative experience of HIV and AIDS. Illness and death of non-household members, for example, former partners who are parents of children within the households or relatives who provide financial support, also impact negatively on households. We also discuss how measuring multiple episodes of illness and deaths can be recorded in household surveys in order to improve quantitative assessments of the impact of HIV and AIDS. [Copyright &y& Elsevier]

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 shows how two publicly available epidemiological modelling packages, namely the Spectrum AIDS Impact Model and the ASSA2003 AIDS and Demographic Model, predict very different impacts from rolling out highly active antiretroviral treatment (HAART) on new HIV infections. Using South Africa as a case study, it shows that the ASSA2003 model predicts a significant drop in new HIV infections as HAART is rolled out, whereas the Spectrum model assumes that HAART does not have a preventative impact (and in fact generates a small increase in new HIV infections). Users will thus draw different conclusions about the public health benefits of HAART depending on which modelling package they use. Despite being presented as a policy-oriented modelling tool capable of exploring 'what if' questions about the impact of different policy choices, the Spectrum model is illequipped to do so with regard to a HAART rollout. Unlike Spectrum, ASSA2003 is more flexible and its assumptions are clear. Better modelling and more information (including about the relationship between HAART and sexual risk behaviour) is required to develop appropriate public-policy modelling for the HAART era. [ABSTRACT FROM AUTHOR]

This paper focuses on youth voices about sex and AIDS and reveals significant discrepancies between the 'ideal adult worldview' and the 'practical youth worldview' on sexual matters. In discussing the 'youth worldview', it draws on Piaget's theories of childhood development and Perry's theory of student development, both theories which postulate that children cannot learn material if they have not reached a particular level of development. It concludes that life skills implementation is the key issue to HIV prevention among young people. It is argued that such a programme should take the rights-based approach in order to get a firm grip of actual sexual practices among youth. It is further argued that this is only possible where there is maximum youth engagement - and this can be achieved through role modelling and the use of visual and arts-based participatory methodologies. [ABSTRACT FROM AUTHOR]

Fagan (1986, p. 859) stated many years ago that 'school psychology has survived the complex interaction between education and psychology, and will continue to do so in future'. Applied and adapted to South(ern) Africa of 2007, one may ask whether inclusive education will survive the complex interaction with the HIV and AIDS pandemic, and whether it will continue to survive in future? This paper focuses primarily on the impact of HIV and AIDS on the inclusive education classroom and suggests that certain dynamics entering the classroom will increase the demands on educators exponentially. It is concluded that successful inclusive education is in jeopardy in South(ern) African classrooms unless drastic measures are taken soon. A lapse to 'inclusion by default' is on the cards in the absence of these measures. [ABSTRACT FROM AUTHOR]

The nature of HIV/Aids media coverage has been widely criticised, mainly by interest groups. This has resulted in constructive, though somewhat fragmented, guidelines on ethically acceptable, accountable HIV/Aids reporting. In this article the analysed and systematically summarised guidelines (Swanepoel, 2005:77-137) are used to evaluate HIV/Aids reporting in three South African Sunday papers. It was found that these newspapers partially meet the interest group criteria. They raise awareness satisfactorily, but agenda setting could be improved. Although there is comprehensive coverage of HIV/Aids issues, critical, in-depth reporting is lacking. Furthermore, there is an exaggerated focus on HIV/Aids politics, and too little on relevant scientific and social issues. A lack of alternative angles and a tendency towards sensationalism are noticeable. The three papers often emphasise the "victim image", and fail to use HIV/Aids-sensitive language consistently. In respect of accuracy, there are deficiencies in the use of news sources. [ABSTRACT FROM AUTHOR]

Aims: This paper examines trends in age-specific mortality in a rural South African population from 1992 to 2003, a decade spanning major sociopolitical change and emergence of the HIV/AIDS pandemic. Changing mortality patterns are discussed within a health-transition framework. Methods: Data on population size, structure, and deaths, obtained from the Agincourt health and demographic surveillance system, were used to calculate person-years at risk and death rates. Life tables were computed by age, sex and calendar year. Mortality rates for the early period 1992-93 and a decade later, 2002-03, were compared. Results: Findings demonstrate significant increases in mortality for both sexes since the mid-1990s, with a rapid decline in life expectancy of 12 years in females and 14 years in males. The increases are most prominent in children (0-4) and young adult (20-49) age groups, in which increases of two- and fivefold respectively have been observed in the past decade. Sex differences in mortality patterns are evident with increases more marked in females in most adult age groups. Conclusions: Empirical data demonstrate a marked "counter transition" with mortality increasing in children and young adults, "epidemiologic polarization" with vulnerable subgroups experiencing a higher mortality burden, and a "protracted transition" with simultaneous emergence of HIV/AIDS together with increasing non-communicable disease in older adults. The health transition in rural South Africa is unlikely to predict patterns elsewhere; hence the need to examine trends in as many contexts as have the data to support such analyses. [ABSTRACT FROM AUTHOR]

The birth of a democratic South African state is being accompanied by increasing rates of HIV/AIDS related deaths among the country's young citizens. By the late 1990s South Africa became known as having the highest HIV/AIDS infection rates globally, with the worst hit province being KwaZulu-Natal, the focus of this article. Given these shocking realities of sick bodies and living in the presence of constant death, it is not surprising that studies that probe the medical, social and economic implications of this disease have dramatically increased over the past decade. However, what remains under explored are general continuities and changes within African women's lived experiences, which are being informed by their changing experiences of physical and spiritual uprootedness, economic and existential survival, constancy of death experiences and the desire for intimacy in a highly strained everyday that continues to be shaped by this epidemic. In addition to exploring these mundane aspects of young women's lives, the paper aims to broaden concepts of agency under limit conditions by emphasizing the role of young women's flawed agency, as they attempt to remake their social worlds under conditions where historical violences still resonate but now with an encounter with AIDS. By fitting the project within a socio-historico and cultural framework of viewing African youth sexualities, I will also show how this creates opportunities to tease out broader issues of personhood, choice, risk, interrelationships, childbearing, individuality, communality and love, and more generally how meanings are generated in times of socio-cultural breakdown. [ABSTRACT FROM AUTHOR]

Based on the Bureau of Economic Research (BER's) 2005 HIV/AIDS survey, this paper provides a snapshot view of the nature and the extent of the impact of HIV/AIDS on companies of different sizes in South Africa, as well as their response to the epidemic. Whereas the focus of most of the previous workplace surveys has been on “evaluating workplace responses”, the present study also considers the economic impact of HIV/AIDS. This study provides evidence of the impact of HIV/AIDS on the largest sample of small, medium and large companies in South Africa to date. The survey results suggest that employer responses are strongly linked to company size, with the majority of medium and large companies indicating that they have an HIV/AIDS policy in place and small companies having done little in the way of action against the epidemic. [ABSTRACT FROM AUTHOR]

The maturing HIM epidemic has led to a decline in the health status of many South Africans, One result is an increasing number of AIDS-affected poor who qualify for a government disability grant. Recent research has drawn attention to the unintended conflict that this may present for poor people who might be faced with choosing between maintaining health through antiretroviral treatment and obtaining money through the state grant. While some evidence suggests that most AIDS-affected people would choose antiretroviral treatment over access to a disability grant, other evidence suggests that some would rather die than lose the grant. This paper is a qualitative exploration of ways that AIDS treatment policies and practices and grants for people disabled by AIDS are currently being negotiated by people caught in the double-bind of managing their own health and income, As South Africa continues to broaden its delivery of antiretroviral treatment and AIDS support services, it is important that planners incorporate an understanding of how an HIM or AIDS diagnosis in the context of entrenched poverty may represent both a threat and a means to financial survival There is a need to consider the 'disinhibiting' effects on HIM prevention and treatment that may result when AIDS support services are aimed at addressing the needs of individuals as opposed to the needs of highly affected communities. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Development Studies 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.)

This paper examines the effect of parental death on the mobility of 39,163 children aged 0-17 in rural KwaZulu Natal, South Africa, in 2000 and 2001. Parental mortality from all causes prior to and during follow-up increased the risk of a child moving by nearly two times after we controlled for the age and gender of the child and household characteristics. However, in the follow-up period, child mobility following maternal deaths from AIDS was lower than child mobility following maternal deaths from other causes. Younger children, boys, and children whose mothers or fathers were resident members of the children's households were also less likely to move. [ABSTRACT FROM AUTHOR]

This paper focuses on an ongoing project in rural South Africa involving teachers and community health workers addressing their work with youth and HIV and AIDS. It outlines a photo-voice component of the project, highlighting in particular the design features of setting up such a project, and in particular addresses five emerging issues in visual methodologies: technical concerns, interpretation, ethical concerns, documentation and taking action. The paper concludes by looking at the ways in which the kind of reflexivity afforded by visual methodologies can help to make visible a plan of action for change. In a province of South Africa that is at the epicentre of the pandemic, this is vital. [ABSTRACT FROM AUTHOR]

Abstract: Debates concerning democratisation and development increasingly engage with what are termed as ‘human rights-based approaches’. As such, whilst critical accounts are correct in cautioning against Rights-Based Development (RBD) in an era of rampant neo-liberalism and donor-driven agendas, the paper proposes that not only are more progressive and political readings of RBD necessary, they already exist ‘on the ground’. The dramatic u-turn in the South African government''s policy concerning HIV/AIDS treatment, for example, is, arguably, situated at the confluence of rights-inspired struggles and the politics of governance. The policy shift therefore provides an opportunity to assess how rights-based approaches to development (RBD) can, under specific conditions, widen critical ‘political space’ and enable more inclusive governance. The key issues posed in the paper are, first, how the South African government''s HIV/AIDS policy can only be properly understood when placed in the context of the broader rhythms of post-apartheid transition and discursive fault-lines underpinning understandings of the epidemic. Second, as embodied through the Treatment Action Campaign – a social movement in South Africa – the paper seeks to explore how human rights principles deployed in a context of social mobilisation and people-driven access to institutional channels, have the potential to impact upon policy-making. Third, setting out the guiding principles of one particular right, the right to health, allows better understanding of RBD more generally. Finally, and by way of conclusion, RBD''s contribution to widening inclusive political space does not have to end at policy-making but can also impact upon rights-based approaches to service delivery. Above all, this case study offers more general theoretical and practical lessons for conceptualizing both RBD and the role of alternative social actors and movements in this. [Copyright &y& Elsevier]

This paper examines changes in households with older people in a northern rural area of KwaZulu Natal province, South Africa, between January 2000 and January 2002. The focus is the impact of adult deaths, especially those from AIDS, on the living arrangements of older people. The longitudinal data are from the Africa Centre Demographic Information System. In 2000, 3,657 older people (women aged 60 years or older, men 65 years or older) were resident in the area, and 3,124 households had at least one older member. The majority (87 %) of older people lived in three-generation households. Households with older people were significantly poorer, more likely to be headed by a woman, and in homesteads with poorer quality infrastructure than households without older members. By January 2002, 316 (8 %) of the older people in the sample had died. Of all the with an older person, 12 per cent experienced at least one adult death The paper shows that older people, particularly those living alone or with children in the absence of other adults, were living in the poorest households. They were also coping with an increasing burden of young adult deaths, the majority of which were attributable to AIDS. [ABSTRACT FROM AUTHOR]

By outlining the political context that shaped the development of AIDS policy in South Africa and highlighting the deeply political aspects of the AIDS crisis, this paper shows why the South African government has not effectively responded to the spread of AIDS. It questions conventional factors, such as wealth, bureaucratic capacity, regime type, and political leadership as explanations for effective government responsiveness to the pandemic. A long-term, effective response to AIDS in South Africa has been hampered by institutional constraints as a result of the legacies of apartheid, democratic restructuring, inappropriate and authoritarian patterns of political leadership, and the dominance of neoliberalism, domestically and internationally. [ABSTRACT FROM AUTHOR]

Most southern African orphans are cared for by extended families but the implications of the spatial dispersal of such families are seldom recognized: orphans often have to migrate to new homes and communities. This paper, based on qualitative research conducted with children and guardians in urban and rural Lesotho and Malawi, examines orphans' migration experiences in order to assess how successful migration might best be supported. Most children found migration traumatic in the short term, but over time many settled into new environments. Although much AIDS policy in southern Africa stresses the role of communities, the burden of care lay with extended family households. Failed migrations, which resulted in renewed migration and trauma, were attributable to one of two household-level causes: orphans feeling ill-treated in their new families or changes in guardians' circumstances. Policy interventions to reduce disruption and trauma for young AIDS migrants should aim at facilitating sustainable arrangements by enabling suitable households to provide care. Reducing the economic costs of caring for children, particularly school-related costs, would: allow children to stay with those relatives (e.g. grandparents) best able to meet their non-material needs; reduce resentment of foster children in impoverished households; and diminish the need for multiple migrations. [ABSTRACT FROM AUTHOR]

AIDS is found in with its widest manifestations in South Africa than any other country in the world. Macroeconomic modelers are divided over whether the overall impact of the epidemic will be to raise or lower per capita GDP. This paper provides a critical overview of recent macroeconomic research on the impact of AIDS in South Africa. It explains how different macroeconomic models arrive at different results and points to the limitations of these models, particularly their failure to take into account the dynamic adjustments suggested by firm-level studies.

Provides an overview of the diverse ways people make a living in harsh physical and economic environments in Mozambique, South Africa and Zimbabwe, according to research conducted by the Sustainable Livelihoods in Southern Africa. Discussion of economic reform programs; Prevalence of HIV and AIDS in the areas; Livelihood strategies of rural people and the emergence of institutional and governance arrangements that facilitate such strategies.

This article discusses the evolution of housing policy in South Africa in the context of HIV or AIDS and globalization. South Africa, a middle-income country is able to provide housing subsidies, specifically, households having an income below 16,000 rand per month are eligible for a housing subsidy. However, two key assumptions that underlie the housing policy, a functioning households and an ability to invest in housing must be called into question. One reason is that the region is confronted by the widespread breakdown of families and the need for a variety of housing services due to HIV or AIDS. In the 1970s the perspective of housing policy changed to the view that individual households benefit from housing, not only as a shelter but also as a response to changing household life and stages and as an investment. In this case, the public sector role as highlighted in the Habitat Agenda of the United Nations includes facilitating of the private sector, communities and the informal sector through the adoption of laws and procedures that foster efficiency. However it is believed that the government have neither the resources nor the capacity to meet all the needs of low-income households, therefore policies must aim at the development of viable and flexible shelter production systems based on the comparative advantage of the public sector. On the other hand, between 3.5 and 4.2 million person are infected with HIV, South Africa is second to India in the number of HIV cases. The implication of such statistics is that a percentage of all households will have at least one family member that is infected with HIV or that will have die from AIDS. Moreover, the upshot of global changes in the structure of demand for goods and service has caused the marginalization of different components of the labor force in South Africa and further worsen by HIV and AIDS prevalence in the region.

The spread and varied impacts of the HIV/AIDS epidemic demonstrate the complex and reciprocal relationships between the socio-political and biophysical dimensions of human health. Yet even with increasing research and policy attention there remain critical gaps in the literature on how HIV-positive households manage health through their engagement with social and ecological systems. This is particularly urgent given improvements in the global response to the epidemic, whereby expanded access to antiretroviral therapy has extended the possibility for survival for years or decades. Because many HIV-positive families and communities in the Global South remain dependent upon a diverse set of resources to generate income and meet subsistence needs, the impacts of disease must be understood within a mix of social processes, including the maintenance of land and collection of natural resources. Similarly, biophysical systems disrupted by HIV/AIDS vary depending upon resource use and locally-specific dynamics that influence opportunities for agrarian production. This paper reports on the findings from a structured survey completed in three communities in northeast South Africa in 2013 that is integrated with focus group discussions and qualitative interviews conducted from 2012–2016. We concentrate upon the diverse ways that individuals and families experience HIV through livelihood systems that are reliant on economic and natural resources. Because the access and use of these resources are mediated by existing social, cultural, and institutional systems, as well as historical spatial economies, we analyze how this produces differential lived experiences for HIV-positive individuals and households in the age of expanded access to antiretroviral therapy. [ABSTRACT FROM AUTHOR]

HIV-AIDS has a global and local presence with both developed and developing countries affected by this disease. South Africa has the largest HIV-AIDS epidemic in the world1. It has been almost 30 years since its discovery and significant gains have been made toward HIV-AIDS prevention, treatment and care. HIV-AIDS programmes have developed instantaneously across the globe in an attempt to assist state health programmes to care and treat for HIV-AIDS individuals. Key components of these programmes have focused on the pillars of HIV-AIDS care; prevention, treatment, wellness and care. However, new evidence is emerging to support a holistic, overarching approach to HIV-AIDS care, that being integrated care. This paper reviews the current landscape of integrated care in HIV-AIDS programmes and proposes smart practices toward optimal patient management. [ABSTRACT FROM AUTHOR]

More than 7-million people are estimated to be living with HIV-AIDS in South Africa where the new infection rate is still on the increase. In order to curtail this disease burden, South Africa has implemented the largest ARV programme in the world . Now as HIV positive individuals live longer, more productive lives, the challenge has become on how to manage the double burden of non-communicable diseases and HIV-AIDS . This paper reviews the current landscape of integrated care in HIV-AIDS/NCDs programmes and proposes smart practices toward optimal patient management. [ABSTRACT FROM AUTHOR]

An introduction to a special issue on HIV/AIDS in South Africa, is presented with topics including role of men in advancing women's interests in the time of HIV and AIDS, and the stigma attached to HIV-positive persons in South Africa.

Despite optimism about the end of AIDS, the HIV response requires sustained financing into the future. Given flat-lining international aid, countries' willingness and ability to shoulder this responsibility will be central to access to HIV care. This paper examines the potential to expand public HIV financing, and the extent to which governments have been utilising these options. We develop and compare a normative and empirical approach. First, with data from the 14 most HIV-affected countries in sub-Saharan Africa, we estimate the potential increase in public HIV financing from economic growth, increased general revenue generation, greater health and HIV prioritisation, as well as from more unconventional and innovative sources, including borrowing, health-earmarked resources, efficiency gains, and complementary non-HIV investments. We then adopt a novel empirical approach to explore which options are most likely to translate into tangible public financing, based on cross-sectional econometric analyses of 92 low and middle-income country governments' most recent HIV expenditure between 2008 and 2012. If all fiscal sources were simultaneously leveraged in the next five years, public HIV spending in these 14 countries could increase from US$3.04 to US$10.84 billion per year. This could cover resource requirements in South Africa, Botswana, Namibia, Kenya, Nigeria, Ethiopia, and Swaziland, but not even half the requirements in the remaining countries. Our empirical results suggest that, in reality, even less fiscal space could be created (a reduction by over half) and only from more conventional sources. International financing may also crowd in public financing. Most HIV-affected lower-income countries in sub-Saharan Africa will not be able to generate sufficient public resources for HIV in the medium-term, even if they take very bold measures. Considerable international financing will be required for years to come. HIV funders will need to engage with broader health and development financing to improve government revenue-raising and efficiencies. [ABSTRACT FROM AUTHOR]

Adolescents living with HIV (ALHIV) struggle to remain engaged in HIV-related care and adhere to antiretroviral treatment (ART) due to a myriad of physical, psychological and cognitive-developmental challenges. We report on the profile of ALHIV aged 10–19 years on ART and the clinical factors associated with their retention in care. A retrospective cohort analysis was conducted with 16,108 ALHIV, aged 10–19 years, who were enrolled in 136 ART clinics in the Ehlanzeni district. Anonymised data were obtained from electronic medical records (Tier.net). Trends in retention in care among adolescents on ART was described using Kaplan-Meier survival estimates. Cox proportional analysis was performed to identify factors associated with retention in care over 2 years. More than half (53%) were females, and median duration on ART was 8 months. Retention in care among adolescents at months 6, 12, 18 and 24 was 90.5%, 85.4%, 80.8% and 76.2%, respectively. After controlling for confounders, risk of dying or lost to follow up increased for female adolescents (aHR = 1.28, 95% CI 1.10–1.49); being initiated on ART while pregnant (aHR = 2.72, 95% CI 1.99–3.69); history of TB infection (aHR = 1.71, 95% CI 1.10–2.65); and started ART at age 10–14 years (aHR = 2.45, 95% CI 1.96–3.05), and 15–19 years (aHR = 9.67, 95% CI 7.25–12.89). Retention in care among adolescents on ART over two-year period was considerably lower than the UNAIDS 2030 target of 95%. Of particular concern for intervention is the lower rates of retention in care among females and pregnant adolescents and starting ART between the ages of 10 and 19 years. Family or caregivers and peer support groups centred interventions designed to promote early initiation and retention in care through early case identification are needed. [ABSTRACT FROM AUTHOR]

After decades of research on the HIV/AIDS epidemic, there remain critical gaps in understanding how HIV-positive people manage their health through their interactions with dynamic and coupled social-ecological systems. During the course of the 2014–2016 El Niño, multiple climate shocks occurred in Southern Africa, which is home to the largest HIV-positive population in the world. Using mixed method longitudinal techniques, we find statistically significant relationships between HIV-positive households and decreased dietary consumption due to a lack of food during and following climate shocks. During the El Niño years, HIV-positive households were more likely to draw on secondary plant collection to manage disease progression, underscoring an important and understudied ecological impact from the epidemic. This demonstrates clear evidence that climate shocks amplify food insecurity vulnerabilities during the El Niño years, likely mediated by changes within coupled social-ecological systems. Knowledge on the direct relationships between HIV management and climate shocks is needed to better inform global responses to the HIV/AIDS epidemic under regimes of increasing uncertainty. [ABSTRACT FROM AUTHOR]

Background: Studies which examine quality of life (QOL) provide important insights that are needed to understand the impacts of HIV/AIDS anti-retroviral treatment (ART), comorbid conditions and other factors on the daily activities of people living with HIV/AIDS (PLH). This study aimed to determine the inter-relationships between clinical factors, behavioural, socio-demographic variables and QOL among PLH.Methods: The secondary analysis used data collected from 293 people living with HIV/AIDS (PLH) receiving second-line ART in Johannesburg in a clinical trial which evaluated the non-inferiority of ritonavir-boosted darunavir (DRV/r 400/100 mg) compared to ritonavir-boosted lopinavir (LPV/r) over a 48 week-period. Physical functioning, cognitive and mental QOL were measured using the Aids Clinical Trial Group questionnaire. Exploratory factor analyses were used to examine the structure, the relationships between and the construct validity of QOL items. Structural equation models which tested the a priori-hypothesised inter-relationships between QOL and other variables were estimated and goodness of fit of the models to the data was assessed.Results: Patients on darunavir presented with lower pill burden. Older patients and women were more likely to report lower QOL scores. Pill burden mediated the effects of age, sex and treatment regimen on physical functioning QOL and adverse effects; the effects of age, sex, treatment regimen and adverse effects on cognitive QOL; and the effects of sex on mental QOL.Conclusion: QOL among PLH is associated with socio-demographic and clinical factors. Therefore, QOL could be enhanced by considering PLH characteristics, clinical factors such as regimen side-effects profile, management of comorbid conditions and mitigating risks such as potential adverse drug-to-drug interactions among patients on ART. [ABSTRACT FROM AUTHOR]

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We used the Practical, Robust Implementation and Sustainability Model to evaluate implementation of South Africa's Central Chronic Medicine Dispensing and Distribution (CCMDD) program, a differentiated service delivery program which allows clinically stable HIV-positive patients to receive antiretroviral therapy refills at clinic- or community-based pick-up points. Across ten clinics, we conducted 109 semi-structured interviews with stakeholders (pick-up point staff, CCMDD service providers and administrators) and 16 focus groups with 138 patients. Participants had highly favorable attitudes and said CCMDD decreased stigma concerns. Patient-level barriers included inadequate education about CCMDD and inability to get refills on designated dates. Organizational-level barriers included challenges with communication and transportation, errors in medication packaging and tracking, rigid CCMDD rules, and inadequate infrastructure. Recommendations included: (1) provide patient education and improve communication around refills (at the patient level); (2) provide dedicated space and staff, and ongoing training (at the organizational/clinic level); and (3) allow for prescription renewal at pick-up points and less frequent refills, and provide feedback to clinics (at the CCMDD program level). [ABSTRACT FROM AUTHOR]

The critical challenges of AIDS and poverty in post-apartheid South Africa impact the ways in which memories are articulated and family and fertility histories ultimately constructed. This article considers three life histories written in the course of ethnographic work on women's childbearing conducted intermittently between 1998 and 2014, and typical of other histories in the same peri-urban locale. Personal accounts of a mother and her two daughters initially centre on domestic strife and adversity – and the family as a whole is represented as struggling and disunited. In the aftermath of the death of one of the daughters from AIDS in 2001, the memories and discourse are subtly reworked by the two women in ways that are meant to counteract stigma, reclaim dignity and defend the family. The paper focuses on reproductive dynamics and memory-making in a hardship-driven and AIDS-affected setting and on the ethnographer's endeavours in witnessing, interviewing and making sense of people's ‘intent’ and ‘the urge to forget, to go on living’. [ABSTRACT FROM PUBLISHER]