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Background: Violence against women (VAW) research is a sensitive topic, which has been conducted mainly using face-to-face methods. The COVID-19 pandemic lockdown and restrictions on movement presented an opportunity to conduct VAW research using remote methods. We discuss how we adapted methods, reflect on lessons learned, and make recommendations highlighting key considerations when conducting remote research on a sensitive topic of VAW. Methods: We designed and conducted an exploratory qualitative study using remote methods with 18 men and 19 women, aged 18 years and older, who lived with their partner or spouse during lockdown in South Africa. The aim of the study was to explore experiences of COVID-19 lockdown, and its link to women and children's experiences of violence in the homes. Data presented in this paper draws from researchers' reflections drawn from debriefing sessions during the research process, and from participants' interview transcripts. Findings: Remote recruitment of participants took longer than anticipated, and we had to re-advertise the study. We could not ensure safety and privacy during interviews. Regardless of all the safety and privacy measures we put in place during the research process, some participants had an adult person present in the room during interviews, and the researchers had no control over interruptions. Rapport was difficult to establish without an in-person connection, which limited disclosure about violence experience (amongst women) and perpetration (amongst men). Conclusions: Given the methodological and ethical challenges which limited disclosure of VAW remotely, we conclude that telephone interviews used in our study impacted on the quality of study data. Therefore, we do not recommend VAW research to be conducted remotely, unless it is essential and participants are already known to the interviewer and trust has been established. [ABSTRACT FROM AUTHOR]

In sub-Saharan Africa, sexual relationships between younger women and older men have been shown to pose a risk of HIV transmission. In South Africa, there has been growing interest in blesser–blessee relationships. This study explores perceptions of these relationships among university students in Durban, South Africa. The study draws on 15 in-depth interviews with students. Participants suggest that older men engage in these relationships for sexual gratification and younger women do so for monetary or material gain. Interviews revealed that participants believed that these relationships are common with both men and women engaging in them and putting themselves at risk of HIV infection. It is imperative to explore the context and motivation for these relationships because of their broader social and health implications. In addition, greater effort should be geared towards addressing the underlying factors that facilitate blesser–blessee relationships. [ABSTRACT FROM AUTHOR]

This study examined the intersecting impact of structural inequalities and transactional sex on in-school adolescent girls' risk of pregnancy and poor educational outcomes in rural northern KwaZulu-Natal. In this article, we understand structural inequalities as providing a basis for transactional relationships between adolescent girls and older men. Participatory visual research methods were employed with 18- and 19-year-old girls and boys to examine multiple systems of oppression and inequalities experienced by inschool rural adolescent girls, focusing particularly on their vulnerability to transactional sex, pregnancy and poor educational outcomes. In this context, moralising discourses on transactional sexual relationships are unhelpful if structural barriers placing girls at risk are not addressed. [ABSTRACT FROM AUTHOR]

Approximately 11 million animals are slaughtered annually in South Africa. This study aimed to explore the experiences of slaughterers working in abattoirs to better address their emotional and physical challenges and how they deal with them. Semi-structured interviews were conducted with 24 participants: 10 halaal, two kosher, and 12 secular slaughterers in 11 different religious and secular abattoirs from Western Cape, South Africa. The participants were all men aged between 25 and 67 years old. The interview texts were analysed using reflexive thematic analysis. The results revealed the emotional and physical toll these men experienced because of their work in slaughtering animals in abattoirs. The study highlighted the dimensions of religion and culture involved in their work, as many men framed their work in terms of religion, culture, and community obligation. [ABSTRACT FROM AUTHOR]

Background: Prostate cancer is topmost in terms of incidence and mortality among men in sub-Saharan Africa, including South Africa. Prostate cancer screening is beneficial only to certain categories of men, making a rational screening approach necessary. Aim: This study aimed to assess the knowledge, attitudes and practice (KAP) regarding prostate cancer screening among primary health care (PHC) providers in the Free State, South Africa. Setting: Selected district hospitals, local clinics and general practice rooms. Methods: This was a cross-sectional analytical survey. Participating nurses and community health workers (CHWs) were selected through stratified random sampling. All available medical doctors and clinical associates were approached to participate, totalling 548 participants. Relevant information was obtained from these PHC providers using self-administered questionnaires. Both descriptive and analytical statistics were computed using Statistical Analysis System (SAS) Version 9. A p -value < 0.05 was considered significant. Results: Most participants had poor knowledge (64.8%), neutral attitudes (58.6%) and poor practice (40.0%). Female PHC providers, lower cadre nurses and CHWs had lower mean knowledge scores. Not participating in prostate cancer–related continuing medical education was associated with poor knowledge (p < 0.001), negative attitudes (p = 0.047) and poor practice (p < 0.001). Conclusion: This study established appreciable KAP gaps relating to prostate cancer screening among PHC providers. Identified gaps should be addressed through the preferred teaching and learning strategies suggested by the participants. Contribution: This study establishes the need to address KAP gaps regarding prostate cancer screening among PHC providers; therefore necessitating the capacity-building roles of district family physicians. [ABSTRACT FROM AUTHOR]

In view of the epidemic proportions of obesity in South Africa and its relationship to cardiometabolic diseases, such as hypertension, a cross sectional study was conducted to investigate the utility of obesity indicators for predicting hypertension among older persons (≥60 years, n = 350) in the Limpopo Province of South Africa. The WHO STEPwise approach was used to collect data on demographic and lifestyle factors. Anthropometrics and blood pressure were measured according to the standard procedures. Receiver operating characteristic curves (ROC) were used to investigate and compare the ability of obesity indicators to predict overall hypertension and either increased systolic (SBP) or increased diastolic (DBP) blood pressure. The area under the ROC curve (AUC) was used to assess a certain indicator's potential to predict overall hypertension and either increased SBP or increased DBP. Multivariate logistic regression analysis was used to determine the relationship of hypertension with obesity indicators. The mean age of the participants was 69 years (±SD = 7), and hypertension (46%), general obesity (36%) and abdominal obesity (57%) were prevalent among older persons. The obesity indicator body mass index (BMI) (AUC = 0.603 (0.52; 0.69)) was the best predictor of hypertension in older men. Waist circumference (WC) (AUC = 0.640 (0.56; 0.72)) and waist-to-height ratio (WHtR) (AUC = 0.605 (0.52; 0.69)) were better predictors of hypertension than BMI and waist-to-hip ratio (WHR) in older women. After adjustment for risk factors, only WC (AOR = 1.22 (1.16; 1.79)) was significantly associated with hypertension in older women, proposing WC as a screening tool for the prediction of hypertension in South African older women. [ABSTRACT FROM AUTHOR]

Background: Sexual assaults are on an epidemic level in the Transkei region of South Africa, despite the government efforts to bring it down. Human Immuno-deficiency Virus (HIV) is also proportionally high in this region of South Africa. Objective: To highlight the problem of sexual assault and HIV infection in the Transkei region of South Africa. Case history: This is a case report of 15-year-old teenagers (SD) who was a schoolgirl in standard 6 when she was assaulted. SD was sexually assaulted repeatedly by an older man of 28 years. She was found sero-converted on HIV testing. On physical examination the introitus was red and bruised. A copious amount semen-like infected fluid was observed in her vagina. The case history, findings, beliefs, and compliance with HIV drugs are discussed. Conclusion: There is high risk of repeated sexual assault and HIV infection in the Transkei region of South Africa. Government must look deeper to prevent these rape attacks as well as HIV infection. [ABSTRACT FROM AUTHOR]

There is little research on older black gay men (OBGM) living with HIV, the research focus having been on the younger lesbian, gay, bisexual, and transgender (LGBT) cohort. This qualitative study explored the ageing and healthcare experiences of OBGM living in a selected township in the Cape Metropole in South Africa, to find strategies to deal with their concerns. In-depth interviews were undertaken with 15 participants, 10 older gay men and 5 health professionals (nurses) working at the local day hospital. Interviews were audio-recorded, transcribed verbatim, and translated from isiXhosa to English before a thematic analysis was undertaken. A key findings of the study was that the OBGM who are people living with HIV were stigmatised and faced discrimination from the healthcare professionals at the hospital. Rejection by their families and communities and the death of their life partners led to isolation and depression. Social workers should be involved in counselling of OBGM, training of healthcare professionals, and facilitating workshops with families and communities in the townships. [ABSTRACT FROM AUTHOR]

In South Africa, young men are generally considered to generate many of the risks associated with informal settlement life, yet their own vulnerability in these environments is seldom considered. Seeking insights into male susceptibility in these impoverished urban spaces is methodologically challenging. How does one encourage poor marginalised young men to speak with candour about their insecurities and challenges? The research methods used, while facilitating openness, should also build their confidence as they reflect on the challenges of everyday life. This paper describes the methodological journey undertaken in a study of young Black men living in informal settlements in Cape Town, South Africa, revealing how they perceive their vulnerability in these environments. It demonstrates how a suite of methods gradually developed through trial and error, with the young men themselves assisting in the adaptation of tools, ranging from interviews using adapted participatory methods to non‐prescriptive diary‐writing. Together they delivered deep and penetrating insights into the lives of the young men, and the nature of their vulnerability. [ABSTRACT FROM AUTHOR]

Background: Studies estimate that circumcising men between the ages of 20-30 years who have exhibited previous risky sexual behaviour could reduce overall HIV prevalence. Demand creation strategies for medical male circumcision (MMC) targeting men in this age group may significantly impact these prevalence rates.Objectives: The objective of this study is to evaluate the cost-effectiveness and cost-benefit of an implementation science, pre-post study designed to increase the uptake of male circumcision for ages 25-49 at a fixed MMC clinic located in Gauteng Province, South Africa.Methods: A health care provider perspective was utilised to collect all costs. Costs were compared between the standard care scenario of routine outreach strategies and a full intervention strategy. Cost-effectiveness was measured as cost per mature man enrolled and cost per mature man circumcised. A cost-benefit analysis was employed by using the Bernoulli model to estimate the cases of HIV averted due to medical male circumcision (MMC), and subsequently translated to averted medical costs.Results: In the 2015 intervention, the cost of the intervention was $9445 for 722 men. The total HIV treatment costs averted due to the intervention were $542,491 from a public care model and $378,073 from a private care model. The benefit-cost ratio was 57.44 for the public care model and 40.03 for the private care model. The net savings of the intervention were $533,046 or $368,628 - depending on treatment in a public or private setting.Conclusions: The intervention was cost-effective compared to similar MMC demand interventions and led to statistically significant cost savings per individual enrolled. [ABSTRACT FROM AUTHOR]

Increased bone resorption is a well-described consequence of primary hyperparathyroidism (PHPT). In South Africa, little is known about the impact of PHPT on skeletal health. To determine the prevalence of decreased bone mineral density (BMD), vertebral fractures and osteitis fibrosa cystica in patients with PHPT who underwent parathyroidectomy. Retrospective study of patients who underwent parathyroidectomy for PHPT at Tygerberg Hospital in Cape Town, from January 2010 to December 2019. Clinical, biochemical and BMD parameters are described. Final analysis included 56 patients (median age 63.5 years; 80.4% female). Initial calcium, parathyroid hormone (PTH) and 25-hydroxyvitamin D (25[OH]D) levels were 2.93 mmol/l, 19.4 pmol/l and 34.0 nmol/l, respectively. Of the total cohort, 71.4% had decreased BMD. The prevalence of osteoporosis and osteopenia in postmenopausal women and men ≥ 50 years was 50.0% and 39.1% respectively; low bone mass for age in premenopausal women and men < 50 years was 20.0%. Vertebral fractures were seen in 21.2% of patients on radiography. Osteitis fibrosa cystica was present in five patients (9.6%). PTH levels were significantly elevated in patients with osteoporosis compared with those with normal BMD (36.4 vs. 16.1 pmol/l; p = 0.02). Two-thirds of patients who underwent parathyroidectomy for PHPT had decreased BMD, with osteoporosis present in 50% of postmenopausal women and older men. One in five had vertebral fractures. These findings underscore the importance of skeletal assessment in the management of PHPT. [ABSTRACT FROM AUTHOR]

Despite recent improvements, men still have worse HIV outcomes than women in South Africa. This study describes how young men form distinct behavioural and attitudinal subgroups, and is intended to inform the design of targeted interventions to encourage HIV testing and initiation on antiretroviral therapy. Data were collected using a cross-sectional survey with questions on men's attitudes, beliefs and behaviours around HIV/AIDS. A total of 2,019 men were randomly sampled from eight district municipalities in KwaZulu-Natal and Mpumalanga provinces between October 2018 and January 2019. Men were eligible to participate if they were aged 20–34, Black African, had an education level below university graduation, were aware of HIV and were willing to disclose whether they had tested for HIV. Each participant responded to a questionnaire asking about their demographic characteristics, reported sexual behaviour, engagement with HIV testing and treatment services, alcohol consumption, HIV knowledge, attitudes to gender equity and reported level of depressive symptoms. Data were analysed using canonical correlation, hierarchical clustering and factor analysis techniques to produce five groups of men. The results were synthesised using Human Centred Design principles to suggests areas for potential intervention for each segment. The results showed that men vary based on their attitudes to gender and masculinity, use of alcohol, testing and treatment behaviour, HIV-related fears and preferences for testing modalities. Segment 1 (21%) avoids the topic of HIV, perhaps fearful of the impact on his life. Segment 2 (23%) is well connected to his community and has social concerns about HIV. Segment 3 (15%) struggles with more distal determinants of HIV acquisition such as unemployment and poor mental health. Segment 4 (25%) has concerns about the lifestyle changes that would be required if he were HIV positive. Segment 5 (16%) has a strong traditional mindset and is fearful of the ramifications of HIV in his community. The results will be used to design targeted interventions to increase HIV testing and treatment rates among young men in South Africa. Further research is required to understand the impact of interventions designed in this way. [ABSTRACT FROM AUTHOR]

Background: Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV and has the potential to significantly impact the HIV epidemic. Given limited resources for HIV prevention, identifying PrEP provision strategies that maximize impact is critical. Methods: We used a stochastic individual-based network model to evaluate the direct (infections prevented among PrEP users) and indirect (infections prevented among non-PrEP users as a result of PrEP) benefits of PrEP, the person-years of PrEP required to prevent one HIV infection, and the community-level impact of providing PrEP to populations defined by gender and age in western Kenya and South Africa. We examined sensitivity of results to scale-up of antiretroviral therapy (ART) and voluntary medical male circumcision (VMMC) by comparing two scenarios: maintaining current coverage ("status quo") and rapid scale-up to meet programmatic targets ("fast-track"). Results: The community-level impact of PrEP was greatest among women aged 15–24 due to high incidence, while PrEP use among men aged 15–24 yielded the highest proportion of indirect infections prevented in the community. These indirect infections prevented continue to increase over time (western Kenya: 0.4–5.5 (status quo); 0.4–4.9 (fast-track); South Africa: 0.5–1.8 (status quo); 0.5–3.0 (fast-track)) relative to direct infections prevented among PrEP users. The number of person-years of PrEP needed to prevent one HIV infection was lower (59 western Kenya and 69 in South Africa in the status quo scenario; 201 western Kenya and 87 in South Africa in the fast-track scenario) when PrEP was provided only to women compared with only to men over time horizons of up to 5 years, as the indirect benefits of providing PrEP to men accrue in later years. Conclusions: Providing PrEP to women aged 15–24 prevents the greatest number of HIV infections per person-year of PrEP, but PrEP provision for young men also provides indirect benefits to women and to the community overall. This finding supports existing policies that prioritize PrEP use for young women, while also illuminating the community-level benefits of PrEP availability for men when resources permit. [ABSTRACT FROM AUTHOR]

Camps that interned black civilians during the South African War (1899-1902) are known as concentration camps, yet this is an inaccurate and misrepresentative picture of what actually transpired during the conflict. Rather, the concentration camps established for black civilians in South Africa late in 1900 and early 1901 were, by mid-1901, incorporated into the newly formed Native Refugee Department which fell under direct command of the British Army. At this point, the camps were mostly closed down and the internees relocated to Boer farms cleared of civilians. There, camps were established by the Native Refugee Department with a completely different function to that of the concentration camp system. These camps operated as forced labour camps in which women, children and elderly men were compelled into the labour of growing crops for the British military in exchange for food. If they refused, they were starved to death under the 'let die' policy. The Dry Harts Forced Labour Camp forms the focus of this article. A combination of sources was used to reconstruct its history: archaeological surveys, the fragmentary written archive, and through accessing local oral history and memory at the site, from 2001-2008. A narrative emerges from this research of the fight for land, the implementation of forced labour, civilian displacement, and the horror of total war, which are not, as some scholars claim, a shared experience with the Boer population at the hands of a common enemy, commensurate with mutual suffering, or even of black participation in the war. The experience of black civilians inside Dry Harts Forced Labour Camp was fundamentally different: theirs was not so-called participation but rather a separate experience of land loss, forced labour, war and displacement. [ABSTRACT FROM AUTHOR]

The literature on intergenerational sexual relationships in Africa focuses predominantly on economic motivations. This paper aims to identify the common reasons for older male sexual partners among young women in South Africa. Data for the study came from the Fourth South African National HIV, Behaviour and Health Survey 2012. A representative sample of 620 young women (15-24 years old) with older male sexual partners was extracted. A multiple logistic regression analysis was conducted to adjust for potential confounders. The authors found that more than a quarter of sexually active young women engaged in age-disparate relationships. The majority of the respondents did not see age as an important factor, while financial support ranked fourth in the list of reasons for having older partners. Women who were 20-24 years old (AOR 1.16, CI: 0.59287-1.87493), divorced, separated or widowed (AOR 1.38, CI: 0.65360-1.92105) and who were students or learners (AOR 1.85, CI: 0.41943-1.29402) were more likely to have an older partner for financial reasons. Thus, financial motivations are not the predominant reason for age-disparate relationships; instead, other reasons including age not being important and feeling secure were more cited. Not all young women in South Africa are seeking financial assistance from older sexual partners. [ABSTRACT FROM AUTHOR]

Evidence indicates that age-disparate sexual partnerships increase a young woman's risk of HIV acquisition. Studies suggest that age-disparate relationships are fuelled by socio-economic disparities, with economically disadvantaged young women in sexual relationships with comparatively wealthier older men. Limited data exists on the socio-economic status of men in age-disparate relationships relative to men in age-similar relationships. This study explores whether men in age-disparate and similar-aged partnerships differ on socio-economic indicators. A 2012 nationally representative cross-sectional survey of 10,034 men was analysed. The sample was restricted to sexually active men older than 24 years old (N = 1330). The survey included information on the men's three most recent sexual partners and three measures of socio-economic status. Multiple regression models were used to compare the socio-economic status of men in age-similar partnerships to men in age-disparate partnerships. Just less than half (44.6%) of the men were involved in only age-similar partnerships. The multiple regression results indicate that household wealth, access to essential services and employment status were not significantly associated with an increased likelihood of men engaging in age-disparate partnerships. Additionally, the relationship between men's wealth and age disparate partnering did not vary according to geographical context. Men engaging in age-disparate partnerships do not differ with regards to their socio-economic status from men in partnerships with women of a similar age. Whilst economic disparity may prevail between males and females within age-disparate relationships, this study reveals that the men in these relationships are not economically advantaged over men in age-similar relationships. [ABSTRACT FROM AUTHOR]

Since the advent of HIV/AIDS, sexuality studies in sub-Saharan Africa (SSA) have focused mainly on the sexual behaviour of the younger generation (15–49 years) and little has been done to understand the sexual behaviour of those a 50 years and above. The objective of this study is therefore to examine the covariates of high-risk sexual behaviour among men aged 50 years plus within the SSA region. Data from Demographic and Health Surveys of 10 SSA countries were pooled together and a sample of 5394 men aged 50 years plus who have ever had sex was analysed. Findings show that in SSA, a large proportion of men aged 50 years plus (74%) were sexually active and a substantial proportion of these men engaged in unsafe sexual behaviours, such as having multiple sexual partners and unprotected sex. The multivariate logistic regression analysis showed that involvement with multiple sexual partners was significantly associated with older age, urban residence, religion, having primary or secondary education, and ever taken an HIV test. Condom use at last sex was significantly associated with age at first sex, multiple sexual partners, level of education and ever been tested for HIV. These results suggest that HIV prevention and intervention programmes should also target older men as they are also sexually active and at risk of being infected because of unsafe sexual practices. [ABSTRACT FROM AUTHOR]

The aim of the study was to ascertain the level of knowledge, attitudes and beliefs of the aged male on HIV and AIDS, and to what extent daily living has been influenced by the disease. The focus of the study was on older men who are affected by HIV and AIDS. In- depth interviewing was done within the exploratory design to gain data of a qualitative and quantitative nature. Interviews focused on the perceptions of participants on illness in general, but HIV and AIDS specifically. Topics such as the influence of HIV and AIDS on the individual, the household and the community were explored. [ABSTRACT FROM AUTHOR]

Engaging men in work towards gender equality is a critical aspect of gender and development. However, there are few documented grassroots-level approaches to undertaking such work. This paper argues that context specific stresses on local constructions of masculinity, such as unemployment, poverty and high HIV prevalence, may provide useful entry points for work with men towards gender equality. While these stresses may act to undermine men's ability to 'achieve' the requirements of traditional constructions of masculinity, particularly the role of men as providers, they simultaneously create spaces for change. In this research, land-use provided a basis from which to engage with a group of older men (45-75 years) around a range of issues, including HIV and AIDS and health. Increases in levels of communication around HIV, household resources and health are used as indicative of the men's moves towards gender-equal behaviour. The paper argues that this was achieved by supporting positive aspects of traditional masculine identities, particularly the role of men as breadwinners, in a social and economic context where these roles are threatened or placed under pressure, while simultaneously working around 'sensitive' issues. [ABSTRACT FROM AUTHOR]

Despite the important consequences that HIV/AIDS is likely to have for older people in South Africa, little empirical work has focused directly on this issue. However, emerging evidence suggests that older people are increasingly affected by the AIDS pandemic. In many households, older people often assume responsibility for the care of those who are sick and/or dying and for children orphaned by AIDS. This study uses qualitative and quantitative methods to provide insights into the multiple impacts of the HIV/AIDS pandemic on the lives of older men and women. The results show that some older men and women feel at risk of HIV infection because of their caregiving activities. Almost 17% of respondents report that they have ever cared for someone with HIV/AIDS, with the percentage somewhat higher in rural areas. The study found that the impact of HIV/AIDS is substantial and is compounded greatly by gender dynamics in the household. [ABSTRACT FROM AUTHOR]