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Key Points: Question: Among Black African adults with hypertension, how effective and safe is a low-dose triple-pill protocol compared with standard-care protocol for lowering blood pressure? Findings: In this randomized trial in Nigeria among 300 Black African patients with uncontrolled hypertension who were either untreated or receiving a single blood pressure–lowering drug, treatment with low-dose triple-pill protocol, compared with standard-care protocol, for 6 months significantly reduced home systolic blood pressure (by 5.8 mm Hg), with no increase in discontinuation of trial treatment due to adverse events. Meaning: Compared with standard-care protocol, treatment with a low-dose triple-pill protocol can improve blood pressure lowering. Importance: With the high burden of hypertension in sub-Saharan Africa, there is a need for effective, safe and scalable treatment strategies. Objective: To compare, among Black African adults, the effectiveness and safety of a novel low-dose triple-pill protocol compared with a standard-care protocol for blood pressure lowering. Design and Setting: Randomized, parallel-group, open-label, multicenter trial conducted in public hospital–based family medicine clinics in Nigeria. Participants: Black African adults with uncontrolled hypertension (≥140/90 mm Hg) who were untreated or receiving a single blood pressure–lowering drug. Interventions: Participants were randomly allocated to low-dose triple-pill or standard-care protocols. The triple-pill protocol involved a novel combination of telmisartan, amlodipine, and indapamide in triple one-quarter, one-half, and standard doses (ie, 10/1.25/0.625 mg, 20/2.5/1.25 mg, and 40/5/2.5 mg), with accelerated up-titration. The standard-care protocol was the Nigeria hypertension treatment protocol starting with amlodipine (5 mg). Main Outcomes and Measures: The primary effectiveness outcome was the reduction in home mean systolic blood pressure, and the primary safety outcome was discontinuation of trial treatment due to adverse events, both from randomization to month 6. Results: The first participant was randomized on July 19, 2022, and the last follow-up visit was on July 18, 2024. Among 300 randomized participants (54% female; mean age, 52 years; baseline mean home blood pressure, 151/97 mm Hg; and clinic blood pressure, 156/97 mm Hg), 273 (91%) completed the trial. At month 6, mean home systolic blood pressure was on average 31 mm Hg (95% CI, 28 to 33 mm Hg) lower in the triple-pill protocol group and 26 mm Hg (95% CI, 22 to 28 mm Hg) lower in the standard-care protocol group (adjusted difference, −5.8 mm Hg [95% CI, −8.0 to −3.6]; P <.001]). At month 6, clinic blood pressure control (<140/90 mm Hg) was 82% vs 72% (risk difference, 10% [95% CI, −2% to 20%]) and home blood pressure control (<130/80 mm Hg) was 62% vs 28% (risk difference, 33% [95% CI, 22% to 44%]) in the triple-pill compared with the standard-care protocol group; these were 2 of 21 prespecified secondary effectiveness end points. No participants discontinued trial treatment due to adverse events. Conclusions and Relevance: Among Black African adults with uncontrolled hypertension, a low-dose triple-pill protocol achieved better blood pressure lowering and control with good tolerability compared with the standard-care protocol. Trial Registration: Pan African Clinical Trials Registry Identifier: PACTR202107579572114 This randomized clinical trial compares the effectiveness and safety of a novel low-dose triple-pill protocol, compared with a standard-care protocol, for blood pressure lowering among Black African adults in Nigeria. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 cell-mediated immunity remains understudied during pregnancy in unvaccinated Black African women living with HIV (WLWH) from low- and middle-income countries. We investigated SARS-CoV-2-specific T-cell responses 1 month following infection in 24 HIV-uninfected women and 15 WLWH at any stage during pregnancy or postpartum. The full-length spike (FLS) glycoprotein and nucleocapsid (N) protein of wild-type (WT) SARS-CoV-2, as well as mutated spike protein regions found in the Omicron variant (B.1.1.529) were targeted by flow cytometry. WT-specific CD4+ and CD8+ T cells elicited similar FLS- and N-specific responses in HIV-uninfected women and WLWH. SARS-CoV-2-specific T-lymphocytes were predominantly TNF-α monofunctional in pregnant and postpartum women living with and without HIV, with fever cells producing either IFN-γ or IL-2. Furthermore, T-cell responses were unaffected by Omicron-specific spike mutations as similar responses between Omicron and the ancestral virus were detected for CD4+ and CD8+ T cells. Our results collectively demonstrate comparable T-cell responses between WLWH on antiretroviral therapy and HIV-uninfected pregnant and postpartum women who were naïve to Covid-19 vaccination. Additionally, we show that T cells from women infected with the ancestral virus, Beta variant (B.1.351), or Delta variant (B.1.617.2) can cross-recognize Omicron, suggesting an overall preservation of T-cell immunity. [ABSTRACT FROM AUTHOR]

BACKGROUND: The basilar artery (BA) is a crucial vessel in the posterior cerebral circulation, supplying blood to the occipital lobes, cerebellum, and brainstem. Variations in BA diameter can be indicative of pathological conditions and may serve as a predictive marker for cerebrovascular events. Despite the importance of these measurements, data on the normal BA diameter in the Black African population is limited. This study aims to establish baseline values for BA diameter in healthy adults in Enugu, southeast Nigeria, and to examine any potential gender differences. METHODS: A cross-sectional study was conducted on 298 subjects (150 males, 148 females) at the University of Nigeria Teaching Hospital Ituku/Ozalla, Enugu State. Participants, referred for brain CT, had normal radiologist reports. Contrast-enhanced brain CT scans were performed using a 64-slice Brilliance Philips scanner. BA diameter was measured on axial images at the midpons level. RESULTS: The participants had a mean age of 49.4 years (±14 years). The BA diameter ranged from 3.1mm to 5.5mm, with a mean of 4.2mm (±0.5mm). Males had a significantly larger BA diameter compared to females (p<0.05). Diameter increased with age in both genders. CONCLUSIONS: This study provides reference values for BA diameter in a Nigerian population, highlighting a gender difference and age-related increase in diameter. These findings contribute to the understanding of BA geometry in Black Africans and can assist in diagnosing and managing cerebrovascular conditions. [ABSTRACT FROM AUTHOR]

Throughout the history of management theories, masculine ideals have dominated the development of organisational leadership structures, often leading to a belief in the inherent superiority of men in leadership roles. Despite progress, many organisations still operate under the assumption that women are somehow deficient compared to men in leadership capabilities. The research objective was to investigate the difficulties Black African women encounter in leadership positions in Kenyan and South African banks, specifically concerning how society views women in leadership roles. The study conducted semi-structured interviews and focus groups involving 41 Black African women managers from the banking sectors of both countries, employing an inter-categorical intersectionality approach. The research revealed a perceived lack of fit for top executive leadership positions among African-Black women. A comparison between masculine and feminine leadership styles underscored the gendered sex-role stereotypes that hindered the advancement of Black African women into top executive roles within the banking sector. In summary, the findings emphasise that, as long as 'think manager, think male' persists in leadership, Black African women will continue to encounter obstacles in attaining top executive positions within the banking sectors of Kenya and South Africa. The study's practical implications are that it emphasises the understanding of women and leadership and its role as an obstacle for Black women managers in the Kenyan and South African banking sectors. The originality of this study is that it contributes to the understanding of women and leadership literature in the banking sectors of Kenya and South Africa, as well as sub-Saharan African countries. [ABSTRACT FROM AUTHOR]

Masculinities are organised hierarchically, and how a man sees himself is often informed by his positioning within this hierarchy. The context within which men are located determines which factors or markers of masculinity become more salient at different times, and so do the social situations and spaces men are interacting within, and with whom they are interacting. Their socio-cultural, political, and economic positioning inform not only how they construct their gendered identities, but also where they are located within social hierarchies of masculinity. This article examines constructions of masculinities among economically marginalised men who seek work on the side of the road in Cape Town, South Africa. In-depth qualitative interviews were conducted with 10 Black African men and the findings suggest that economic provision remains a central feature in participants' constructions of masculinity. Men's experiences of precarious work not only impact how they see themselves but also their ability to establish and maintain romantic relationships which, as argued in this study, serve an important role in validating and affirming participants' masculinity. This study shows that when some men are not able to provide, their romantic relationships fail, which adversely impacts their self-esteem. In response, some of the participants in this study turned towards alcohol abuse, and neglecting/abandoning their homes and families as a way to avoid the shame and humiliation they experience as 'men who cannot provide'. [ABSTRACT FROM AUTHOR]

The number of people in exile is rising. Sexual and ethnic minority refugee and asylum-seeking people present with special needs. This study utilised a collective narrative participatory design to explore how storying collective ways of resisting the effects of trauma, amongst gay and lesbian forced migrant people of Black African and Asian backgrounds in an urban context (London, UK) can be constitutive of healing. To do this, purposeful sampling procedures were pursued. Data collection was through individual and group format story telling sessions. Both sessions were structured around a co-constructed metaphor 'Passport of Life'. Narrative analysis was employed to examine the data, co-shaped with participants. Findings indicate that participants' (collective) storytelling is crafted as a site for resistances to emerge and be re-affirmed. Resistance pathways are inextricably linked to participants' diverse subjectivities. Healing is constituted as a dynamic process, bound by narrated and physical configurations of spaces of togetherness, which have re-definitional, hope-inducing, and social justice properties. The results support the use of participatory and narrative means for expanding (untold) stories of overcoming and supporting opportunities for healing and redress amongst this population. Implications for policy making, research, and psychological practice are considered. [ABSTRACT FROM AUTHOR]

Disparities in social determinants of health have been linked to worse patient-reported outcomes and higher rates of hospital readmission following shoulder arthroplasty. Identification of perioperative predictors of increased healthcare utilization is of particular interest to surgeons to improve outcomes and mitigate the total cost of care. The effect of social deprivation on healthcare utilization has not been fully characterized in the context of shoulder arthroplasty. A retrospective review was performed from of a single institution's experience with primary shoulder arthroplasty between 2012 and 2020. Demographic variables (age, race, and legal sex) and healthcare utilization (hospital readmission, emergency department (ED) visits, follow-up visits, and telephone calls) were recorded within 90 days of surgery. The Area Deprivation Index was recorded, and patients were separated into terciles according to their relative level of social deprivation. Outcomes were then stratified based on Area Deprivation Index tercile and compared. A total of 780 patients were included. The least, intermediate, and most deprived groups consisted of 195, 371, and 214 patients, respectively. The level of social deprivation was not a predictor of increased healthcare utilization through readmission, the ED, or the outpatient clinic. Identifying as Black or African American was an independent predictor of readmission and ED visitation. Female sex was an independent predictor of increased postoperative telephone calls. Patients undergoing shoulder arthroplasty have similar use of hospital resources regardless of their level of social deprivation. We hope these results can be used to guide clinical decision-making, increase transparency, and manage patient outcomes following shoulder arthroplasty surgery. [ABSTRACT FROM AUTHOR]

Aim. To explore how Black African international students adjust to their new university environment and gain insight into how they feel supported to engage in physical activity (PA). Background. People from ethnic minority backgrounds have poor physical activity levels compared with white populations in the UK. The Black population is known to have the lowest PA levels among the ethnic minority groups in the UK. This trend is suggested to be the case among university students, but no research has examined this. Ethnic minority students, including international students, encounter adaptation difficulties such as cultural barriers and social isolation which affect their university experiences and health behaviours such as physical activity. Methodology. This was a qualitative method, with in‐depth semistructured interviews conducted with five African students (two males and three females) aged between 21 and 40 years from a university in the West Midlands. The transcribed interviews were analysed using Braun and Clarke's thematic analysis. Results/Findings. Culture and lifestyle of physical activity; knowledge, experience, and self‐motivation; the effect of various social groups, activities, and services at the university; and weather variations and physical settings were the identified themes. The key finding of the study is that respondents engaged in PA to a greater extent at the British university than they did in their home countries. This was due to a combination of factors, including low‐cost gym memberships and events and a general lack of racial or gender‐based discrimination. Conclusions/Recommendations. Participants expressed satisfaction with the cultural and social support systems at their university, such as sports clubs and societies, and mental health support services that encouraged them to learn about and engage more in physical activity. Although some barriers, such as weather variations, were mentioned, various indoor options coupled with cheaper gymnasiums motivated students to remain or become active. Understanding the experiences of minority student groups in physical activity could help in reviewing current provisions and extending them to a wider population. [ABSTRACT FROM AUTHOR]

The article, titled "Progress, politics and the place of elite black African women in Kenya’s extractive sector," explores the experiences of elite black African women working in Kenya's extractive sector. The dissertation challenges mainstream feminist theories and methods, arguing that they fail to effectively engage with the experiences of black African women in this traditionally masculine sector. The study adopts African feminisms as an alternative lens for understanding the intersection of race, gender, and elitism in the extractive sector. It also examines the role of place-making and the construction of the ideal worker body in shaping the experiences of black African women in the sector. [Extracted from the article]

Cervical cancer is one of the leading causes of cancer-related death among African women. Unfortunately, in most sub-Saharan African nations, women are vulnerable if they are unaware that cervical cancer is preventable with frequent screening and early treatment. The aim of this study was to examine Black African immigrant women's perceptions and experiences of cervical screening in British Columbia, Canada. Twenty Black African immigrant women were interviewed using the qualitative research method Interpretive Description. Data collection approaches included indepth interviews and analytic memos. Data were analyzed using a constant comparative technique guided by a socioecologic framework to capture subjective experiences and perceptions. Four key themes were identified, including confusing conceptualizations about cancer and cancer screening, competing priorities, concerns for modesty, and commitment to culture. The study findings point to the need for more active approaches to promoting cervical screening for this population. [ABSTRACT FROM AUTHOR]

Postwar migrants from the Caribbean and Indian subcontinent (Bangladesh, India, and Pakistan) to the UK are now experiencing the onset of age‐related diseases such as dementia. Our evidence base, both quantitative and qualitative, documenting the experiences of family caregivers of people with dementia is largely drawn from studies undertaken with white European, North American, and Australasian populations. Consequently, there is a need for research in the field of dementia caregiving to reflect the increasing diversity in ethnic identities of the older adult population of the UK. Using semistructured interviews, we investigated the experiences of 18 caregivers of people with dementia in Black Caribbean, Black African, and South Asian (Indian, Pakistani, and Bangladeshi) communities in England. Participants were recruited from the Join Dementia Research platform and were predominantly female intergenerational carers. We identified the following three themes: motivation to care (spending time with the care recipient and reciprocity), positive and negative consequences of caregiving (rewards and consequences), and the cultural context of caregiving (cultural norms and values supporting caregiving and negative attitudes towards dementia). Our findings develop existing literature by identifying (a) the importance of spending time with the person they care for, (b) the absence of faith as a caregiving driver, and (c) the challenge of watching the declining health of a parent. We highlight how the different motivations to care are intertwined and dynamic. This is illustrated by the linking of obligation and reciprocity in our dataset and positive and negative experiences of caregiving. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to share learning about practical steps that can be taken to eliminate persistent racism from the workplace, including racism by people who have cognitive impairments who do not understand the impact of their behaviours. Design/methodology/approach: This paper is informed by qualitative research. An independent researcher was commissioned to recruit 45 black British, black African and black Caribbean women living in Norfolk and working for a range of employers. Parameters were agreed in advance (aims, consent, data protection). A list of questions was provided to the researcher. The questions covered experiences of prejudice and discrimination. Data collection included face to face/online/telephone interviews, focus groups and questionnaires. The researcher recorded the women's views and compiled them in a findings report. The report was shared with the women to confirm that their views had been recorded accurately. The author has also convened conversations with over 100 professionals representing providers of public services, including social and domiciliary care. Findings: The author identified that it will be impossible for employers to eliminate persistent racism from their workplaces until all managers consistently and diligently address every report of racism effectively, in line with the steps set out in this paper. The purpose is to establish, over time, a workplace culture where racism is never tolerated or allowed to persist, and workers and managers learn – and become more confident – to recognise, address and eliminate racism at work. Until this is embedded, racism affecting workers will continue to go unchecked and unacknowledged in the workplace. Research limitations/implications: The data gathered to inform this paper (specifically the research commissioned and described in this abstract, in addition to other data, such as conversations convened with professionals) is qualitative data. It cannot be assumed that the experiences of the people interviewed reflect the experiences of all people. However, the voices of participants have highlighted issues to inform future planning. Practical implications: The author must be clear that, so far there has been no definitive solution to persistent racism in the workplace. The learning so far is being shared with the hope that this assists others with developing strategies to eliminate persistent racism. Social implications: Workplaces across the UK are committed to eradicating racism. However, the rate of change is glacial. This research paper shares learning about how to address this, to increase the pace of change, to begin to genuinely eliminate persistent racism from the workplace. Originality/value: To the author's knowledge, the learning from this research is original and not replicated elsewhere. [ABSTRACT FROM AUTHOR]

AIMS: Assessment of skin biophysical parameters in a South African nursing populationmay provide insight in long-termchanges in their skin condition in a practical setting. This study aimed to investigate changes in skin barrier function parameters over a period of 2 years, in nursing students completing their tertiary education. METHODS: Transepidermal water loss, stratum corneum (SC) hydration, and skin surface pH were measured in female nursing students (63 white, 42 Black African) three times a year and repeated for 2 years. Linear mixed models and Bonferroni post hoc tests were performed to test changes over time in skin barrier function parameters. RESULTS: Transepidermal water loss and SC hydration significantly (p < .001) decreased over 2 years in first-year students, whereas only specific differenceswere established for senior students. Skin surface pH significantly (p < .001) varied over the 2 yearswith significant increases (p < .031) in thewintermonths. The only significant difference (p < .001) between white and Black African students was established in skin surface pH. CONCLUSION: This study demonstrated the variability of skin barrier function parameters, specifically seasonal variation in skin surface pH. This study also revealed possible long-term changes in skin condition through the recovery of the SC in a practical setting. [ABSTRACT FROM AUTHOR]

After the first generation of Pan-Africans formed at the beginning of the 20th century mainly by black Americans and Caribbeans, the second generation is formed with black Africans. These black Africans are inspired and influenced by the founding fathers of Pan-Africanism. Marcien Towa (1931-2014) is one of them. The philosopher is a key figure in the intellectual history of Africa who has contributed ardently, alongside other renowned intellectuals, to the writing of the modern history of Africa. His fight very legitimately was to wash the Africans of opprobrium (the stereotyped images of Africa and its inhabitants created by the colonizers). Through his criticism of Senghorian negritude, he makes a remarkable contribution to the reflection on the movement, a considerable contribution to the ideology of Pan-Africanism. [ABSTRACT FROM AUTHOR]

Black African students are increasingly choosing the United States as their preferred destination, and many choose to study at predominantly White institutions (PWIs). The purpose of this qualitative study was to investigate reasons that may influence their identification and commitment to those PWIs. We interviewed 20 sub-Saharan Africans at two predominantly White Southeastern universities. Findings revealed that construed external image, overall satisfaction with the school, promotion of the institution, and willingness to maintain membership shape the extent to which Black African students are identified and committed to their university of choice. Furthermore, the study also found that prestige does not appear to influence Sub-Saharan African students' identification and commitment to a school in the United States., but race has mixed effects depending on how it gets interpreted by students. These findings suggest implications for research and practice for student affairs professionals to better serve and retain their international populations. [ABSTRACT FROM AUTHOR]

AbstractThis study utilizes qualitative interview data to chronicle the migration journeys of 15 Black African international students who escaped the 2022 Russian invasion of Ukraine. This research addresses a literature gap related to the vulnerabilities and challenges experienced by non-national minorities in times of crisis. While the migration journey out of Ukraine was difficult for both nationals and non-nationals, interview data highlights how Black African international students faced specific obstacles related to their foreignness and race. Their problems frequently centered on accessing information, decision making, and experiencing racial discrimination. [ABSTRACT FROM AUTHOR]

James Burnett, Lord Monboddo's (1714–1799) contribution to Scottish Enlightenment thinking on race is regularly held to be twofold. As a Lord of Session, he supposedly defended slavery on Aristotelian grounds, infamously voting against Joseph Knight's freedom in Knight v. Wedderburn (1778). In his philosophical writings, Monboddo is known for his arguments in favour of the humanity of orangutangs, which scholars have claimed informed both his own views on slavery and also wider apologetics for the trade. At the same time, Monboddo is frequently cited as providing a fulsome defence of the achievements of black Africans against Hume's footnote in 'Of Natural Characters' (added in 1753). The full significance of Monboddo's counterexample to Hume's claims, the civilization of black ancient Egypt, has not been adequately understood. In this article I undertake a deep dive into Monboddo's views on race, slavery, and the black origins of civilization present in his largely ignored six-volume Antient Metaphysics (1779–1799). The arguments that emerge show that Monboddo was not quite the apologist for enslaving black Africans as he is sometimes presented as being, but also that his thought was far from the enlightened Scottish mainstream. [ABSTRACT FROM AUTHOR]

This issue of the Journal of Scottish Philosophy focuses on race and racism during the Scottish Enlightenment. One article examines how American Enlightenment thinkers, such as Benjamin Franklin and Thomas Jefferson, promoted white hegemony while also advocating for the abolition of slavery. Another article explores the views of novelist Elizabeth Hamilton on race and religion, concluding that she can be described as a cultural racist. A third article defends David Hume's universalist account of human nature against accusations of racism. The final article discusses the ideas of James Burnett, Lord Monboddo, who challenged Hume's claims about the achievements of black Africans. The issue aims to contribute to the understanding of race and racism in Scottish Enlightenment philosophy. [Extracted from the article]

Background: People living with human immunodeficiency virus (HIV) are disproportionately impacted by socioeconomic deprivation and are at increased risk of developing other long‐term conditions (LTCs). These illnesses require transformative action to tackle the adverse effects on their health. Data on lived experiences of LTCs among people living with HIV of Black African and Black Caribbean ethnicities are sparse, and how people with LTCs are impacted by social determinants of health (SDoH). Methods: Through a phenomenological study design this qualitative study, conducted in 2022, comprised four focus group discussions (FGDs) with 20 people of Black ethnicities living with HIV were purposively invited from a community organisation (CO) in London, including four semistructured interviews with CO staff. Following transcription, qualitative data were analysed thematically and measures to validate the findings were implemented. Results: The findings are presented in terms of the following four levels of SDoH: (1) individual determinants (such as the impact of SDoH on lifestyle modification and self‐management); (2) interpersonal determinants (such as positive experiences of accessing healthcare for LTCs); (3) clinical determinants (such as care pathway barriers) and (4) systemic determinants (such as systemic barriers related to race/ethnicity). Conclusions: It is necessary to provide ongoing and interactive education to community members who live with HIV, focusing on risks and management of LTCs. Additionally, individuals would benefit from support to navigate increasingly complex and fragmented health services. Health Service staff require cultural competence when caring for patients of Black African and Black Caribbean ethnicities with complex health and psychosocial needs. Patient or Public Contribution: The research team collaborated with an HIV CO in South London from the very start of the project to agree the study design and learn about the realities of their daily lived experiences. Community collaborators helped to develop the semistructured interview and FGD topic guides, and were directly involved in the data gathering, analysis and validation. [ABSTRACT FROM AUTHOR]

In this article, I discuss Katuntu (...and you too), a work I devised and performed with Injairu Kulundu in fulfilment of my Masters in Theatre Making from the University of Cape Town in October 2009. In the play, we harnessed memory to depict loss caused by an uprooted girlhood, portraying the consequences of fragmented memory on Black African women with immigrant pasts, in the hope that it might resonate with others who share the experience of similarly disrupted girlhood. We used song performance in the creation of shared girlfriend memory. I argue that the concept of girlfriend aesthetic offers a methodology for re-membering by providing a reflective surface upon which one sees in the experience of the girlfriend other, something that incites one's own memory. [ABSTRACT FROM AUTHOR]

We open this issue with two articles about different kinds of playacting. First, we have Alude Mahali's "A Girlhood Disrupted: Performing Memory Using the Girlfriend Aesthetic" in which she discusses her play, Katuntu (...and you too), that she wrote to "depict loss caused by an uprooted girlhood, [that portrays] the consequences of fragmented memory on Black African women with immigrant pasts, in the hope that it might resonate with others who share the experience of similarly disrupted girlhood." For her, the girlfriend aesthetic provides a way of "re-membering by providing a reflective surface upon which one sees in the experience of the girlfriend other, something that incites one's own memory." [ABSTRACT FROM AUTHOR]

Losing a significant other through death is a tragic experience worsened by the novel coronavirus disease 2019 (COVID-19). To curb this massive increase of deaths, the South African government introduced various rules to regulate the burial process. However, these COVID-19 regulations have caused major ruptures and disruptions on how bereaved families observe and practice cultural rites and customs following death within an African context. Consequently, many bereaved family members, particularly Black Africans, struggle with adhering to the regulations and funerals have been coined ' super spreaders ' of the virus. The concerns raised in this article are twofold, namely, the impact of the Covid-19 regulations on how Black Africans grieve and mourn, as well as the involvement of social workers in formulating regulations that ought to be adhered to. This article explores the fissures and bricolages brought about by COVID-19, ultimately suggesting possible ways of dealing the losses ascribed to the pandemic. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare workforce diversity is essential for increasing access and reducing racial/ethnic health disparities. We examined the growth and trends in physician assistant/associate (PA) workforce demographic composition by initial year of certification. Methods: Drawing on data from the National Commission on Certification of Physician Assistants, we aggregated gender, age (1975-2020), race/ethnicity, and underrepresented in medicine (URiM) (2000-2020). Descriptive statistics of demographics were calculated by the initial certification year and assessed for trends using the Cochran-Armitage test. Results: Analyses revealed an 11.7% annual growth rate in PAs earning initial certification and a change in gender composition (23.9% to 74.2% female) from 1975 to 2020. Between 2000 and 2020, we observed significant increases (all p<0.001) in the proportions of PAs who self-identify as Asian (5.7 percentage points), Hispanic/Latino(a) (3.5 percentage points), and multiracial (2.4 percentage points). However, there was a decline (all p<0.001) in the proportions of PAs who self-identify as Black/African American (1.2 percentage points), American Indian/Alaska Native (0.1 percentage points), Native Hawaiian/Pacific Islander (0.1 percentage points), and other race (1.1 percentage points). Trend analyses revealed that the proportion of PAs identifying as URiM decreased over the past 21 years. Conclusion: Ongoing assessment of the PA workforce demographics is essential to track the progress and effectiveness of diversification initiatives. [ABSTRACT FROM AUTHOR]

While the South African labour market showed some signs of improvement in the 2000s with unemployment rate gradually dropping to as low as 22.7% at the end of 2007, things unfortunately turned downhill in 2009–19 (sometimes referred to as the 'lost decade'). Using the 2009 and 2019 Quarterly Labour Force Survey data, this study derived descriptive statistical estimates on labour force, employment and unemployment; the empirical findings suggested strongly that patterns in the labour market outcomes deteriorated during this decade. Unemployed individuals were largely black Africans and concentrated amongst the less educated individuals. They remained out of work for longer and, on average, spent more time seeking employment. The data also indicated the presence of hysteresis in unemployment. Key ameliorating policies in this scenario are skills development and structural reform in the labour market. The former is difficult to achieve, even in the long-term, while the latter is politically challenging. [ABSTRACT FROM AUTHOR]

This paper engages a (post)feminist-aligned critical reading of women's gendered performances in Afrobeats music videos to highlight—in the visual culture of this popular African musical genre—the visibility of sexually assertive black African women who variously subvert heteropatriarchal moral public scripts about "respectable" African womanhood and expression of their sexualities in relation to black African men. In my considerations of postfeminist sensibilities, I align with Simidele Dosekun by regarding postfeminism as a transnational cultural sensibility with flexible contours that render it analytically applicable and valuable as a scholarly lens in an African popular cultural landscape. I deploy a multimodal discourse analysis of five Afrobeats music videos (derived from a larger corpus of videos from my PhD study), their storylines, plot progressions, and the accompanying lyrical contents, to advance my arguments. The article draws significantly on postfeminist literature and key perspectives from bodies of feminist critiques of popular culture to demonstrate inflections of feminine subjectivities that I theorise as "sexssertive," given their active constructions of counter-narratives in relation to conservative and restrictive meanings of black African womanhood. I conclude by considering the implications hereof for broader feminist efforts towards the just treatment of women across diverse African contexts in the domains of sexuality and sexual expression. [ABSTRACT FROM AUTHOR]

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Drawing on fieldwork conducted at a South African University, this qualitative study examines the lived experiences of black foreign students studying and living in South Africa. The study sought to understand the role that Pentecostalism plays in mediating the everyday experiences of black foreign students within and beyond the university campus spaces. A total of 30 student patrons from two Pentecostal churches were purposively sampled for the study. Data were collected using qualitative methods, including in‐depth interviews, participant observation, and informal conversations. Data were recorded, transcribed, and thematically analysed. The study findings revealed that for many African foreign students in South Africa, Pentecostalism mediated their sense of being on campus and allowed them to deal with the real and perceived social disarticulation fashioned by xenophobic terrains and attendant socio‐material anxieties. I assert that Pentecostal communities helped African foreign students to embed themselves and adjust to life on campus. These communities allowed them to forge convivial relationships and mutuality with fellow students and other Church members. Building on extant scholarly arguments and debates on Pentecostalism and student mobilities, I argue that Pentecostalism play(ed) a central role in the (de)construction of a sense of 'Otherness' through socio‐spiritual rituals including, sermons (the word), proselytisation and other social practices, albeit with varying degrees of success. Although Pentecostal networks strongly mediated black African foreign students' everyday navigation in precarious social spaces, the anxiety and the feeling of otherness are not completely removed. [ABSTRACT FROM AUTHOR]

This qualitative study aimed to provide family caregivers with an independent platform to reflect on and identify their needs in the role of dementia caregiver. Thirty caregivers were interviewed using a semi-structured approach, and data analysis followed a reflective thematic analysis method. The study revealed that Black African caregivers in townships require sufficient information and orientation to dementia-specific services, psychoeducation on dementia as a disease and its behavioural manifestations, as well as practical skills to manage the disease process. Caregivers expressed the need for in-depth, accessible education to boost their confidence and resilience in handling the challenges of dementia caregiving. They also proposed community initiatives to raise awareness, promote knowledge, and facilitate early detection and diagnosis of dementia. Additional needs included informational and educational workshops, resources like transportation services and helplines, day care facilities, media campaigns, and collaboration with the government for funding and policy change. New caregivers were advised to seek comprehensive education, support, and services while preserving the dignity of their family members with dementia. Remarkably, the identified needs and community initiatives aligned with the priority areas outlined by ADI for a National Dementia Plan, which South Africa currently lacks. The study highlights the importance of developing a National Dementia Plan in South Africa through collaboration among stakeholders, including communities, policy-makers, and multidisciplinary healthcare teams, while ensuring that individuals and families affected by dementia have a voice. [ABSTRACT FROM AUTHOR]

Purpose: To compare the demographics, clinical presentation, and outcomes of intravitreal (IV) anti-VEGF monotherapy in the management of treatment-naïve polypoidal choroidal vasculopathy (PCV) and neovascular age-related macular degeneration (nAMD) in Nigerians. Methods: This is a retrospective, interventional, comparative study. Data obtained from consecutively treated PCV and nAMD patients include age, sex, laterality, symptom duration, LogMAR visual acuity (pre- & post-treatment), occurrence of vitreous hemorrhage, optical coherence tomography central macular thickness (CMT), and duration of clinic visits. Data was analyzed using IBM SPSS version 22.0, P PCV (38% versus 19%) p = 0.036. Vitreous hemorrhage: more common in PCV (42% versus 19%) p = 0.001. nAMD patients had poorer baseline vision (LogMAR 1.4 versus LogMAR 1.2) p = 0.2, thicker maculae (361 microns versus 331 microns), and received more mean intravitreal anti-VEGF injections (4 versus 3). Visual and anatomical outcomes were better for PCV; final vision (LogMAR 0.89 versus LogMAR 1.04), p = 0.064, final CMT (247 microns versus 331 microns), p = 0.05. nAMD patients had higher rate of >12 months follow-up (57.6% versus 35.0%) p = 0.002. Conclusion: Demographic and clinical differences exist between PCV and nAMD. Though chronic presentation for both diseases is common, treatment improves vision and anatomy in most patients, moreso in PCV. Earlier treatment will likely yield better outcomes.

This paper explores the explanatory models of mental challenges among Black Africans in England. It argues that understanding these models is critical for providing culturally appropriate care to this population. The study employed qualitative methodology, and interpretative phenomenological analysis (IPA). Twelve mental health service users who are living in England and self‐identified as first or second‐generation Black Africans were purposively selected. The data were gathered using face‐to‐face semistructured interviews. Data were manually analysed in accordance with IPA concepts of searching for common, unique and idiosyncratic themes across transcripts. The findings revealed three themes Black Africans associated to their explanatory model of mental health challenges: complexities of migration, African‐centred worldview and negative life experiences. To help alleviate the Eurocentric nature of mental health practice in England, it is hoped that this explanatory model will become an integral part of mental health practice in England and around the world. [ABSTRACT FROM AUTHOR]

The literature on marriage supports teaching essential skills to enhance relationship quality and prevent divorce. However, limited marriage and relationship curricula tailored for African cultures, especially within the South African context, are currently available. This study aimed to redress gaps in literature and practice, outlining elements for inclusion into a marriage enrichment program (MEP) grounded on PREP 8.0 (Prevention and Relationship Education Program) and current baseline research conducted in South Africa. A qualitative descriptive phenomenological design was utilized, using face‐to‐face interviews with leaders and social services practitioners (SSPs) and a pilot study with couples, all sampled purposively. Findings show that (1) Black Africans are in high need of MEPs, revealed through intense gratitude and (2) a prerequisite for positive outcomes is the integration of equally necessary traditional contextual components with modern practices, elucidated by practical recommendations. A contextual and culturally relevant MEP is a systematic attempt to improve the functioning of marriage through education, effectively supporting Black Africans to cultivate healthy, stable family relationships. [ABSTRACT FROM AUTHOR]

The article discusses the Polaroid Evidence Project (PEP), which provided police in Long Island with Polaroid cameras in the 1990s to document domestic violence. The project aimed to professionalize police work by adopting social service practices. While the images were used as evidence in domestic violence cases, the original photographs are not easily accessible to the public due to record-keeping practices. The article also explores how artists Eleanor Macnair and Laetitia Ky incorporate domestic violence imagery into their work, challenging traditional notions of evidence and expanding the aesthetic registers used to describe domestic violence. Additionally, the monograph "Legal Spectatorship: Slavery and the Visual Culture of Domestic Abuse" examines the use of photographic evidence in domestic violence cases, exploring the historical context of slavery and its impact on the visual representation of abuse. This study provides valuable insights into the role of photography in shaping perceptions of domestic violence and offers a unique perspective for those interested in the intersection of law, visual culture, and social issues. [Extracted from the article]

Objectives The current study investigates how physical distancing during the coronavirus disease 2019 (COVID-19) pandemic was associated with increased anxiety among a cohort of midlife older Black South African adults and the extent to which household size and virtual social contact modify this association for men and women. Methods We analyze data from a phone survey conducted from July 2021 to March 2022 as part of Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (n  = 2,080). We employ logistic regression to estimate the association between changes in in-person social interactions and anxiety symptoms and examine whether the association is modified by household size and changes in virtual social contact. We perform analyses separately for women and men. Results Declines in in-person social interactions were associated with increased anxiety for women and men (odds ratios [OR] = 2.52, p  < .001). For women only, declines were greater for those living in larger households (OR = 1.11, p  = .032). Declines were buffered by increased virtual social contact for both women (OR = 0.55, p  = .025) and men (OR = 0.45, p  = .019). Discussion Although the anxiety symptoms of women and men were similarly affected by declines in in-person social interaction, the modifying influence of household size is unique to women, likely due to gender-specific social roles. For women, living in larger households may mean greater caregiving burden, exacerbating the detrimental association between physical distancing and anxiety. On the other hand, both women and men may have used virtual means to connect with friends and family living outside their homes, buffering against increased anxiety. [ABSTRACT FROM AUTHOR]

Background: Sebaceous carcinoma is a very rare malignant skin adnexal tumor that is occasionally aggressive. We have not seen a case of sebaceous carcinoma in our center in the last 10 years. It is extremely rare in Black Africans. Case presentation: We described the case of a 55-year-old man African man who presented to our ophthalmologist with complaints of growth on the right upper eyelid for 8 months. He had surgery and chemotherapy for rectal carcinoma 6 years prior to presentation and received his last dose of chemotherapy 5 years before seeing our ophthalmologist. There was a history of spontaneous unprovoked bleeding from the lesion. He subsequently underwent surgical excision under general anesthesia. Histology of the mass showed an effaced architecture due to proliferating malignant epithelial cells disposed as trabecules, solid nests, and tongues. The microscopic features of widespread multivacuolated cytoplasm of the neoplastic cells led us to conclude that the tumor was a sebaceous carcinoma. The patient is alive and well. Conclusion: Sebaceous carcinoma is a rare malignant skin adnexal tumor in Black Africans. It can present as an eyelid mass with spontaneous bleeding. It can follow cancer chemotherapy either because of its association with other tumors in Muir–Torre syndrome or because of mutagenic effects of chemotherapeutic agents. [ABSTRACT FROM AUTHOR]

In South Africa, households were formed at about twice the rate that the population grew be-tween census 1996 and census 2011 and the number of single-person households ballooned by 150%. Reweighted household survey data shows a surge in household formation in the late 1990s was driven by prime-aged and older women and Black African men, likely connected to new freedoms afforded to these groups after the transition to democracy. Household formation steadied in the 2000s, hiding variation in who formed what types of households. Astonishing growth in the rate at which South Africans live alone was led by Black African men, a group historically associated with circular labour migration. Women instead are heading up complex households including children. These changes connect to long-term marital decline. By 2011, most female heads were never-married and the growing majority population group of never-married adults increased their rate of household formation. [ABSTRACT FROM AUTHOR]

Background We compared the quality of ethnicity coding within the Public Health Scotland Ethnicity Look-up (PHS-EL) dataset, and other National Health Service datasets, with the 2011 Scottish Census. Methods Measures of quality included the level of missingness and misclassification. We examined the impact of misclassification using Cox proportional hazards to compare the risk of severe coronavirus disease (COVID-19) (hospitalization & death) by ethnic group. Results Misclassification within PHS-EL was higher for all minority ethnic groups [12.5 to 69.1%] compared with the White Scottish majority [5.1%] and highest in the White Gypsy/Traveller group [69.1%]. Missingness in PHS-EL was highest among the White Other British group [39%] and lowest among the Pakistani group [17%]. PHS-EL data often underestimated severe COVID-19 risk compared with Census data. e.g. in the White Gypsy/Traveller group the Hazard Ratio (HR) was 1.68 [95% Confidence Intervals (CI): 1.03, 2.74] compared with the White Scottish majority using Census ethnicity data and 0.73 [95% CI: 0.10, 5.15] using PHS-EL data; and HR was 2.03 [95% CI: 1.20, 3.44] in the Census for the Bangladeshi group versus 1.45 [95% CI: 0.75, 2.78] in PHS-EL. Conclusions Poor quality ethnicity coding in health records can bias estimates, thereby threatening monitoring and understanding ethnic inequalities in health. [ABSTRACT FROM AUTHOR]

Background: The appropriateness of hypertension thresholds for triggering action to prevent cardiovascular and renal complications among non-White populations in the UK is subject to question. Our objective was to establish ethnicity-specific systolic blood pressure (SBP) cutoffs for ethnic minority populations and assess the efficacy of these ethnicity-specific cutoffs in predicting adverse outcomes. Methods: We analyzed data from UK Biobank, which included 444,418 participants from White, South Asian, Black Caribbean, and Black African populations with no history of cardiorenal complications. We fitted Poisson regression models with continuous SBP and ethnic groups, using Whites as the referent category, for the composite outcome of atherosclerotic cardiovascular disease, heart failure, and chronic kidney disease. We determined ethnicity-specific thresholds equivalent to the risks observed in Whites at SBP levels of 120, 130, and 140 mm Hg. We adjusted models for clinical characteristics, sociodemographic factors, and behavioral factors. The performance of ethnicity-specific thresholds for predicting adverse outcomes and associated population-attributable fraction (PAF) was assessed in ethnic minority groups. Results: After a median follow-up of 12.5 years (interquartile range, 11.7–13.2), 32,662 (7.4%) participants had incident composite outcomes. At any given SBP, the predicted incidence rate of the composite outcome was the highest for South Asians, followed by White, Black Caribbean, and Black African. For an equivalent risk of outcomes observed in the White population at an SBP level of 140 mm Hg, the SBP threshold was lower for South Asians (123 mm Hg) and higher for Black Caribbean (156 mm Hg) and Black African (165 mm Hg). Furthermore, hypertension defined by ethnicity-specific thresholds was a stronger predictor and resulted in a larger PAF for composite outcomes in South Asians (21.5% [95% CI, 2.4,36.9] vs. 11.3% [95% CI, 2.6,19.1]) and Black Africans (7.1% [95% CI, 0.2,14.0] vs. 5.7 [95% CI, -16.2,23.5]) compared to hypertension defined by guideline-recommended thresholds. Conclusions: Guideline-recommended blood pressure thresholds may overestimate risks for the Black population and underestimate risks for South Asians. Using ethnicity-specific SBP thresholds may improve risk estimation and optimize hypertension management toward the goal of eliminating ethnic disparities in cardiorenal complications. [ABSTRACT FROM AUTHOR]

This article assesses how adaptation governance within the eThekwini (Durban) metropolitan municipality, KwaZulu‐Natal Province of South Africa, addresses the vulnerability and adaptation of black African women to flood impacts within the municipality. The article argues that there is an intersectional lens through which black local women's experiences of vulnerability to the impact of climate change disasters need to be understood and addressed. Qualitative research methodologies were employed to collect data through semi‐structured interviews and focus group discussions with local black African women from four areas in Durban who have experienced frequent floods over the past years. Personnel from eThekwini municipality's Environmental Planning and Climate Protection Department and Disaster Management Department were also interviewed. The feminist political ecology perspective was used to unpack the nuances in power relations that engendered black African women's vulnerability and adaptation to flood impacts within the municipality. The study's findings revealed that the overall vulnerability experiences of black African women in Durban are shaped by factors relating to the lack of an 'intentionally gendered' approach to adaptation governance in the municipality. Adopting an intentional approach to adaptation governance is essential to inform policies responding to local black Africans' vulnerability and adaptation experiences within the study's context. [ABSTRACT FROM AUTHOR]

Zachary McLeod Hutchins' book, "Before Equiano: A Prehistory of the North American Slave Narrative," explores the early Black African life in colonial North America through an analysis of newspapers and archival materials from the early eighteenth century. Hutchins argues that the popular understanding of slavery underwent a transformation between the eighteenth and nineteenth centuries, and that the genre of the slave narrative has been defined based on this later understanding. The book expands the archive of early Black life writing and provides important context for the nineteenth-century slave narrative and the broader tradition of Black life writing. [Extracted from the article]

Adolescent girls and young women (AGYW) in South Africa experience contextual barriers to HIV risk reduction including incomplete schooling, unintended pregnancy, substance use, and gender-based violence. A cluster randomised trial in Cape Town allocated 24 Black and Coloured communities to a gender-focused HIV risk-reduction intervention or HIV testing, with 500 AGYW total enrolled. We evaluated intervention efficacy by comparing mean differences overall, by community population group (Black and Coloured) and among those with structural barriers based on neighbourhood, education, and employment (n = 406). Both arms reported reductions in alcohol, cannabis, and condomless sex, with no intervention efficacy overall. Among AGYW with barriers, intervention participants reported fewer days of methamphetamine use at 6 months (t(210) = 2·08, p = ·04). In population group analysis, we found intervention effects on alcohol and sexual communication. Intervention participants in Black communities had fewer days of alcohol use at 12 months (t(136) = 2·10, p = ·04). Sexual discussion (t(147) = −2·47, p = ·02) and condom negotiation (t (146) = −2·51, p = ·01) increased for intervention participants at 12 months in Coloured communities. Gender-focused interventions must address population group differences and intersecting barriers to decrease substance use and increase education, skills, and sexual health protection. [ABSTRACT FROM AUTHOR]

Introduction: To commemorate March 8, 2023 (International Women's Day), Natur'art engages in a vast caravan of awareness against the harmful effects of the act of depigmentation. Artificial depigmentation (AD) is the lightening of the skin using chemicals. The products employed are highly active corticosteroids, hydroquinone, as well as mercurial products such as soda. Artificial depigmentation is a practice that has emerged over the past three decades and has become one of the main reasons for dermatology consultations. In Mali, one in four women engages in depigmenting, and this phenomenon is not yet to stop as depigmentation products dominate the market. Objective: The main objective of this project was to make African women aware of the dangers of this practice and to make them aware that beauty is plural through the enhancement of the natural integrity of the skin and hair. Timeline of Activities: The awareness caravan on the harmful effects of artificial depigmentation was held at different places of the capital Bamako. The opening ceremony was held at the Bamako International Conference Centre (CICB) on Friday, March 26, 2023. The conference on the main theme followed by booth visits with the exhibition of artistic images of the skin of black African women and finally some high schools chosen on the basis of their high number of girls served as a place of awareness. The setup ended at about 8:10, and the actual ceremony began at 8:30. It was marked by three interventions. The first intervention was that of the Minister of Health and Public Health. The second was the presenter of Natur'art, Awa Bagayoko, who explained the initiative of the caravan, the innovative idea of Natur'art, consisting of preserving and enhancing the natural complexion of the African woman. There were a number of conferences about depigmentation. Conclusion: This awareness-raising caravan, the first of its kind in Mali, served as a motor to intensify the fight against this harmful practice that devalues black African women. [ABSTRACT FROM AUTHOR]

This article discusses recent publications on the letters and conferences of Thomas Merton, a cloistered white monk who continues to inspire academic research, books, and conferences. The author explores the transformative experience that Merton's writings provoke and the personal connections readers feel to his work. The article reviews three recent publications that offer previously unpublished letters and lectures, providing insight into Merton's commitment to friendship, dialogue, and contemplative spirituality. The author highlights Merton's engagement with current topics such as inter-religious dialogue, racism, war, Indigenous issues, ecology, and the feminine face of the divine. The article suggests that Merton studies are not coming to an end, as recent events and publications indicate ongoing interest in his work. [Extracted from the article]

Background: Hydatidosis is a parasitic infection caused by Echinococcus granulosus and humans are usually an accidental intermediate host. Involvement of the musculoskeletal system is reported to occur in 0.5% to 4% of the cases. Case presentation: We present our experience with two cases of musculoskeletal hydatidosis in black African patients that required orthopaedic surgical intervention. A 51-year-old black African female presented with right hip hydatid disease and a 37-year-old black African female presented with the disease affecting the left shoulder. Both patients presented with joint pain and reduced range of motion. The patient with involvement of the shoulder had a background history of human immunodeficiency virus, this was not present with the other patient. Diagnostic work-up confirmed peri-articular hydatid disease and both patients were surgically managed with arthroplasty. Post-operative complications encountered include hardware loosening from bone lysis and hardware failure. Discussion: The medical literature describes a limited number of cases of peri-articular musculoskeletal hydatid disease. Patients are often subjected to many investigations, prolonged treatment periods and multiple surgeries. Concurrent use of medical and surgical treatment is advocated however, the choice of surgery is individualised. Conclusion: Hydatid disease must always feature in the differential diagnosis of multiple lytic bone lesions and radical surgical intervention may be required from the outset. [ABSTRACT FROM AUTHOR]

Breast cancer (BC) is an increasing public health issue worldwide. BC incidence and mortality rates are rising in transitioning countries in Africa, with the most rapid increase occurring in Sub-Saharan Africa (SSA). Female BC represents 25.8% of all cancer diagnosis in SSA. Early age at onset, high grade and triple negative tumors are hallmarks of BC in this region, associated with germline pathogenic variants in susceptibility genes. While several genes have been associated with genetic predisposition (BRCA1, BRCA2, PALB2, TP53, PTEN, CDH1, STK11, ATM, CHEK2, NBN, BARD1, BRIP1, RAD50, RAD51C, RAD51D, … ), most studies have reported contribution of BRCA1 and BRCA2 pathogenic variants. Genetic contribution of BRCA genes has been estimated at 27% in Caucasian women. Available data from population of African origin are scarce and have mainly focused on pathogenic variants of BRCA1 and BRCA2. Reports from main studies on large sample size highlighted that BRCA1 still the major gene associated with BC in SSA. In addition, BRCA2, PALB2, and P53, are also on the top major genes with high penetrance, associated with BC. Mutation spectrum of BC genes in black African women seems to be different from Caucasian with increasing number of founder mutations identified. We hypothesis that the genetic contribution of known BC genes may be different between women of black African origin compared to Caucasians. In this review we explore the genetic contribution of known breast cancer genes in women of African origin, and discuss perspectives for prevention and patients care strategies in the era of precision medicine. [ABSTRACT FROM AUTHOR]

In a country where depression, anxiety, and suicide rates within the student population rank among the highest in the world, access to mental health care is vital. This is especially true for students moving from rural areas to urban-based tertiary education institutions. Since South Africa became a democracy, institutions of higher learning previously the preserve of the country's White minority opened their doors to black Africans. While some White families sent their children to private or so-called "Model-C" schools, most black communities lacked the financial means to do the same. Consequently, most black African students remain in rural areas until they reach Grade 12 before moving to the city where most institutions of higher education are located. The shift from rural to urban areas brings with it a combination of excitement and anxiety for Black students who leave their homes for the first time in search of a qualification that offers them a chance at becoming employable. This study aimed to examine the availability and perceived effectiveness of mental health facilities for students coming from rural South Africa. To understand students' perceived perceptions of mental health services, the study applied an experienced-centered narrative (ECN) as the theoretical framework. The study employed a qualitative research design using a narrative approach to explore students' experiences. Semi-structured interviews were conducted with ten participants. The findings revealed the intersectionality of class, race, language, and geography contribute to how students understand, access, and utilize mental health services facilities in institutions of higher learning. Additionally, students indicated that mental health services are helpful and, therefore, effective. However, the processes and how the services are delivered can be improved. [ABSTRACT FROM AUTHOR]