Contextualizing group rape in post‐apartheid South Africa

Collective male sexual violence is part of a continuum of sexual coercion in South Africa. This paper is based on long‐term ethnographic work in an urban township in the former Transkei region. Drawing on intensive participant observation and interviews with young men in particular, it attempts to make sense of emergent narratives relating to streamlining, a local term for a not uncommon form of collective sexual coercion involving a group of male friends and one or more women. The paper begins with an overview of existing anthropological literature on collective male sexual violence, going onto elaborate the different scenarios associated with group sexual violence in the fieldsite. It seeks to provide a multi‐layered contextualization of the phenomenon by considering prevailing gender discourses, subcultural issues pertaining to the urban tsotsi phenomenon, the rural practice of ukuthwala (bride capture), young working‐class Africans' experiences of marginalization, and the complex links between political economy and violence in this setting.     

云南省5年HIV职业暴露因素分析

[目的]分析艾滋病病毒（HIV）职业暴露现状,探讨职业暴露后应急预防处理方法。[方法]对云南省2005年～2010年报告的由于职业因素引起的HIV暴露案例进行分析。[结果]2005年～2010年共发生职业暴露1138人,包括医护人员和公安司法人员;暴露类型主要包括针刺伤647例（56．9％）、血液接触皮肤粘膜305例（26．8％）和抓伤96例（8．4％）。974（85．6％）人实施暴露后预防（PEP）,采用基本用药程序或强化用药程序进行干预治疗,所有病例随访未发现HIV抗体阳转者。[结论]HIV职业暴露后感染的危险度较低,但是应严格遵守安全防护措施,暴露后及时使用预防用药,可有效阻断发生艾滋病职业暴露后感染。     

Risk of mesothelioma from exposure to crocidolite asbestos: a 1995 update of a South African mortality study

OBJECTIVE—To find the risk of developing mesothelioma in a cohort born in 1916-36 in Prieska, Northern Cape Province, South Africa.
METHODS—A birth cohort mortality study was carried out in a small town in the Northern Cape Province, South Africa, with a history of crocidolite asbestos mining and milling. The cohort comprised all white births registered in the magisterial district of Prieska from 1916 to 1936, inclusive (2390). Causes of death due to mesothelioma and other cancers as recorded on medical certificates of cause of death were investigated. Person-years analysis was used to calculate mortalities due to mesothelioma, other respiratory cancers, and other non-respiratory cancers. Proportional cancer mortalities were also calculated for mesothelioma and other specific neoplasms.
RESULTS—The follow up rate for the cohort was 74.3% in 1995, and 683 traced members (38.6%) had died. Cause of death was unknown for 6.4% of deaths. There were 118 cases of cancer, 28 of them from mesothelioma, giving a cause specific mortality for mesothelioma of 277 (170-384) per 10⁶ person-years. The rates for men and women were 366 and 172 per 10⁶ person-years, respectively. The mortality for lung cancer (29 deaths) was 287 (135-436) per 10⁶ person-years, and that for other non-respiratory cancers (60 deaths) was 593 (442-745). Two cases of laryngeal and four of colon cancer were observed. All cancer mortality, mesothelioma, and lung cancer proportional cancer mortality ratios were increased.
CONCLUSION—The mortality for mesothelioma in men was twice that in women, probably because men were more likely to have had both occupational and environmental exposure to asbestos. Nevertheless, the mortality in women was still high and is probably indicative of the environmental exposure as white women were rarely employed in the asbestos industry in the Prieska area. Due to the long latency from first exposure to diagnosis of the neoplasm, the cause specific mortality in this cohort could be expected to increase rapidly over the next 10 years.


Keywords: South Africa; asbestos; environmental exposure; occupational exposure; cohort; mesothelioma; lung cancer     

Concerns about partner infidelity are a barrier to adoption of HIV-prevention strategies among young South African couples

As part of a larger study to examine the feasibility and acceptability of a couples-based HIV-prevention intervention, we conducted formative in-depth interviews with 10 couples to explore topics such as challenges in practising safer sex, HIV-prevention strategies, gender power and violence, and issues of trust and infidelity. In this study, both men and women perceived infidelity as ubiquitous in their social context and were therefore unable to discuss HIV risk and prevention without suspicions of infidelity in their own relationship. This impacted couples' ability openly and effectively to discuss strategies to prevent HIV and thus may have contributed to the limited uptake of HIV-prevention strategies, such as condom use and HIV testing. The contentious nature of safe-sex discussions placed both members of the couple at a higher risk for HIV acquisition within the partnership. This study sheds light on how existing relationship norms in South Africa influence HIV-prevention communication within couples and suggests that new ways of approaching conflictual issues such as mistrust and infidelity are vital in order for HIV-prevention programmes to succeed.     

Gender norms in South Africa: implications for HIV and pregnancy prevention among African and Indian women students at a South African tertiary institution

In post‐Apartheid South Africa, women are constitutionally guaranteed protections and freedoms that were previously unknown to them. These freedoms may have positive implications for women's ability to negotiate sexual protection with partners and hence prevent unintended pregnancy and decrease their risk of HIV. Among tertiary institution students, who are a relatively ‘privileged’ group, there is little information on gender norms that might shape responses to HIV‐prevention programmes. To elicit gender norms regarding women's and men's roles, condom and contraceptive use, sexual communication and sexual pleasure, we conducted 10 semi‐structured focus group discussions with African and Indian female tertiary institution students in order to understand how norms might be used to buttress HIV‐ and pregnancy‐prevention. Participants reported dramatic changes in the structure of gender norms and relations with the formal recognition of women's rights in the post‐Apartheid context. These generational shifts in norms are supported by other research in South Africa. At the same time, women recognized the co‐existence of traditional constructions of gender that operate to constrain women's freedom. The perceived changes that have taken place provide an entry point for intervention, particularly for reinforcing emerging gender norms that promote women's protection against unintended pregnancy and HIV/STIs.     

Human immunodeficiency virus postexposure prophylaxis for occupational exposure in a medical school hospital in Thailand

This is a retrospective review of occupational exposure to human immunodeficiency virus (HIV) and subsequent postexposure prophylaxis (PEP) among healthcare workers (HCWs) in King Chulalongkorn Memorial Hospital (KCMH), Bangkok, Thailand. From January 2002 to December 2004, data were collected from incident reports, the hospital's infectious diseases unit and the emergency department. There were 315 reported episodes of occupational exposure among 306 HCWs. Nurses (34.0%) were the HCWs most frequently exposed and percutaneous injury (91.4%) was the most common type of exposure. One-third of the source patients tested were infected with HIV. PEP was initiated following 200 (63.5%) of the 315 exposures and was started within 24h in >95% of cases. The most commonly prescribed PEP regimen was zidovudine, lamivudine and nelfinavir. Fifty-six percent of HCWs given PEP completed a four-week course but the remainder discontinued PEP prematurely due to side-effects, or after negative results from the source, or following informed risk reassessment or from their own accord. No exposed HCW acquired HIV during the study period. Appropriate counselling and careful risk assessment are important in achieving effective HIV PEP among HCWs.     

Negotiating the use of female-initiated HIV prevention methods in a context of gender-based violence: the narrative of rape

Female-initiated methods of HIV prevention are needed to address barriers to HIV prevention rooted in gender inequalities. Understanding the sociocultural context of pre-exposure prophylaxis (PrEP) trials, including gender-based violence, is thus critical. MTN-003C (VOICE-C), a qualitative sub-study of the larger MTN-003 (VOICE) trial, examined sociocultural barriers and facilitators to PrEP amongst women in Johannesburg. We conducted focus-group discussions, in-depth interviews and ethnographic interviews with 102 trial participants, 22 male partners, 17 community advisory board members and 23 community stakeholders. We analysed how discussions of rape are emblematic of the gendered context in which HIV risk occurs. Rape emerged spontaneously in half of discussions with community advisory board members, two-thirds with stakeholders and among one-fifth of interviews/discussions with trial participants. Rape was used to reframe HIV risk as external to women’s or partner’s behaviour and to justify the importance of PrEP. Our research illustrates how women, in contexts of high levels of sexual violence, may use existing gender inequalities to negotiate PrEP use. This suggests that future interventions should simultaneously address harmful gender attitudes, as well as equip women with alternative means to negotiate product use, in order to more effectively empower women to protect themselves from HIV.     

Looking to the future: South African men and women negotiating HIV risk and relationship intimacy

This paper examines the approaches heterosexual men and women in South Africa use to engage their partners in discussions of HIV and risk factors in their relationships. These strategies entail balancing the risks of infection while managing the challenges of maintaining a relationship. In a context in which there is a great deal of insecurity in relationships it is especially challenging to discuss HIV risks with partners. Our findings reveal that concerns about children or the desire to have children provided a legitimate basis for discussing HIV risk with partners. The focus of these discussions is on the future for their children. Research in South Africa should attend to men's and women's desires to have and to raise children. HIV prevention and treatment programmes can capitalise on concerns regarding children, and the future of the family, to engage men and women in discussing mutually acceptable strategies for preventing infection and ensuring safe conception.     

HIV非职业暴露后预防药物使用的影响因素研究进展

非职业暴露后预防（nPEP）是阻断HIV传播的一种生物学手段，欧美等国家及WHO均推荐在HIV高危人群中推广使用nPEP，但至今其使用率依然很低。信息-动机-行为技巧模型（IMB模型）可以准确的解释健康行为的发生和改变，本文以该模型为理论框架对nPEP药物使用的影响因素研究进行综述，为更深入研究如何促进nPEP的使用提供基础。     

Human rabies post exposure prophylaxis in Bhutan, 2005-2008: trends and risk factors

The aim of this study was to understand the use and distribution of human rabies post exposure prophylaxis (PEP) vaccine in Bhutan and to identify risk factors for receiving an incomplete course of the vaccine. We analyzed post exposure treatment records from 28 medical hospitals from 2005 to 2008. Males (59%) accounted for significantly more PEP events than females (41%) across all age groups (P < 0.001). Children - particularly 5-9 years of age - received more rabies PEP than other age groups. Animal bite and non-bite accounted for 27% (n = 2239) and 16% (n = 1303) of rabies PEP, respectively, whilst 57% (n = 4773) of the PEP events had no recorded information about the reasons for post exposure treatment. Post exposure treatment was provided throughout the year with a higher number during the winter and spring months. The number of PEP events significantly (P < 0.001) increased between 2005 and 2008, from <1000 to >2800 events, respectively. Significantly (P < 0.001) more PEP events were reported from the southern parts of Bhutan that are endemic for rabies or those areas in eastern Bhutan that have reported rabies outbreaks than other parts of Bhutan. Forty percent (n = 3360) of the patients received an incomplete course of vaccine (<5-doses of vaccine intramuscular). Results suggest that patients with animal bite injury were less likely to receive an incomplete vaccine course than non-bite recipients, and patients presented to hospitals in rabies endemic or outbreak areas were less likely to receive an incomplete course than in non-rabies areas or rabies free areas. Similarly, patients presenting to hospitals for PEP during spring and summers months were less likely to receive an incomplete vaccine course than those during other seasons. Public education campaigns need to be conducted in Bhutan to reduce dog bite incidents and also to prevent mass exposures to rabies. A thorough assessment of each individual case based on the WHO guidelines would reduce unnecessary PEP (and therefore costs) in Bhutan.     

Masculinity and HIV disclosure among heterosexual South African men: implications for HIV/AIDS intervention

Relationships and constructions of masculinity are central to understanding the process of male HIV disclosure, which is an important step towards accessing HIV-related services. Data from in-depth interviews and focus-group discussions with 23 HIV-positive, self-identified heterosexual, Black South African men were used to explore the disclosure process and how this process was negotiated in the context of constructions of masculinity. Of these men, 20 had disclosed to one or more persons, with partners and siblings being the preferred confidants. Disclosure was dependent on the acceptance of HIV status, perceived support and healthy relationships with others, HIV counselling and participation in educational and training activities. Non-disclosure was explained as a result of stigma, fear of rejection, discrimination, a lack of healthy relationships with others and lack of access to suitable disclosure strategies. Negative perceptions of HIV and hegemonic conceptions of masculinity hindered men from disclosing and seeking health services. Many men, however, managed to renegotiate their masculine identities to become responsible, knowledgeable HIV-positive individuals, protecting their families and becoming community educators. Findings suggest the need to consider gendered, contextual, skills-building/income-generating and guided interventions to promote male HIV disclosure and service uptake.     

Exploring factors that influence the integration of HIVST with HCT using a qualitative comparative cross-over design in KwaZulu-Natal,South Africa

ABSTRACT

The World Health Organization recommends using HIV self-testing (HIVST) to improve HIV testing coverage by integrating self-testing for HIV into public domain primary healthcare (PHC) clinics in areas with a high burden of HIV. However, an understanding of the relationship and interaction between HIVST and the standard HIV counselling and testing (HCT), the primary HIV testing approach within public PHC clinics, is limited. We therefore sought to compare experiences of people seeking an HIV test, specifically, how HIVST can be used to enhance HCT when introduced together. A cross-over study design was used wherein participants were randomly exposed to either HCT followed by HIVST or HIVST followed by HCT. Semi-structured interviews were conducted at the baseline, and after each testing exposure. Forty volunteers were enrolled and 119 interviews were completed. Although a higher preference for HIVST was reported, a symbiotic relationship between HIVST and HCT was identified, where benefits of one testing approach overcame barriers of the other. Introducing HIVST as an additional testing approach with HCT within PHC facilities in South Africa could positively influence HIV testing given their complementary relationship. HIVST and HCT should accommodate HIV testing situations among HIV testing naïve and repeat testing populations.     

Co-administration study in South African infants of a live-attenuated oral human rotavirus vaccine (RIX4414) and poliovirus vaccines

A double-blind, placebo-controlled phase II trial (e-Track 444563-014/NCT00346892) was conducted in South Africa to evaluate the co-administration of RIX4414 (live-attenuated human G1P[8] rotavirus vaccine) and oral poliovirus vaccine (OPV) administered simultaneously. Healthy infants (n=450) were randomized into three groups (RIX4414+OPV, RIX4414+IPV or Placebo+OPV) to receive two oral doses of RIX4414/placebo with OPV or IPV using two vaccination schedules (6-10 weeks and 10-14 weeks). Serum anti-rotavirus IgA antibodies (ELISA) and neutralizing antibodies (micro-neutralization assay) to poliovirus serotypes 1, 2 and 3 were measured. Co-administration of RIX4414 with OPV did not result in a decrease in the high sero-protection rates against poliovirus serotypes 1, 2 and 3 detected after the third OPV dose (98-100%). The anti-rotavirus IgA antibody sero-conversion rates were higher for the 10-14 weeks schedule (55-61%) compared to the 6-10 weeks schedule (36-43%). Solicited symptoms were reported at similar rates between RIX4414 and placebo groups and no serious adverse events related to RIX4414 were reported. This study provided evidence that RIX4414 can be co-administered with routine EPI immunizations including OPV and that two doses of RIX4414 were well tolerated and immunogenic in South African infants.     

Accessing ART in Malawi while living in South Africa – a thematic analysis of qualitative data from undocumented Malawian migrants

The majority of international migrants from Malawi to South Africa are undocumented, and some of them are on ART. This study explored how these migrants manage to access ART. Qualitative data were collected using open-ended questions in semi-structured interviews. 23 returned undocumented Malawian migrants from South Africa participated in the study. Also, key informant discussions were held with three health workers. Data collection took place in April and May 2015 at a rural village of Namwera in Mangochi district in southern Malawi. Interviews were audio-recorded, transcribed and translated into English for thematic analysis. The guardians collected ART from health facilities in Malawi on behalf of the migrants. The guardians sent ART through truck and bus drivers to the migrants in South Africa. The migrants shared their ART. Others bought ART from the ‘street pharmacies’. Others accessed ART from South African health facilities through the help of their South African friends. There are risks to dispensing ART to the migrants who do not themselves present at health facilities. There is value to more regular contacts between clients and health service system that is compromised by alternative strategies. It is better to deliver ART services in South Africa to the undocumented migrants.     

Secrecy,empowerment and protection: positioning PrEP in KwaZulu-Natal,South Africa

Abstract

The release of World Health Organisation guidelines recommending the prophylactic use of daily Truvada^® for all populations at high risk of acquiring HIV opens the way for implementation of oral pre-exposure prophylaxis (PrEP). The impact of new prevention technologies is, however, dependent on demand creation strategies such as user awareness, acceptability and access, which in turn are influenced by sociocultural and gender norms. This study was conducted in three locations in KwaZulu-Natal, urban, rural and peri-urban, with six participatory workshops. Knowledge, desirable features of a product and demand positioning for PrEP were assessed using a participatory action media research process which included art-based activities and group discussion using a semi-structured interview schedule. The data were analysed using thematic analysis. The key themes that emerged in relation to product adoption were: ability to maintain secrecy of product use; the need for agency with personal choices around HIV prevention; and an increased desire for HIV protection. Findings reaffirm the influence of user engagement in understanding the sociocultural dynamics that influence demand creation for PrEP adoption.     

The South African universal preschool year: a case study of policy development and implementation

Background

South Africa is the first sub‐Saharan African country to legislate, fund and implement free preschool education. Human rights and restitution were at the forefront of the political struggle for democracy in South Africa. Levelling the playing fields by improving the school readiness of children disadvantaged by the racist policies of Apartheid is essential to the transformation of South African society.

Methods

A review of published and unpublished documents on Grade R was undertaken, and access and enrolment data come from the National Department of Basic Education's Education Management Information System (EMIS).

Results

A decade after initiation in 2005, 79% of 5‐year‐olds was enrolled in a preschool class; the vast majority of them in free public schools. Grade R is near universal and on track to becoming compulsory. It is part of the Foundation Phase (Grades 1–3) of schooling, falling under the Department of Basic Education, but also part of a broader national strategy to improve early child development under the direction of an Inter‐Departmental Steering. Evaluations demonstrate wide access to Grade R and high uptake, especially in the poorest areas. However, the quality of Grade R provision in these areas is not up to standard because of low levels of funding; inadequate training, supervision, remuneration and retention of Grade R teachers; insufficient learner support materials; and inadequate monitoring and quality assurance.

Conclusions

Lack of quality, amongst other factors, contributes to a widening school performance gap between children from more and less privileged areas. Quality of Grade R as well as earlier learning and subsequent years of schooling must be improved to achieve South Africa's aim to reduce poverty and inequality through, amongst others, parent and family involvement, learning in the home and preschool preparation.     

Impact Evaluation of Domains of Learning on Universal Work Precautions (UWP) Amongst Nursing Staff in a Tertiary Care Hospital,Western India

Introduction:Second key strategy of National AIDS Control Program (NACP IV) is comprehensive care and support by providing quality services through zero stigma and discrimination. Quality of services can be improved by eliminating stigma and discrimination and making health care provider aware of associated occupational hazards. Nursing staff play crucial role and are more at risk therefore their understanding, perception and skill must be assessed in different domains of learning to improve the contents and methodology of trainings.Results:In pretest evaluation scores showed minor and statistically not significant variations in terms of participant''s gender, age, designation work experience and status of having received any similar training in the past. Impact of the training was visible as overall mean scores increased from 10.6 ± 2.7 to 13.8 ± 5.8; gain being statistically highly significant (P value < 0.001). Gain was highest in cognitive (from 58% to 77%) followed by psychomotor (from 48% to 62%) and minimal in affective domain (from 75% to 76%).Conclusions:After undergoing the training, participants were benefitted more in cognitive domain than psychomotor and affective domain. Acquired knowledge, skill and communication skill if evaluated as done in this study will improve the methodology of such trainings making them more effective.     

Re-examining 'professionalism' in pharmacy: a South African perspective

Although defining itself as a patient-centred profession, private sector (community and private hospital) pharmacy often appears to be that of a product-for-profit centred occupation. This perception has been at the core of the medical profession's attempts to reduce the professional autonomy of pharmacy, and has appeared at the forefront of the South African Department of Health's positioning of private sector pharmacy. Using as a starting point the debate surrounding attempts by the South African Minister of Health to regulate the price of medicines, I propose that the present negative positioning of private sector pharmacy in South Africa could be ameliorated by pharmacy practice that evidences a redefined understanding of professionalism.     

Fatigue among South African adolescents living with HIV: is the Chalder Fatigue Questionnaire a suitable measure and how common is fatigue?

Evidence suggests that HIV-infected adolescents experience elevated levels of fatigue that impacts their functioning at school and other important aspects of their lives. Yet, fatigue has not been measured amongst this population group. In this cross-sectional, mixed-methods study, we explored the psychometric properties of the 11-item Chalder Fatigue Questionnaire (CFQ) amongst 134 South African adolescents (11–18 years old) receiving antiretroviral therapy in the Western Cape. Using the Likert scoring method for the CFQ, the mean total score was 14.89 (SD = 3.83) and about a quarter (n = 33, 24.63%) of adolescents scored ≥18, indicating problematic levels of fatigue. The CFQ demonstrated good internal consistency with a Cronbach’s alpha of 0.83 (0.84, with item 11 deleted), which is comparable to other validation studies. On the first iteration of the principal component analysis (PCA) with a Varimax rotation, three factors accounted for 59.15% of the variance. However, the third factor consisted of one item only which we chose to remove from the analysis. On the second iteration of the PCA, a two-factor solution was retained that accounted for 54.24% of the variance. The first factor, ‘Physical fatigue’, represented the first eight items on the scale. The second factor, ‘Mental fatigue’, represented items 9 and 10. The CFQ also demonstrated modest content and construct validity. The CFQ is a short, easy-to-use and cost-effective measure of fatigue, and demonstrates reliability and validity amongst a South African sample of adolescents. Given the high rate of fatigue amongst our participants, we recommend that future interventions be developed to reduce fatigue among HIV-infected adolescents, which may ultimately lead to improvements in school performance and social functioning. Future research may include test–retest reliability of the CFQ in order to show stability over time.