Culture as a discursive resource opposing legal abortion

The notion of ‘culture’ features in the abortion literature to explicate, first, contestation of the meaning of abortion (as in the ‘culture wars’ about abortion), second, the normalisation of abortion in certain countries (as in ‘abortion culture’), third, the response of women to abortion within a particular social milieu and fourth, cross-cultural variability in attitudes towards and experiences of abortion. What is missing is an exploration of how ‘culture’ may be deployed as a discursive resource to oppose legal abortion. In this article, we report on a study conducted in a rural area of South Africa. We conducted focus group discussions utilising hypothetical vignettes to stimulate talk. Although, inconsistencies were evident in participants’ talk, in the context of cultural discussions, abortion was constructed as killing and inevitably destructive of cultural values and traditions. Abortion was equated with colonialist interventions and as something that should be opposed in the preservation of culture. Furthermore, cultural opposition to abortion was rooted in fears around the breakdown of gendered and generational power relations. Examples of how culture may be used in everyday interactions to induce shame and negative experiences are also discussed.     

Attrition from HIV care among youth initiating ART in youth‐only clinics compared with general primary healthcare clinics in Khayelitsha,South Africa: a matched propensity score analysis

IntroductionYouth living with HIV (YLWH) are less likely to initiate antiretroviral therapy (ART) and remain in care than older adults. It is important to identify effective strategies to address the needs of this growing population and prevent attrition from HIV care. Since 2008, two clinics have offered youth‐targeted services exclusively to youth aged 12–25 in Khayelitsha, a high HIV‐prevalence, low‐income area in South Africa. We compared ART attrition among youth in these two clinics to youth in regular clinics in the same area.MethodsWe conducted a propensity score matched cohort study of individuals aged 12–25 years initiating ART at eight primary care clinics in Khayelitsha between 1 January 2008 and 1 April 2018. We compared attrition, defined as death or loss to follow‐up, between those attending two youth clinics and those attending general primary healthcare clinics, using Cox proportional hazards regression. Follow‐up time began at ART initiation and ended at attrition, clinic transfer or dataset closure. We conducted sub‐analyses of patients attending adherence clubs.ResultsThe distribution of age, sex and CD4 count at ART initiation was similar across Youth Clinic A (N = 1383), Youth Clinic B (N = 1299) and general clinics (N = 3056). Youth at youth clinics were more likely than those at general clinics to have initiated ART before August 2011 (Youth Clinic A: 16%, Youth Clinic B: 23% and general clinics: 11%). Youth clinics were protective against attrition: HR 0.81 (95% CI: 0.71–0.92) for Youth Clinic A and 0.85 (0.74–0.98) for Youth Clinic B, compared to general clinics. Youth Clinic A club patients had lower attrition after joining an adherence club than general clinic patients in adherence clubs (crude HR: 0.56, 95% CI: 0.32–0.96; adjusted HR: 0.48, 95% CI: 0.28–0.85), while Youth Clinic B showed no effect (crude HR: 0.83, 95% CI: 0.48–1.45; adjusted HR: 1.07, 95% CI: 0.60–1.90).ConclusionsYLWH were more likely to be retained in ART care in two different youth‐targeted clinics compared to general clinics in the same area. Our findings suggest that multiple approaches to making clinics more youth‐friendly can contribute to improving retention in this important group.