Child participation in research: reflections on ethical challenges in the southern African context

This article reflects on several challenges that particular cultural, socio-economic and catastrophic factors (such as the HIV epidemic) pose to ethical practice in research involving child participation in a region such as southern Africa. With reference to concrete situations, we discuss research practices in relation to: countering the widespread power disparity between adults and children; ensuring the authenticity of children's evidence; obtaining informed consent; ensuring non-malfeasance and beneficence; and preserving the anonymity of participants and their sources. Within the authors' own research experience, selected elements of practice that have been helpful in addressing these issues are offered. It is hoped that the article may have relevance not only in the southern African context, but also for developing countries elsewhere.     

Muted voices: HIV/AIDS and the young people of Burkina Faso and Senegal

This article explores the discrepancies between the vocal public discourse on HIV/AIDS and sexuality as generally encouraged by policy-makers and donor communities in Africa, and the often hushed voices of their target groups: young people in African communities. Based on fieldwork among urban youth in Senegal and Burkina Faso, we describe the silence of young people with regard to HIV/AIDS and sexuality as a social phenomenon, with focus given to family relations, peer relations and gender aspects in partnerships. Drawing on Foucault and Morrell, an inability and unwillingness to speak about HIV/AIDS and sexuality are analysed as a response to an everyday life characterised by uncertainty. This response represents a certain degree of resistance, while it constitutes a major barrier to any HIV/AIDS prevention effort. Finally, we stress that despite great constraints in their everyday lives, young people have some room to manoeuvre and are able to apply some negotiating strategies to reduce sexually-related health risks.     

Gendered socioeconomic conditions and HIV risk behaviours among young people in South Africa

Recent evidence suggests that the burden of new HIV infections in sub-Saharan Africa is concentrated among young people, especially females. Even in a country such as South Africa where knowledge among young people of how to protect oneself from infection is rather high, such information may not always be usable in daily situations of economic and social disadvantage that characterise many of their lives. Despite this possibility, there are surprisingly few definitive studies that examine the effects of socioeconomic status on HIV risk and prevention behaviours among youth in South Africa.

Using household survey data collected in 2001, this study investigates how socioeconomic disadvantage has influenced the sexual behaviour and experiences of 4 000 young women and men aged 14–24 years in KwaZulu-Natal province — an area characterised by high HIV prevalence and high rates of poverty and inequality. Socioeconomic disadvantage, measured here as low relative household wealth, is found to be associated with a variety of unsafe sexual behaviours and experiences, particularly for females. Among young women low wealth is associated with earlier sexual debut, having had multiple sexual partners in the year before the survey, and lower chances of condom use at last sex. It is also associated with increased chances that first female sexual experience is non-consensual and with higher odds of females having traded sex and having experienced physically forced sex. For females and males, low wealth reduces the chances of discussing safe-sex practices with the most recent sexual partner. Without sufficient attention, during the design and placement of HIV prevention programmes, to the gendered economic and social conditions in which individuals live — conditions that can make people more or less vulnerable to behaviours and experiences that may lead to infection — the potential effectiveness of the global response to HIV/AIDS is sacrificed.     

Responses to VCT for HIV among young people in Kampala,Uganda

Attitudes to voluntary counselling and testing (VCT) for HIV among young men and women in a slum area of Kampala, Uganda, were studied through 22 individual semi-structured interviews and 5 focus group discussions. Attitudes to VCT ranged from having no problem with the procedure to being very reluctant. Despite fear of stigma, the participants perceived 'positive living' after HIV testing as realistic. VCT was regarded as an important step to avoid HIV infection, but informants expressed the need for the service to be more accessible in terms of cost, time and quality of pre- and post-test counselling. We argue that counselling without HIV testing should be available for those who are reluctant to test. Poverty and gender power imbalances appeared to limit youths' possibility of making rational decisions about sexual behaviour and accessing VCT. The importance of considering the context in which such issues are being negotiated and decided is highlighted.     

Flourishing in Life: An Empirical Test of the Dual Continua Model of Mental Health and Mental Illness among Canadian University Students

In 2008-2009 a national household mailout was undertaken across Australia by beyondblue: the national depression initiative. The aim was to raise awareness of depression and encourage people to seek more information via the beyondblue information line or website. Following the staggered dispatch of information across the country, 2051 telephone surveys were conducted to evaluate recall of the material, and calls to the beyondblue infoline and website hits were monitored. The results indicate that direct mail can be a highly effective strategy to not only promote mental health, but also encourage information and help seeking. The impact of a range of factors on recall and help-seeking behaviour is also explored. Findings reveal the impact of demographic factors whilst also highlighting the potential importance of brand recognition and perceived relevance of information when determining those most likely to recall and respond to mailouts as mental health promotion strategy.     

The Simalelo Peer Education Programme for HIV prevention: a qualitative process evaluation of a project in Zambia

The aim of the project was to evaluate a peer education programme in Zambia run by local people in relation to changes in behaviours, the effects of the programme on the community and the dynamics of peer health promotion. A qualitative process evaluation using focus groups consisting of both participants in the peer education programme and educators was utilised. The peer education programme was aimed at setting up anti-AIDS clubs through recreational activities, empowering people in a variety of ways, and reaching people in some of the most remote parts of the country. Key findings indicate that the programme had an impact on participants' attitudes to HIV/AIDS as well as on lifestyle and behaviour, both in relation to sexual practices and cultural norms. Knowledge about HIV prevention was substantial and clear. Most importantly, the findings suggest that success of the programme is related to the fact that it brought the community together to fight AIDS. Peer education programmes must be able to motivate people to work together with appropriate methods, empower local communities and consider issues of long-term sustainability.     

Work and Excessive Sleepiness among Brazilian Evening High School Students: Effects on Days Off

Abstract

Previous studies have revealed that students who work and study build up sleep deficits during the workweek, which can trigger a sleep rebound during days off. The objective of this study was to investigate the impact of working/non-working on sleepiness during days off among high school students. The study population, aged 14–21 years, attended evening classes in São Paulo, Brazil. For the study, the students completed questionnaires on living conditions, health, and work; wore actigraphs; and completed the Karolinska Sleepiness Scale (KSS). To predict sleepiness, a logistic regression analysis was performed. Excessive sleepiness was observed on the first day off among working students. Results suggest that working is a significant predictor for sleepiness and that two shifts of daily systematic activities, study and work, might lead to excessive daytime sleepiness on the first day off. Further, this observed excessive sleepiness may reflect the sleep debt accumulated during the workweek.     

Lower trabecular volumetric BMD at metaphyseal regions of weight‐bearing bones is associated with prior fracture in young girls

Understanding the etiology of skeletal fragility during growth is critical for the development of treatments and prevention strategies aimed at reducing the burden of childhood fractures. Thus we evaluated the relationship between prior fracture and bone parameters in young girls. Data from 465 girls aged 8 to 13 years from the Jump‐In: Building Better Bones study were analyzed. Bone parameters were assessed at metaphyseal and diaphyseal sites of the nondominant femur and tibia using peripheral quantitative computed tomography (pQCT). Dual‐energy X‐ray absorptiometry (DXA) was used to assess femur, tibia, lumbar spine, and total body less head bone mineral content. Binary logistic regression was used to evaluate the relationship between prior fracture and bone parameters, controlling for maturity, body mass, leg length, ethnicity, and physical activity. Associations between prior fracture and all DXA and pQCT bone parameters at diaphyseal sites were nonsignificant. In contrast, lower trabecular volumetric BMD (vBMD) at distal metaphyseal sites of the femur and tibia was significantly associated with prior fracture. After adjustment for covariates, every SD decrease in trabecular vBMD at metaphyseal sites of the distal femur and tibia was associated with 1.4 (1.1–1.9) and 1.3 (1.0–1.7) times higher fracture prevalence, respectively. Prior fracture was not associated with metaphyseal bone size (ie, periosteal circumference). In conclusion, fractures in girls are associated with lower trabecular vBMD, but not bone size, at metaphyseal sites of the femur and tibia. Lower trabecular vBMD at metaphyseal sites of long bones may be an early marker of skeletal fragility in girls. © 2011 American Society for Bone and Mineral Research.     

Young Malawians on the interaction between mental health and HIV/AIDS

Previous research has identified high levels of mental health problems among people affected by HIV. This study surveys specifically adolescents in southern Malawi on their experience of the impacts of living with HIV or AIDS on one's mental health. At the same time, the study explores the link between mental health problems and subsequent HIV-risk behaviour. Short texts relating everyday scenarios that depicted symptoms of three mental health problems (i.e.depression, anxiety and HIV-related brain impairment) formed the basis of in-depth discussions in 12 existing groups of secondary school students, orphans and vulnerable children, teenage mothers, and out-of-school youths, in both rural and urban settings. The responses show that these young people recognised the mental health sequelae of HIV/AIDS as impacting upon many aspects of one's life. The young people traced these 'interruptions' and 'disruptions' through deteriorating psychological and socio-economic conditions. They showed awareness of a two-way interaction between HIV/AIDS and mental illness, indicating that the latter can increase thoughts of suicide and HIV risk-taking behaviour. More importantly, they identified a number of locally derived community interventions, which if supported by statutory health and education services, can significantly ameliorate their situations. The findings provide avenues for practical integration of mental health provision within HIV prevention, education and care initiatives.     

The Effects of a School-Based Educational Intervention on Preadolescents' Knowledge of and Attitudes towards Mental Illness

This study set out to identify the sources of help Irish adolescents would be willing to access when distressed, and to investigate associations between participants' willingness to seek help and their emotional and behavioural difficulties. The participants were 1079 thirteenfifteen year old secondary school students. They completed the Strengths and Difficulties Questionnaire (Goodman, 1997) and a specially designed measure assessing likelihood of seeking help from various sources, as part of the baseline assessment in an on-going evaluation of a school-based mental health promotion initiative. Results show that participants are most willing to seek help from informal sources when distressed, and males are significantly more likely than females to report that they would not seek help from any source. Greater reluctance to seek help is associated with increased difficulties for both males and females. Possible barriers to help seeking by adolescents are discussed.