Road to elimination of mother-to-child transmission in South Africa

Keynote address at the 11th SA AIDS Conference in Durban, South Africa on 21 June 2023

The role of alcohol restriction on femicide in South Africa: Evidence from the COVID-19 epidemic

49th Annual Symposium of the Kettil Bruun Society (KBS) for Social and Epidemiological Research on Alcohol held in Western Australia from 27-31 May 2024.Introduction Alcohol is a key risk factor for femicide (killing of women and girls), the most extreme and severe form of gender-based violence (GBV). The objective of this study was to examine the relationship between different types of femicides and alcohol, over a period of alcohol prohibition during the COVID-19 lockdown restrictions in South Africa. Study Methods : A retrospective analysis of women and girls 14 years and older killed (femicides) between 1 April 2020 and 31 March 2021 were identified from a proportionate random sample of mortuaries. We used poison regression models and incidence rate ratios (IRR) to compare the number of cases of intimate partner femicides (IPF) or non-intimate partner femicides (NIFP) across periods when alcohol sales were completely or partially banned with a period with no restrictions. We also calculated the Age-Standardised Rates (ASR) for overall femicides, IPF and NIPF and used incidence rate Ratios (IRR) to compare the two studies. Results: There was a 63% decrease among all femicides (IRR=0.37: 95%CI: 0.30-0.47) during the complete alcohol ban period compared to periods of no restrictions with a similar statistical significant decline for IPF (IRR=0.39: 95%CI: 0.28-0.53)) and NIPF (IRR=0.39: 95%CI: 0.27-0.55). This pattern is non-existent for the corresponding calendar periods of the 2017 study. Despite the decline during specific lock down periods, an overall significant increase in the ASR for intimate partner femicide was found in 202/21 compared to 2017 (IRR=1.12: 95%CI: 100-1.26) while the ASRs for all femicide (IRR=0.95: 95%CI: 0.88-1.03) and non-intimate partner femicide (IRR= 0.98: 95% CI: 0.86-1.11) were similar across the two surveys. Conclusion: The unintended social experiment during COVID-19 lockdown has shown the definitive role of alcohol on femicide in South Africa. We have shown a clear trend of decrease in all forms of femicides during the period of complete alcohol prohibition compared to partial or no ban periods. This analysis confirms the role of alcohol in women and girl’s vulnerability to GBV and the importance of addressing alcohol in prevention interventions

Young men’s reflections on their experience of co-developing an intervention to address their masculinities: Siyaphambili Youth Project (“Youth Moving Forward”)

Presented at the Governing Masculinity Conference, at Queen Mary University of London, 21 and 22 February 2024."Interventions working with young, poor, black men to ‘transform’ masculinities often exclude the voices of those ‘targeted’, drawing on stereotypical ideas about masculinity, resulting in less effective interventions and mischaracterizing young men. Siyaphambili Youth Project in South Africa worked with young men to co-develop an intervention including their concepts of masculinities. We conducted a co-development process involving an NGO (Project Empower), two research organizations (South African Medical Research Council, and University College London and 8 young men (18-24 years) referred to as Youth Peer Research Associates (YPRAs), recruited from one rural and one urban community. Over 24 months we co-developed an intervention addressing the overlapping challenges of masculinities, HIV, violence, and poor mental health. YPRAs were involved in three activities: (1) participatory research activities to understand how structural inequalities impacted on lived experiences, (2) co-developing a Theory of Change and (3) intervention design. We interviewed YPRAs about their experiences of being involved in co-development. The co-development process helped YPRAs explain how they experienced structural marginalisation (racism, economic, and political) and how this shaped their identities and interpersonal practices including their experience and perpetration of violence. Through involvement in the process, some described reflection and starting to change: talking about their problems, rather than resorting to physical violence, recognising how they used alcohol to deal with conflict and stress and starting to talk about HIV-prevention/treatment. Despite this, the co-development process did not address their structural exclusion, and they continued to face and struggle with the wider challenges of their lives, however, potentially with a different set of response options to these challenges. Co-developing an intervention enabled a more nuanced picture of how structural marginalization shaped young men’s lives, and for YPRAs enabled some to reflect on their masculinities and strategize new ways to address their challenges.

Early lessons learned from a cash transfer plus gender transformative economic intervention seeking to improve wellbeing among women caregivers of CALHIV in South Africa

Poster presented at the African Workshop on HIV & Women 2024. Nairobi, Kenya. 22-23 February 2024

Early lessons learned from a cash transfer plus gender transformative economic intervention seeking to improve wellbeing among women caregivers of CALHIV in South Africa

Poster presented at the African Workshop on HIV & Women 2024. Nairobi, Kenya. 22-23 February 2024

Engaging with young people with mental health lived experience to inform the statistical analysis of a large South African dataset

Poster presented at the South African Association for Child and Adolescent Psychiatry and Allied Professions Congress. Stellenbosch, Western Cape. 7-9 March 2024

Engaging with young people with mental health lived experience to inform the statistical analysis of a large South African dataset

Poster presented at the South African Association for Child and Adolescent Psychiatry and Allied Professions Congress. Stellenbosch, Western Cape. 7-9 March 2024

The role of alcohol restriction on femicide in South Africa: Evidence from the COVID-19 epidemic

49th Annual Symposium of the Kettil Bruun Society (KBS) for Social and Epidemiological Research on Alcohol held in Western Australia from 27-31 May 2024.Introduction Alcohol is a key risk factor for femicide (killing of women and girls), the most extreme and severe form of gender-based violence (GBV). The objective of this study was to examine the relationship between different types of femicides and alcohol, over a period of alcohol prohibition during the COVID-19 lockdown restrictions in South Africa. Study Methods : A retrospective analysis of women and girls 14 years and older killed (femicides) between 1 April 2020 and 31 March 2021 were identified from a proportionate random sample of mortuaries. We used poison regression models and incidence rate ratios (IRR) to compare the number of cases of intimate partner femicides (IPF) or non-intimate partner femicides (NIFP) across periods when alcohol sales were completely or partially banned with a period with no restrictions. We also calculated the Age-Standardised Rates (ASR) for overall femicides, IPF and NIPF and used incidence rate Ratios (IRR) to compare the two studies. Results: There was a 63% decrease among all femicides (IRR=0.37: 95%CI: 0.30-0.47) during the complete alcohol ban period compared to periods of no restrictions with a similar statistical significant decline for IPF (IRR=0.39: 95%CI: 0.28-0.53)) and NIPF (IRR=0.39: 95%CI: 0.27-0.55). This pattern is non-existent for the corresponding calendar periods of the 2017 study. Despite the decline during specific lock down periods, an overall significant increase in the ASR for intimate partner femicide was found in 202/21 compared to 2017 (IRR=1.12: 95%CI: 100-1.26) while the ASRs for all femicide (IRR=0.95: 95%CI: 0.88-1.03) and non-intimate partner femicide (IRR= 0.98: 95% CI: 0.86-1.11) were similar across the two surveys. Conclusion: The unintended social experiment during COVID-19 lockdown has shown the definitive role of alcohol on femicide in South Africa. We have shown a clear trend of decrease in all forms of femicides during the period of complete alcohol prohibition compared to partial or no ban periods. This analysis confirms the role of alcohol in women and girl’s vulnerability to GBV and the importance of addressing alcohol in prevention interventions