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

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

Test Determining classes of food items for health requirements and nutrition guidelines using Gaussian mixture models

Introduction: The identification of classes of nutritionally similar food items is important for creating food exchange lists to meet health requirements and for informing nutrition guidelines and campaigns. Cluster analysis methods can assign food items into classes based on the similarity in their nutrient contents. Finite mixture models use probabilistic classification with the advantage of taking into account the uncertainty of class thresholds. Methods: This paper uses univariate Gaussian mixture models to determine the probabilistic classification of food items in the South African Food Composition Database (SAFCDB) based on nutrient content. Results: Classifying food items by animal protein, fatty acid, available carbohydrate, total fibre, sodium, iron, vitamin A, thiamin and riboflavin contents produced data-driven classes with differing means and estimates of variability and could be clearly ranked on a low to high nutrient contents scale. Classifying food items by their sodium content resulted in five classes with the class means ranging from 1.57 to 706.27 mg per 100 g. Four classes were identified based on available carbohydrate content with the highest carbohydrate class having a mean content of 59.15 g per 100 g. Food items clustered into two classes when examining their fatty acid content. Foods with a high iron content had a mean of 1.46 mg per 100 g and was one of three classes identified for iron. Classes containing nutrient-rich food items that exhibited extreme nutrient values were also identified for several vitamins and minerals. Discussion: The overlap between classes was evident and supports the use of probabilistic classification methods. Food items in each of the identified classes were comparable to allowed food lists developed for therapeutic diets. This data-driven ranking of nutritionally similar classes could be considered for diet planning for medical conditions and individuals with dietary restrictions.YB and AG time on this research was funded by the South African Medical Research Council

Global Evidence, Local Adaptation (GELA) – an integrated knowledge translation approach to promote newborn and child health guidelines in South Africa

17th Public Health Association of South Africa (PHASA) Conference, Gqeberha, South Africa, 10-13 September 2023.The Global Evidence, Local Adaptation (GELA) project aims to maximise the impact of research on poverty-related diseases by increasing researchers and decision-makers’ capacity to use global research to develop locally relevant guidelines for newborn and child health in South Africa and other two Sub-Saharan countries

The impact of seeking protection orders for severe violence on the lives of female survivors in South Africa

Paper presented at the European Conference on Domestic Violence, 11- 14 September 2023, Reykjavik, Iceland.Severe intimate partner violence (IPV) has an enduring impact on affected women. In South Africa, the two predominant routes for women experiencing severe IPV are social and legal services. Protection orders (POs) are a common legal route to prevent the recurrence of intimate partner violence. However, evidence on the effectiveness of POs is almost entirely from high-income countries, and little is known about its impact on women’s lives. This study aims to address a critical research gap among women who seek POs in South Africa by examining their severe violence experience/s, and the impact of obtaining a POs on their overall well-being.Methods: In-depth interviews were conducted with 20 demographically diverse women recruited from a magistrate’s court in South Africa. Participants were at differing stages of the PO process. Findings: This study highlights the complex decision-making process in applying for a PO; experiences of severe violence; barriers to obtaining a PO. It shows that most PO -seeking women in South fear being killed by their intimate partner. Key precipitating factors to applying for a PO include: keeping themselves and children safe, obtaining justice, ending a life of violence and “starting over”. Conclusions and implications: Deciding to obtain a PO is complex and multi-faceted including “ a fear of being killed”. Women face personal, social and legal barriers in applying for, obtaining and finalizing POs against their IPs. Findings have important implications for health-care, legal practitioners, and key stakeholders in the social and criminal justice system

Case studies describing cost analyses that supported evidence informed decision – going beyond the ICER

17th Public Health Association of South Africa (PHASA) Conference. Gqeberha, South Africa. 10-13 September 2023

Developing infographics to communicate COVID-19 rapid review conclusions in South Africa

Presented at the 27th Cochrane Colloquium, London, UK from 3-6 September 2023