AllPay and no work: spheres of belonging under duress

Includes abstract.Includes bibliographical references.AllPay and No Work explores the consequences of post-apartheid political-economic changes on the social fabric of Manenberg, a residential neighbourhood on the Cape Flats, Cape Town. I show that despite the important benefits of codified human rights for all, recent macro-level changes have meant that young women are currently struggling to establish themselves in their local spheres as socially valued individuals, or achieving "positive personhood". In a context of relative deprivation being socially valued is critical for belonging to "coping systems", the systems of support and reciprocity that cushion the worst aspects of suffering

Motivations, facilitators and barriers to accessing hepatitis C treatment among people who inject drugs in two South African cities

Background Treatment of hepatitis C (HCV) among people who inject drugs (PWID) is a critical component of efforts to eliminate viral hepatitis. A recent study found high HCV prevalence among PWID in two cities, Pretoria (84%) and Cape Town (44%). Very few (< 5%) HCV-infected individuals attended follow-up appointments. This sub-study explores differences between stated desire for cure and appointment attendance in light of perceived facilitators and barriers to HCV treatment and care access among PWID. Method Two sets of semi-structured interviews were implemented in a group of HCV-infected participants opportunistically sampled and recruited at harm reduction service sites. Initial interviews, conducted before the planned hospital appointment date, asked participants (N = 17, 9 in Pretoria and 8 in Cape Town) about past experiences of healthcare provision, plans to attend their referral appointment and perceived barriers and facilitators to seeking hepatitis treatment. Second interviews (n = 9, 4 in Pretoria, 5 in Cape Town), conducted after the planned referral appointment date, asked about appointment attendance and treatment experience. Trained social scientists with experience with PWID conducted the interviews which were recorded in detailed written notes. Data was thematically analysed in NVivo 11. Results Despite routine experiences of being stigmatised by the healthcare system in the past, most participants (n = 16, 94%) indicated a desire to attend their appointments. Attendance motivators included the desire to be cured, fear of dying and the wish to assist the research project. Perceived barriers to appointment attendance included fear of again experiencing stigmatisation and concerns about waiting periods and drug withdrawal. Perceived facilitators included the knowledge they would be treated quickly, and with respect and access to opioid substitution therapy. In the end, very few participants (n = 5) went to their appointment. Actual barriers to attendance included lack of finances, lack of urgency and forgetting and fatalism about dying. Conclusions South Africa can learn from other countries implementing HCV treatment for PWID. Successful linkage to care will require accessible, sensitive services where waiting time is limited. Psychosocial support prior to initiating referrals that focuses on building and maintaining a sense of self-worth and emphasising that delayed treatment hampers health outcomes is needed

Barriers to access of healthcare services for rural women – Applying gender lens on TB in a rural district of Sindh, Pakistan

Background: Women in rural districts of Pakistan face numerous barriers to healthcare, rendering gender-responsive health programming important, including for Tuberculosis (TB). This study was conducted to assess the general understanding of TB and of access to healthcare for women, as a first step towards implementation of a gender responsive TB programme in TandoAllayar, a rural district of Pakistan.Methods: A total of 36 participants were interviewed. The focus group discussion guide comprised of questions on: (1) family/household dynamics (2) community norms (3) healthcare system (4) women’s access to healthcare (5) TB Awareness;, and (6) women’s access to TB Care.Results: Limited autonomy in household financial decision-making, disapproval of unassisted travel, long travel time, lack of prioritization of spending on women’s health and inadequate presence of female health providers, were identified as barriers to access of healthcare for women, higher in younger women. Facilitators to access of TB care included a reported lack of TB-related stigma, moderate knowledge about TB disease, and broad understanding of tuberculosis as a curable disease. Other suggested facilitators include health facilities closer to the villages and the availability of higher quality services.Conclusion: Significant barriers are faced by women in access to TB care in rural districts of Pakistan. Programme implementers in high burden countries, should shift towards improved gender-responsive TB programming

Empathic response and no need for perfection : reflections on harm reduction engagement in South Africa

The importance of community involvement in public health research processes is well established. The literature is, however, less forthcoming about processes of community inclusion in public health project implementation, especially when it comes to projects focusing on key populations. The Step Up Project is the first multi-city harm reduction service provision project for people who inject drugs in South Africa. Since inception, the Project has made concerted efforts to work with and alongside people who actively identify as people who inject drugs. This paper outlines two features in relation to project-beneficiary dynamics that emerged in a qualitative project evaluation conducted by an external researcher and a funder representative. The first was that people accessing the project comfortably expressed criticisms of both themselves and the project, and noted when their behaviour contradicted project ideals. The second was the extent to which engagement with the project was reported to be fostering a renewed sense of personhood and right to exist in the world. These findings are, we suggest, in principle related to two forms of community engagement: consistent empathic response and community advisory groups. This implies that programmes need to focus on their mode of approach as much as on the content of their approach. It further implies that programme impact not be limited to quantitative assessment measures.The United States Centres of Disease Control and Prevention [grant number NU2GGH000257] and Mainline [grant number 15.08.03.MLN.026], [grant number BtG2 MLN PC 001].https://www.tandfonline.com/toc/ccph202019-04-27hj2018Family Medicin

Hepatitis B, hepatitis C and HIV prevalence and related sexual and substance use risk practices among key populations who access HIV prevention, treatment and related services in South Africa : findings from a seven-city cross-sectional survey (2017)

BACKGROUND: People who use drugs including people who inject drugs (PWUD/ID), sex workers (SWs) and men who have sex with men (MSM) are at increased risk of HIV and viral hepatitis infection. Limited epidemiological data on the infections exists in key populations (KPs) in South Africa. We investigated the prevalence of hepatitis B (HBV), hepatitis C (HCV) and HIV and selected risk factors among these KPs to inform effective responses. METHODS: We used convenience sampling to recruit a targeted 3500 KPs accessing HIV-related health services across Cape Town (SWs, MSM, PWUD/ID), Durban (SWs, PWUD/ID), Pietermaritzburg (SWs), Mthatha (SWs), Port Elizabeth (SWs), Johannesburg (MSM) and Pretoria (MSM and PWUD/ID) into a cross-sectional survey. An interviewer questionnaire to assess socio-demographic characteristics, drug use and sexual risk practices, was administered. HBV surface antigen (HBsAg); HCV antibody, viral load and genotype, and HIV antibody, was tested. RESULTS: Among the 3439 people included in the study (1528 SWs, 746 MSM, 1165 PWUD/ID) the median age was 29 years, most participants were black African (60%), and 24% reported homelessness. 82% reported substance use in the last month, including alcohol (46%) and heroin (33%). 75% were sexually active in the previous month, with condom use at last sex at 74%. HIV prevalence was 37% (highest among SWs at 47%), HBsAg prevalence 4% (similar across KPs) and HCV prevalence was 16% (highest among PWUD/ID at 46%). CONCLUSIONS: HBV, HCV and HIV pose a health burden for KPs in South Africa. While HIV is key for all included KPs, HCV is of particular importance to PWUD/ID. For KPs, HBV vaccination and behavioural change interventions that support consistent condom and lubricant access and use are needed. Coverage of opioid substitution therapy and needle and syringe services, and access to HCV treatment for PWUD/ID need to be expanded.http://www.biomedcentral.com/bmcinfectdispm2020Family Medicin

Understanding hepatitis B, hepatitis C and HIV among people who inject drugs in South Africa: findings from a three-city cross-sectional survey

Abstract Background People who inject drugs (PWID) are at high risk for hepatitis C (HCV), hepatitis B (HBV) and HIV without accessible harm reduction programmes. Coverage of needle and syringe and opioid substitution therapy (OST) services in South Africa is below global recommendations and no hepatitis services exist for PWID. We assessed HCV, HBV and HIV prevalence and risk factors among PWID accessing harm reduction services in Cape Town, Durban and Pretoria to inform policy and programming. Methods We conducted a cross-sectional survey among PWID in these cities between August 2016 and October 2017. Participants were opportunistically sampled while accessing services. Study team members administered a questionnaire that assessed sociodemographic characteristics, drug use and sexual risk practices. We tested for HCV (antibody, viral load and genotype), HBV surface antigen (HBsAg) and HIV. Bivariate and multivariate analyses assessed associations with HCV serostatus. Results Nine hundred and forty-three PWID were included in the per protocol analysis. The majority (87%, 819/943) were male, the overall median age was 29 and most lived on the street (66%, 626/943). At last injection, 77% (722/943) reported using a new needle and syringe and 17% (163/943) shared equipment. HIV prevalence was 21% (196/926), HBsAg positivity 5% (47/936), HCV seroprevalence 55% (513/937), HCV viraemic prevalence (proportion tested with detectable HCV) 43% (404/937) and HCV viraemic rate (proportion HCV antibody positive with detectable HCV) 79% (404/513). HCV genotype 1a (73%, 270/368) was the most prevalent. In multivariate analysis, HCV infection was positively associated with residing in Pretoria (adjusted odds ratio (aOR) 1.27, 95% CI 1.21–1.34), living on the street (aOR 1.90, 95% CI 1.38–2.60), frequent injecting (aOR 1.58, 95% CI 1.15–2.16) and HIV infection (aOR 1.69, 95% CI 1.15–2.47), and negatively associated with black race (aOR 0.52, 95% CI 0.36–0.74) and sexual activity in the previous month (aOR 0.61, 95% CI 0.42–0.88). Conclusions HCV and HIV are major health threats affecting PWID in these cities. Access to OST and needle and syringe services needs to be increased and integrated with HCV services. Social and structural factors affecting PWID who live on the street need to be addressed

Drug Policies and Development

The 12th volume of International Development Policy explores the relationship between international drug policy and development goals, both current and within a historical perspective. Contributions address the drugs and development nexus from a range of critical viewpoints, highlighting gaps and contradictions, as well as exploring strategies and opportunities for enhanced linkages between drug control and development programming. Criminalisation and coercive law enforcement-based responses in international and national level drug control are shown to undermine peace, security and development objectives. Edited by Julia Buxton, Mary Chinery-Hesse and Khalid Tinasti. Paperback reference: Julia Buxton, Mary Chinery-Hesse and Khalid Tinasti (eds.) (2020) Drug Policies and Development, Conflict and Coexistence, International Development Policy series No.12 (Geneva, Boston: Graduate Institute Publications, Brill-Nijhoff). Order your copy on Brill-Nijhoff’s website. Videos and events. Les politiques anti-drogues et le développement. Entre conflit et coexistence. Ce douzième numéro thématique de la Revue internationale de politique de développement s'intéresse aux relations entre la politique internationale de lutte contre les drogues et les objectifs de développement aujourd'hui et dans une perspective historique. Cet ensemble de 15 articles rassemble diverses perspectives critiques qui mettent en avant les lacunes et les contradictions ainsi que les stratégies et les opportunités pour améliorer les relations entre le contrôle des drogues et les programmes de développement. Les auteurs analysent pourquoi la pénalisation et les réponses coercitives de lutte contre la drogue aux niveaux international et national sapent les objectifs de paix, de sécurité et de développement. Edité par Julia Buxton, Mary Chinery-Hesse et Khalid Tinasti. Référence papier (en anglais): Julia Buxton, Mary Chinery-Hesse and Khalid Tinasti (eds.) (2020) Drug Policies and Development, Conflict and Coexistence, International Development Policy series No.12 (Geneva, Boston: Graduate Institute Publications, Brill-Nijhoff). Commandez votre livre sur le site de Brill-Nijhoff. Vidéos et conférences en ligne. Políticas de drogas y desarrollo. Entre conflictos y coexistencia El número temático 12 de International Development Policy explora la relación entre las políticas internacionales en materia de drogas y los objetivos de desarrollo, tanto en la actualidad como según una perspectiva histórica. En sus artículos se analiza el nexo existente entre las drogas y el desarrollo desde una variedad de puntos de vista críticos, destacando las lagunas y contradicciones, así como indagando en las estrategias y posibilidades para reforzar los vínculos entre la fiscalización de drogas y los programas de desarrollo. Se muestra, asimismo, cómo la penalización y las medidas coercitivas nacionales e internacionales de fiscalización de drogas basadas en actividades de detección y represión debilitan la paz, la seguridad y los objetivos de desarrollo. Editado por Julia Buxton, Mary Chinery-Hesse y Khalid Tinasti. Referencia de la versión impresa (en inglés): Julia Buxton, Mary Chinery-Hesse and Khalid Tinasti (eds.) (2020) Drug Policies and Development, Conflict and Coexistence, International Development Policy series No.12 (Geneva, Boston: Graduate Institute Publications, Brill-Nijhoff). Pida su ejemplar en el sitio web de Brill-Nijhoff