The invention of moffie life in Cape Town, South Africa

Philosophiae Doctor - PhD (Anthropology)This dissertation is an ethnography of the figure of the moffie as a performance of same sex desire amongst gender non-conforming men, as it is celebrated in the 'coloured' ('coloured' is a constructed racial category, similar to 'white' and 'black' designated onto South Africans during the system of legislated racial segregation) townships of Cape Town. In this dissertation I demonstrate that the moffie is central to the lives of gender non-conforming men living in the 'coloured' townships of Cape Town. Through historical and contemporary ethnography, I show how moffie life is a representation of same sex desire amongst men that is highly visible. I reveal how moffie life is socially sanctioned through feminine self-styling, embodied through that of the gay hairdresser, annual gay beauty pageant competitions and Gay Pride events

The Feasibility of implementing a sexual risk reduction intervention in routine clinical practice at an ARV clinic in Cape Town: a case study

This case study with one lay adherence counsellor assessed the implementation of Options for Health, a sexual risk-reduction intervention based on Motivational Interviewing (MI), in an antiretroviral clinic in Cape Town, South Africa. In most cases Options was not delivered with fidelity and less than one-third of intended recipients received it; the counsellor often forgot to do Options, was unsure how to deal with particular cases and felt that there was not always time to do Options. Options was not implemented in a way that was consistent with MI. Revisions to the implementation plan and training programme are required.Web of Scienc

From research to practice: Lay adherence counsellors' fidelity to an evidence-based intervention for promoting adherence to antiretroviral treatment in the Western Cape, South Africa

In the Western Cape, lay counsellors are tasked with supporting antiretroviral (ARV) adherence in public healthcare clinics. Thirty-nine counsellors in 21 Cape Town clinics were trained in Options for Health (Options), an evidence-based intervention based on motivational interviewing (MI). We evaluated counsellors’ ability to deliver Options for addressing poor adherence following 5 days training. Audio-recordings of counselling sessions collected following training were transcribed and translated into English. Thirty-five transcripts of sessions conducted by 35 counsellors were analysed for fidelity to the Options protocol, and using the Motivational Interviewing Treatment and Integrity (MITI) code. Counsellors struggled with some of the strategies associated with MI, such as assessing readiness-to-change and facilitating change talk. Overall, counsellors failed to achieve proficiency in the approach of MI according to the MITI. Counsellors were able to negotiate realistic plans for addressing patients’ barriers to adherence. Further efforts aimed at strengthening the ARV adherence counselling programme are needed.Department of HE and Training approved lis

"Things were better then": an ethnographic study of the violence of everyday life and remembrance of older people in the community of Belhar"

Magister Artium - MAThis minithesis provides an ethnographic account of the life world of older people in the community of Belhar in the Cape Peninsula, which was historically categorised as a 'coloured' community during the implementation of the Group Areas Act. By content analysing newspaper articles published in the early 1980s and specifically during the implementation of the Group Areas Act I found that many of the residents reported that they lived in fear of their lives, in what was once known as a 'prestige suburb'. At the present time the community of Belhar is an intensely gang-infested area. From preliminary research done by myself at a senior citizen centre in Belhar, the high incidence of violence was a recurring theme throughout discussions with older people. In fact when I posed the question Why do you come to the centre five days a week? to a group of older people they answered without hesitation It is unsafe for an older person to be alone during the day. Answers like these to many of the questions that I posed would almost always be followed with Things were better then. It also was apparent that the older people in this community remember (or perhaps reconstruct) the past in the context of their present living situation. This became the leading theme in my study and is also the background against which I had formulated my research questions. However this study not only focused on the impact of the high incidence of violence on the community of older people but also essentially looked at elderly residents; everyday lived experiences in Belhar. The research sample consisted of twenty elderly residents and four key informants. The latter provided mainly infrastructural data on the community. Primary data was collected by using ethnographic techniques of inquiry which included participant observation and unstructured interviews. Results revealed that older people occupy a liminal space both in the community and in their households. I also found that the elderly stroke victim is twice silenced and marginalized due to the constraints brought on by their chronic illness and their status as an older person in the community.South Afric

"It's important to take your medication everyday okay?" An evaluation of counselling by lay counsellors for ARV adherence support in the Western Cape, South Africa

There is growing interest in standard care programmes for antiretroviral (ARV) adherence support. In South Africa, individual counselling following ARV initiation is a main strategy for supporting adherence in the public sector. Egan’s client-centred ‘‘Skilled Helper’’ counselling model is the predominant model used in HIV counselling in this context. This study evaluated counselling delivered by lay ARV adherence counsellors in Cape Town in terms of adherence to Egan’s model. Thirty-eight transcripts of counselling sessions with non-adherent patients were analysed based on the methods of content analysis. These sessions were conducted by 30 counsellors. Generally counsellors’ practice adhered neither to Egan’s model nor a client-centred approach. Inconsistent with evidence-based approaches to counselling for ARV adherence support, counsellors mainly used informationgiving and advice as strategies for addressing clients’ nonadherence. Recommendations for improving practice are made. The question as to how appropriate strategies from developed countries are for this setting is also raised.Web of Scienc

Myths, misconceptions, othering and stigmatizing responses to Covid-19 in South Africa: A rapid qualitative assessment.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a new strain of virus in the Coronavirus family that has not been previously identified. Since SARS-CoV-2 is a new virus, everyone is at risk of catching the Coronavirus disease 2019 (Covid-19). No one has immunity to the virus. Despite this, misconceptions about specific groups of people who are immune to Covid-19 emerged with the onset of the pandemic. This paper explores South African communities' misconceptions about who is most vulnerable to Covid-19. A rapid qualitative assessment was conducted remotely in Gauteng, KwaZulu-Natal and the Western Cape provinces of South Africa. Recruitment of study participants took place through established relationships with civil society organizations and contacts made by researchers. In total, 60 key informant interviews and one focus group discussion was conducted. Atlas.ti.8 Windows was used to facilitate qualitative data analysis. The qualitative data was coded, and thematic analysis used to identify themes. The results show a high level of awareness and knowledge of the transmission and prevention of SARS-CoV-2. Qualitative data revealed that there is awareness of elderly people and those with immunocompromised conditions being more vulnerable to catching Covid-19. However, misconceptions of being protected against the virus or having low or no risk were also evident in the data. We found that false information circulated on social media not only instigated confusion, fear and panic, but also contributed to the construction of misconceptions, othering and stigmatizing responses to Covid-19. The study findings bring attention to the importance of developing communication materials adapted to specific communities to help reduce misconceptions, othering and stigmatization around Covid-19

High Rates of Unprotected Sex occurring among HIV-Positive Individuals in a Daily Diary Study in South Africa: The Role of Alcohol Use

Objective: To assess the prevalence of unprotected sex and examine the association between alcohol consumption before sex and unprotected sex among HIV+ individuals in Cape Town, South Africa. Methods: For 42-days daily phone interviews assessed daily sexual behaviour and alcohol consumption. Logistic and Poisson GEE models were used to examine associations between alcohol consumption before sex and subsequent unprotected sex. Results: During the study which yielded 3,035 data points, the 58 HIV+ women and 24 HIV+ men drank an average of 6.13 drinks when they drank, and reported 4,927 sex events, of which 80.17% were unprotected. Over half (58%) of unprotected sex events were with HIV-negative or HIV-status-unknown partners. Extrapolating from the data using likelihood of infection per act estimates we calculated that an estimated 2.95 incident HIV-infections occurred during the study. Drinking alcohol before sex by the female, the male, or by both partners, increased the proportion and number of subsequent unprotected sex events. However, these associations held only when the quantity of alcohol consumed corresponded to moderate or higher risk drinking. Conclusions: Among HIV-positives engaging in moderate or higher risk drinking prior to sex increases the likelihood and rate of unprotected sex. Prevention efforts need to address reducing alcohol-involved unprotected sex among HIV-positive persons

Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa

AIDS stigmas interfere with HIV prevention, diagnosis, and treatment and can become internalized by people living with HIV/AIDS. However, the effects of internalized AIDS stigmas have not been investigated in Africa, home to two-thirds of the more than 40 million people living with AIDS in the world. The current study examined the prevalence of discrimination experiences and internalized stigmas among 420 HIV-positive men and 643 HIV-positive women recruited from AIDS services in Cape Town, South Africa. The anonymous surveys found that 40% of persons with HIV/AIDS had experienced discrimination resulting from having HIV infection and one in five had lost a place to stay or a job because of their HIV status. More than one in three participants indicated feeling dirty, ashamed, or guilty because of their HIV status. A hierarchical regression model that included demographic characteristics, health and treatment status, social support, substance use, and internalized stigma significantly predicted cognitive-affective depression. Internalized stigma accounted for 4.8% of the variance in cognitive-affective depression scores over and above the other variables. These results indicate an urgent need for social reform to reduce AIDS stigmas and the design of interventions to assist people living with HIV/AIDS to adjust and adapt to the social conditions of AIDS in South Africa.Internalized stigma AIDS Coping South Africa Discrimination Depression