Negotiating masculinities : studying risk behaviours associated with performances of 'coloured' masculinities

The overarching aim of this thesis was to study masculinity roles and associated risk behaviours amongst a group of marginalised 'coloured' men from two deprived communities, one urban and one rural, in Cape Town, South Africa. To achieve this aim, the research examined two broad questions. The first question asked: What levels of conformity to masculinity norms are expressed amongst a sample of 'coloured' men from two communities in Cape Town and how are these are related to their reported levels of gender role stress and risk -taking behaviours? The second question the study aimed to address asked: In what contexts are marginalised 'coloured' masculinities performed and how do these shape 'coloured' men's subjective ideas about 'what it means to be a man'. The study employed a mixed method approach involving a questionnaire design as well as focus groups to address the research questions. Three hundred men completed questionnaires consisting of demographic and risk evaluation questions and three measures of male attitudes, namely the Male Attitude Norms Inventory-III (MANI-III), the Masculine Gender Role Stress (MGRS) scale and the Maudsley Violence Questionnaire (MVQ). In addition, fourteen focus group discussions were facilitated with 108 of the 300 men to elicit deeper meanings of marginalised 'coloured' masculinities and men's understandings of masculine roles. The quantitative findings of the study revealed that most men reported mild endorsement of traditional masculine norms. At a univariate level of analysis, men who endorsed masculinity norms were more likely to report an education level of less than grade 9; more likely to report stress associated with gender role performance failure, machismo, acceptance of violence and hostile sexism. Hostile sexism, however, emerged as the only predictor associated with conformity to masculinity. A thematic analysis of the qualitative data revealed that performances of masculinity included displays of hostile sexism, the use of violence and risk-taking behaviour. Further findings show that marginalised 'coloured' men's performances of masculinities were shaped by their contexts which included high levels of poverty and deprivation, prevalent violence against women and high levels of risky alcohol consumption. The key contributions of this study includes the fact that this study discusses 'coloured' masculinity in terms of how these men attempt to accomplish forms of masculinities in a marginalised context. This dissertation also expands the research knowledge on marginalised masculinities by studying a group of men that have not received much attention previously. The thesis also makes a relevant contribution to existing knowledge as it presents a range of findings that add to research on masculinities, risk-taking behaviour, race, gender-based violence and marginalisation. The study showed the continued relevance of the Sex Role Paradigm to understanding masculinity roles and norms. Furthermore, the study contributes to the existing knowledge on masculinity measurements as it used the first local masculinity scale and provided a revised version of this psychometrically sound masculinity tool for use amongst marginalised men

Achieving 90-90-90: A Focus on Sero-Discordant Couples

The South African Department of Health adopted numerous strategies to manage the HIV epidemic. Recently, the global 90-90-90 HIV treatment strategy was adopted. This strategy hope to ensure that 90% of people living with HIV will know their status, 90% of those testing HIV positive will receive sustained antiretroviral therapy and 90% of those receiving antiretroviral therapy will reach and maintain viral suppression by 2020. With a focus on literature, policies and implementation interventions, this chapter aims to provide an overview on current strategies used to reach the 90-90-90 goals and discusses how these strategies can be strengthened among sero-discordant couples within the South African public health system

Implications of Social Stigma on the Health Outcomes of Marginalised Groups

Research Focus: Stigma is a longstanding issue for South Africa as it is influenced by a history of typification. Social marginalisation is influenced by a myriad of socially structured norms and those who experience stigma, are often faced with social devaluation within their society. In addition, experiences of discrimination may lead to internalised stigma that may lower the self-esteem and agency as well as negatively affect the well-being of many. Methods: This chapter uses current literature to propose that stigma, remain a public health concern. Recommendations: The findings suggest recommendations that are likely to enhance programme and policy interventions aimed to decrease stigma. Overview Stigma has been a longstanding issue for South Africa as it is influenced by a history of typification. Social marginalisation is influenced by a myriad of socially structured norms and those who experience stigma, are often faced with social devaluation within their society. This policy brief proposes that stigma, and in particular its association with certain marginalised groups, remain a public health concern. It further discusses possible recommendations that are likely to enhance both programme and policy interventions aimed to decrease stigma or at the least, make individuals aware of their complicity in reproducing and maintaining social stigmatisation

The impact of a faculty development programme for health professions educators in sub-Saharan Africa: an archival study

BACKGROUND: In 2008 the sub-Saharan FAIMER Regional Institute launched a faculty development programme aimed at enhancing the academic and research capacity of health professions educators working in sub-Saharan Africa. This two-year programme, a combination of residential and distance learning activities, focuses on developing the leadership, project management and programme evaluation skills of participants as well as teaching the key principles of health professions education-curriculum design, teaching and learning and assessment. Participants also gain first-hand research experience by designing and conducting an education innovation project in their home institutions. This study was conducted to determine the perceptions of participants regarding the personal and professional impact of the SAFRI programme. METHODS: A retrospective document review, which included data about fellows who completed the programme between 2008 and 2011, was performed. Data included fellows’ descriptions of their expectations, reflections on achievements and information shared on an online discussion forum. Data were analysed using Kirkpatrick’s evaluation framework. RESULTS: Participants (n=61) came from 10 African countries and included a wide range of health professions educators. Five key themes about the impact of the SAFRI programme were identified: (1) belonging to a community of practice, (2) personal development, (3) professional development, (4) capacity development, and (5) tools/strategies for project management and/or advancement. CONCLUSION: The SAFRI programme has a positive developmental impact on both participants and their respective institutions.National Research FoundationDepartment of HE and Training approved lis

“It had a lot of cultural stuff in it”: HIV-serodiscordant african American couples' experiences of a culturally congruent sexual health intervention

The increased life expectancy of people living with HIV has brought about an increase in serodiscordant couples, in which there is risk of HIV transmission. Therefore, interventions that promote sexual health and reduce risk are critical to develop for these couples. Given the disproportionate burden of HIV among populations of color, it is also critical that these interventions are culturally congruent. The EBAN intervention for African American serodiscordant couples recognizes the centrality of culture in shaping sexual behaviors and helps couples develop intimacy and positive prevention behaviors. The analytic objective of our study was to examine the knowledge and awareness gained by participants in the intervention. Participants: Participants (n=17) who completed at least half of the eight intervention sessions. Methods: Brief post-implementation semi-structured interviews were conducted between January 1, 2016 and December 31, 2016. Team-based, targeted content analysis focused on knowledge and awareness gains. Results: Participants described learning about sexual health, expanded sexual options, and sexual communication. The “EBAN café,” a component that gives couples a menu of options for safer sex behaviors, was particularly popular

Association between ART adherence and mental health : results from a national HIV sero-behavioural survey in South Africa

This paper assesses the levels of antiretroviral treatment (ART) adherence and mental health distress among study participants in a national behavioural HIV-sero prevalence study South Africa. The study was a cross-sectional population-based multi-stage stratified cluster random survey, (SABSSM V, 2017). Structured questionnaires were used to collect information on socio-demographics, HIV knowledge, perceptions, HIV testing and HIV treatment history. Study participants were tested for HIV infection, antiretroviral use, viral suppression, and ART drug resistance. A total of 2155 PLHIV aged 15 years or older who were on ART were included in the study. Incidence of either moderate or severe mental health distress was 19.7%. Self-reported ART adherence among study participants with no, mild, moderate, or severe mental distress was 82%, 83%, 86% and 78%, respectively. The adjusted odds ratio for ART non-adherence was 0.58 (95% CI 0.24; 1.40) for mild mental distress, 0.82 (95% CI 0.35; 1.91) for moderate mental distress and 2.19 (95% CI 1.14; 4.19) for severe mental distress groups compared to the no mental health distress group. The other factors that were associated with ART non-adherence in adjusted models included education level, alcohol use and province/region of residence. The study revealed that mental health remains a challenge to ART adherence in South Africa. To improve ART adherence, HIV continuum of care programs should include screening for mental health among people living with HIV.The President’s Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention under the terms of Cooperative Agreement Number NU2GGH001629. Additional funding was also received from the South African Department of Science and Technology (now known as the Department of Science and Innovation), South African National AIDS Council, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Right to Care, United Nations Children’s Fund (UNICEF), the Centre for Communication Impact, Soul City, and love Life.http://link.springer.com/journal/10461hj2023Psycholog

Knowledge, attitudes and prevention practices regarding HIV/AIDS among barbers in Ho municipality, Ghana

The barbing industry poses particular public health risks if it is not conducted in a safe and hygienic manner. These risks can lead to the transmission of infectious diseases like the Human Immunodeficiency Virus (HIV) to the barbers or their clients. This study investigated the knowledge, attitudes and prevention practices regarding HIV transmission among barbers in the Ho Municipality. A descriptive cross-sectional design was employed. A pretested structured questionnaire was administered to a consented sample of barbers sampled using a multistage random sample design. Descriptive and inferential statistics were performed using Stata version 14.0 software programme where 0.05 level was used as a measure of significance. The knowledge level of the barbers regarding HIV/AIDS was inadequate (63.6%). Knowledge was significantly associated with work experience [AOR = 13.56 (95% CI: 2.73–67.25); p=0.001], with attitude [AOR=4.07 (95% CI: 1.27–13.08); p= 0.018], with level of education [AOR=10.22 (95% CI: 2.24–46.64); p=0.003], with marital status [AOR = 0.07 (95% CI: 0.01–0.50); p = 0.008] and with number of clients per day [AOR = 0.13 (95% CI: 0.03–0.52); p = 0.004]. The attitude of barbers was also inadequate (58.7%). Attitude was significantly associated with the mode of learning the barbing profession [AOR = 0.32 (95% CI: 0.11–0.89); p = 0.029], and with level of knowledge [AOR = 5.48 (95% CI: 2.01– 14.93); p = 0.001]. Majority of the participants exhibited poor prevention practices regarding HIV/AIDS (87.6%). Prevention practice was significantly associated with work experience [AOR = 24.92 (95% CI: 2.08–297.86); p = 0.011] and with level of knowledge [AOR = 12.57 (95% CI: 1.35–116.86); p = 0.026]. The barbers in Ho exhibited inadequate knowledge and attitude regarding HIV/AIDS, and also manifested poor prevention practices regarding HIV/AIDS. Programmes aimed at improving the knowledge, attitudes and prevention practices should be implemented among barbers, with focus on those without any formal education, those with less than five years work experience and those with more than ten clients a day

Prevalence and factors associated with intimate partner violence among the adolescent girls and young women in South Africa: findings the 2017 population based cross-sectional survey

Abstract Background Evidence indicate that intimate partner violence (IPV) is disturbingly high among South African adolescent girls and young women (AGYW). Understanding prevalence and risk factors for IPV among these emerging adults is critical for developing appropriate interventions to prevent adverse health outcomes later in life. This study investigates the prevalence and factors associated with lifetime physical IPV experience among AGYW, aged 15–24 years, using the South African national HIV prevalence, incidence, behaviour and communication survey conducted in 2017. Methods The data used in this secondary analysis was obtained from a cross-sectional, population-based household survey data, conducted using a multi-stage stratified random cluster sampling approach. Multivariate stepwise backward logistic regression modelling was used to determine factors associated with IPV. Results Of 716 AGYW that responded to the two commonly answered questions on IPV, 13.1% (95% CI: 9.6–17.6) indicated that they experienced IPV. The odds of reporting experiences of IPV were significantly lower among AGYW residing in high SES households [AOR = 0.09 (95% CI: 0.02–0.47), p = 0.004] than low SES households, and those residing in rural informal/tribal areas [AOR = 0.01 (95% CI: 0.00–0.22), p = 0.004] than urban areas. AGYW experiencing IPV had higher odds of reporting psychological distress compared to their counterparts [AOR = 4.37 (95% CI, 0.97–19.72), p = 0.054]. Conclusion The findings highlight the need for targeted structural and psychosocial interventions in low SES households and especially in urban areas