Making memory work: Performing and inscribing HIV/AIDS in post-apartheid South Africa

This thesis argues that the cultural practices and productions associated with HIV/AIDS represent a major resource in the struggle to understand and combat the epidemic. Research into HIV/AIDS is dominated by biomedical scholarship, and yet in South Africa, the main drivers of the epidemic are social and economic. The cultural productions analysed in this thesis confront and illuminate many of the contradictory and unresolved questions facing HIV/AIDS research today. The primary materials analysed in this thesis are the cultural texts that explore representations and performances of HIV/AIDS in South Africa from 1995-2012. I locate experiences of HIV/AIDS in a range of theatrical, literary and visual artworks, including prose, drama and memoir, as well as film and critical work across an array of genres. More than simply surveying HIV/AIDS cultural artefacts, I offer socially and historically contextualised accounts of how stories from post-apartheid writers, performers, artists and subjects engage with HIV/AIDS within a climate hostile to their existence. In my analysis of the texts considered, I develop an argument that underlines the interventionist capacities of cultural production around HIV/AIDS. I investigate to what degree these texts aim to change consciousness and challenge the social behaviours that contribute to HIV prevalence. I argue that the most significant responses to HIV/AIDS in the last thirty years have been grassroots cultural practices that empower those who otherwise have had little agency in dictating their own circumstances and histories of the epidemic. These findings lead me to argue for a paradigm shift in HIV/AIDS research: from the widespread application of medical hegemony to the consideration of community-level cultural interventions in addressing the epidemic

Digitising and archiving HIV and AIDS in South Africa: The Museum of AIDS in Africa as an archival intervention

The AIDS epidemic in South Africa has demanded interventions from a number of different forums. Drawing on theory relating to the archive in post-apartheid South Africa and data from the online archive from the Museum of AIDS in Africa (MAA), this article explores the possibilities and challenges of using digital technologies alongside physical artefacts to intervene in the AIDS epidemic in South Africa by creating a postcolonial AIDS archive. Focusing in particular on the case of the MAA, in this article I examine the ability of the MAA to act as an archival intervention into the epidemic in two ways. The first of these is through the development of physical and digital archives that prioritise diversity and accessibility in order to reach marginalised constituencies. The second is by breaking the silence about those made most marginalised and vulnerable by HIV and AIDS through giving them the opportunity to contribute to the Museum’s digital content

Opening the black box:A mixed-methods investigation of social and psychological mechanisms underlying changes in financial behaviour

We use a mixed-methods approach to open the ‘black box’ of a combined financial literacy and parenting intervention (‘Parenting for Lifelong Health’) to elucidate the key mechanisms through which changes in financial behaviour are realised. Drawing on qualitative data from 16 focus groups and 42 in-depth interviews, we find evidence for three pathways of change. Higher financial skills and, linked to this, higher financial confidence, a more optimistic future outlook and emotional support provided by peers and family members are described as key facilitators of improved financial behaviour. These mechanisms are cross validated in subsequent quantitative analyses based on standardised interviews from a randomised controlled trial with 552 households. A mediation analysis indicates that the programme’s effect on financial behaviour is significantly mediated by financial skills and self-efficacy (24% of total effect) and optimism (22% of total effect). We further show that the psychological factors are significantly reinforced by increased levels of social support in the family and wider community. Mediating variables remain robust in sensitivity analyses and are confirmed as significant paths when entered simultaneously into a structural equation path model. Our findings highlight possible target points for financial literacy interventions and motivate the inclusion of psychosocial programme components

Mediation pathways for reduced substance use among parents in South Africa:A randomized controlled trial

Background: Substance use is a major public health concern worldwide. Alcohol and drug use have increased during recent decades in many low- and middle-income countries, with South Africa, where this study was conducted, having among the highest rates in the world. Despite existing evidence on the effectiveness of family-based interventions in reducing substance use among parents and caregivers in low- and middle-income countries, little is known about the mechanism of change that contributes to the reduction. This study investigated mediators of change in a parenting programme (Parenting for Lifelong Health [PLH]) on reducing substance use among parents and caregivers of adolescents through three potential mediators: parental depression, parenting stress and family poverty. Methods: The current study used a pragmatic cluster randomized controlled trial design. The total sample comprised 552 parent and caregiver of adolescents M = 49.37(SD = 14.69) who were recruited from 40 communities in South Africa’s Eastern Cape. Participants completed a structured confidential self-report questionnaire at baseline and a follow-up test 5 to 9 months after the intervention. Structural equation modeling was conducted to investigate direct and indirect effects. Results: Analyses indicated that the effect of the PLH intervention on reducing parental substance use was mediated in one indirect pathway: improvement in parental mental health (reduction in parental depression levels). No mediation pathways from the PLH intervention on parental substance use could be associated with parenting stress or family poverty. Conclusions: The findings of the study suggest that intervention approaches targeting mental health among parents and caregivers have promise for reducing parental substance use. These findings emphasize the need to create supportive environments and systems for parents who suffer from emotional strain and mental health problems, particularly within families experiencing adversity. Trial registration: Pan-African Clinical Trials Registry PACTR201507001119966. Registered on 27 April 2015. The trial can be found by searching for the key word ‘Sinovuyo’ on the Pan-African Clinical Trials Registry website or via the following link: http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?_nfpb=true&_windowLabel=BasicSearchUpdateController_1&BasicSearchUpdateController_1_actionOverride=%2Fpageflows%2Ftrial%2FbasicSearchUpdate%2FviewTrail&BasicSearchUpdateController_1id=111

“It Has Changed”: Understanding Change in a Parenting Program in South Africa

BackgroundPoor parenting that leads to child maltreatment during adolescence presents a major public health burden. Research from high-income countries indicates that evidence-based parenting program interventions can reduce child maltreatment. Much less is known, however, about how beneficiaries of these programs experience this process of change. Understanding the process that brings about change in child maltreatment practices is essential to understanding intervention mechanisms of change. This is particularly important given the current scale-up of parenting programs across low- and middle-income countries.ObjectivesThis study aimed to provide insight into how caregivers and adolescents attending a parenting program in South Africa perceived changes associated with abuse reduction.MethodsSemi-structured interviews were conducted with caregivers and adolescents (n = 42) after the intervention, as well as observations of sessions (n = 9) and focus group discussions (n = 240 people). Participants were adolescents between the ages of 10-18 and their primary caregiver residing in peri-urban and rural program clusters in the Eastern Cape Province of South Africa. Data were coded in Atlas.ti, and thematic content analysis was conducted.FindingsBased on participant perceptions, the Sinovuyo Teen parenting program workshops catalyzed change into practice by creating an environment that was conducive to learning alternatives. It did so through prioritizing a process of mutual respect, openness, and being valued by others, giving legitimacy to a respectful reciprocity and new ways of spending time together that enabled caregivers and teenagers to shift and normalize more positive behaviors. This in turn led to reductions in physical and verbal abuse.ConclusionsThis study's findings may be of use to policymakers and practitioners who need to understand how parenting programs support parents and teenagers in increasing positive parenting approaches and changing potentially harmful practices. It additionally highlights the importance of assessing the experiences of both parents and teenagers attending such programs

Strengthening a culture of prevention in low- and middle-income countries: Balancing scientific expectations and contextual realities

Relevant initiatives are being implemented in low- and middle-income countries (LMICs) aimed at strengthening a culture of prevention. However, cumulative contextual factors constitute significant barriers for implementing rigorous prevention science in these contexts, as defined by guidelines from high-income countries (HICs). Specifically, disseminating a culture of prevention in LMICs can be impacted by political instability, limited health coverage, insecurity, limited rule of law, and scarcity of specialized professionals. This manuscript offers a contribution focused on strengthening a culture of prevention in LMICs. Specifically, four case studies are presented illustrating the gradual development of contrasting prevention initiatives in northern and central México, Panamá, and Sub-Saharan Africa. The initiatives share the common goal of strengthening a culture of prevention in LMICs through the dissemination of efficacious parenting programs, aimed at reducing child maltreatment and improving parental and child mental health. Together, these initiatives illustrate: (a) the relevance of adopting a definition of culture of prevention characterized by national commitments with expected shared contributions by governments and civil society, (b) the need to carefully consider the impact of context when promoting prevention initiatives in LMICs, (c) the iterative, non-linear, and multi-faceted nature of promoting a culture of prevention in LMICs, and (d) the importance of committing to cultural competence and shared leadership with local communities for the advancement of prevention science in LMICs. Implications for expanding a culture of prevention in LMICs are discussed

Disclosure of physical, emotional and sexual child abuse, help-seeking and access to abuse response services in two South African Provinces

Physical, emotional and sexual child abuse are major problems in South Africa. This study investigates whether children know about post-abuse services, if they disclose and seek services, and what the outcomes of help-seeking behaviour are. It also examines factors associated with request and receipt of services. Confidential self-report questionnaires were completed by adolescents in South Africa as part of a communitybased study of children aged 10-17 (n=3515) in two provinces. Child abuse, disclosure and outcomes of help-seeking were measured using internationally recognized measures. Prevalence of frequent (>weekly) physical abuse was 7.4%, frequent emotional abuse 12.4%, and lifetime contact sexual abuse 9.0%. 98.6% of children could name one suitable confidante or formal service for abuse disclosure, but only 20.1% of abuse victims disclosed. Of those, 72% received help. Most common confidantes were caregivers and teachers. Of all abuse victims, 85.6% did not receive help due to non-disclosure or inactivity of services, and 14.4% received help: 4.9% from formal health or social services and 7.1% through community vigilante action. Emotional abuse, sexual abuse and female gender were associated with higher odds of help-seeking. While children in South Africa showed high knowledge of available services, access to formal services among abused children was low and not all those requesting services received them. Notably fewer children received help from formal services than through community vigilante action. Urgent action is needed to improve service access for child abuse victims

Parenting for lifelong health:A pragmatic cluster randomised controlled trial of a non-commercialised parenting programme for adolescents and their families in South Africa

Objective To assess the impact of ‘Parenting for Lifelong Health: Sinovuyo Teen’, a parenting programme for adolescents in low- and middle-income countries, on abuse and parenting practices. Design Pragmatic cluster randomised control trial. Setting 40 villages/urban sites (clusters) in the Eastern Cape province, South Africa. Participants 552 families reporting conflict with their adolescents (aged 10-18). Intervention Intervention clusters (n=20) received a 14-session parent and adolescent programme delivered by trained community members. Control clusters (n=20) received a hygiene and hand-washing promotion programme. Main outcome measures Primary outcomes: abuse and parenting practices at one and 5-9 months post-intervention. Secondary outcomes: Caregiver and adolescent mental health and substance use, adolescent behavioural problems, social support, exposure to community violence, and family financial wellbeing at 5-9 months post-intervention. Blinding was not possible. Results At 5-9 months post-intervention, the intervention was associated with lower abuse (caregiver report incidence rate ratio (IRR) 0.55 (95% CI 0.40 to 0.75, p Conclusions This parenting programme shows promise for reducing violence, improving parenting and family functioning in low-resource settings.</p

A parenting programme to prevent abuse of adolescents in South Africa:Study protocol for a randomised controlled trial

An estimated one billion children experience child abuse each year, with the highest rates in low- and middle-income countries. The Sinovuyo Teen programme is part of Parenting for Lifelong Health, a WHO/UNICEF initiative to develop and test violence-prevention programmes for implementation in low-resource contexts. The objectives of this parenting support programme are to prevent the abuse of adolescents, improve parenting and reduce adolescent behavioural problems. This trial aims to evaluate the effectiveness of Sinovuyo Teen compared to an attention-control group of a water hygiene programme.This is a pragmatic cluster randomised controlled trial, with stratified randomisation of 37 settlements (rural and peri-urban) with 40 study clusters in the Eastern Cape of South Africa. Settlements receive either a 14-session parenting support programme or a 1-day water hygiene programme. The primary outcomes are child abuse and parenting practices, and secondary outcomes include adolescent behavioural problems, mental health and social support. Concurrent process evaluation and qualitative research are conducted. Outcomes are reported by both primary caregivers and adolescents. Brief follow-up measures are collected immediately after the intervention, and full follow-up measures collected at 3-8 months post-intervention. A 15-24-month follow-up is planned, but this will depend on the financial and practical feasibility given delays related to high levels of ongoing civil and political violence in the research sites.This is the first known trial of a parenting programme to prevent abuse of adolescents in a low- or middle-income country. The study will also examine potential mediating pathways and moderating factors. Pan-African Clinical Trials Registry PACTR201507001119966