Participation in HIV vaccine trials.

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What should South African HIV vaccine trials do about social harms?

Phase I and II HIV vaccine trials are currently underway in South Africa. Sites are being prepared for Phase III vaccine trials. Participants in these trials risk exposure to 'social harms' that may impact on participant enrolment and retention and threaten their welfare. Potential social harms should be prevented, minimised and/or addressed. This paper examines the literature on potential social harms in HIV vaccine trials. It outlines the type and severity and frequency of potential social harms and ways these have been monitored in settings in the developed world and Thailand. We argue that many of these social harms are likely to manifest in South African trials, however, it is also likely social harms may manifest differently in our setting, such as domestic violence. Therefore careful formative research is required to identify what constitutes a social harm in our setting. Measures should be carefully tailored to record such events and methods established to prevent or address these. © 2007 Taylor & Francis.Articl

Survey examines South Africa's attitude towards corporal punishment

This article summarises some of the findings of a survey on corporal punishment of children. This is the first South African national survey of attitudes towards the use of corporal punishment by caregivers and parents. It should be noted that this study formed part of a larger study of intimate violence that examined the prevalence of, and links between, partner violence and corporal punishment. The information was obtained from SASAS, a national household survey conducted by the Human Sciences Research Council (HSRC) every year that covers a wide range of social issues. This SASAS was conducted in late 2003. Two of the SASAS modules were the intimate partner violence study and the corporal punishment study.

Corporal punishment of children: a South African national survey

Commissioned by Save the Children Sweden, JulyThe study to be reported here is the first South African national survey of attitudes to the use of corporal punishment by caregivers. It should be noted here that this study formed part of a larger study of intimate violence that examined the prevalence of, and links between, partner violence and corporal punishment. These results and full technical details are reported elsewhere (Dawes, De Sas Kropiwnicki, Kafaar, & Richter in press; Dawes et al. 2004). There is a dearth of good information available on the incidence and prevalence of corporal (physical) punishment in the South African context or the disciplinary attitudes used by parents and caregivers to warrant their use of corporal punishment. However, the limited data suggests that it is very common and widely accepted mode of child rearing in the South African context. Current gaps in our knowledge compromise our ability to understand this form of violence against children, and weaken efforts to create viable intervention strategies in order to address the problem. It is therefore hoped that evidence produced by this study can be used to inform intervention. In addition to reporting on the extent and severity of corporal punishment by South African parents we report on predictors of this form of intimate violence. Attitudes to corporal punishment in schools are also addressed. Finally, the study provides baseline data that can be used to track change over time, as various initiatives are undertaken to deepen a culture of democracy and children's rights. The study focuses on the views and practices of persons over 16 years of age. Children were not included as participants in this research. As it is critical to access the views and voices of children, children will participate in a series of future studies that build on participatory work commenced by Save the Children Sweden (2002)

Community members' perceptions of enablers and inhibitors to participation in HIV vaccine trials

We present the findings of a qualitative investigation into the factors that may enable or inhibit participation in a future HIV vaccine trial. Thirty-seven semi-structured interviews and two focus groups were conducted with trial site community members who had attended HIV vaccine education workshops conducted by the community involvement programme of the South African AIDS Vaccine Initiative (SAAVI). Our findings indicate that enablers and inhibitors to participation in HIV vaccine trials may be further classified as either abstract or concrete. Each sub-theme was classified as an abstract inhibitor, abstract enabler, concrete inhibitor, or concrete enabler. Abstract inhibitors were fear of illness or death, lack of information about HIV/AIDS and HIV vaccines, and an HIV vaccine trial's association with HIV/AIDS. Abstract enablers were participants' reported sense of altruism and quality of life issues, such as protection from becoming infected with HIV. Concrete inhibitors were the monetary costs associated with participation, fear of being tested for HIV and receiving test results, negative reactions from family and community members, time delays between receiving trial participation information and actual enrolment, and a general mistrust of researchers. Concrete enablers were practicalities and convenience, financial rewards, a safe testing environment, positive family reactions to trial participation, the different levels of participation available to different members of the community, the salience of HIV in communities, positive community reactions to vaccine trials, and the presence of role models. In addition to these quadrants, the enablers and inhibitors have also been located within a contextual framework that includes the individual, family, community, and societal levels. Our research contributes to an understanding of the concerns of potential HIV vaccine trial participants within the South African context. Our findings illustrate the applicability of international research to proposed vaccine trial activities in South Africa and should, therefore, inform the development and implementation of successful community preparedness activities. © Psychological Society of South Africa. All rights reserved.Articl

Social and behavioral science in HIV vaccine trials: A gap assessment of the literature.

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Factors associated with prevalence of mental disorder in people living with HIV/AIDS in South Africa

The study examines the association between the presence of mental disorder and a range of independent variables. A sample of 900 HIV-positive individuals was administered the Composite International Diagnostic Interview to determine the presence of selected mental disorders. A structured interview assessed support received and factors that may contribute to mental disorder. Overall prevalence of mental disorder was 43.7% - though higher in Stage 3 (49.7%) and in Stage 4 (68%) of the disease. Eighteen percent of respondents were receiving antiretroviral treatment. Having had pre- and post-test counselling was not related to mental disorder; nor were the number of sessions, the professional status of the counsellor and perceived helpfulness of counselling. Being in an HIV support group was related to presence of a mental disorder, although the frequency of attendance was not. Although most of those who disclosed their HIV status found the experience helpful there was a significant positive association between presence of a mental disorder and having disclosed HIV-positive status. Although being a member of an association for people with HIV/AIDS and being religious was perceived as helpful, neither was statistically associated with the presence of mental disorder. Discrimination by community and family and isolation were related to mental disorder. Death of a significant other due to AIDS was related to mental disorder. The findings suggest a strong need for provision of psychiatric care as part of AIDS care as well as strengthening of support services.

Is participation in HIV vaccine trials a health promoting behaviour?

Health behaviours are individual acts by which people aim to preserve or enhance their health. Theories commonly used to understand health behaviour include the Health Belief Model, the Theories of Reasoned Action and Planned Behaviour, the Transtheoretical Model of Change, Social Cognitive Theory and Problem-Behaviour Theory. Targets for health-promotion interventions include exercise, smoking cessation and condom use. Some behaviours that may contribute to changes in population health, however, are not health behaviours as traditionally understood. For example, participating in an HIV vaccine trial may have the potential to contribute long-term to lowering HIV incidence. To what extent, though, can or should we apply models of health behaviour to HIV vaccine trial participation? This article grapples with the theoretical challenges facing social scientists who conduct research related to HIV vaccine trial participation. We initially consider decision making regarding trial participation from both the participant and investigator perspectives, before considering how these alternate decision-making narratives might impact on the conduct of HIV vaccine trials. We conclude by arguing that social scientists need to move beyond a narrow focus on health promotion theory and to engage in the interrelated scientific activities of theory testing and theory building. © 2007 Taylor & Francis.Articl