Hegemonic and shamed masculinities: implications of traumatic historical impacts on black men in a post democratic South Africa.

HEARD, 2021.The landscape of post-Apartheid South Africa is characterised by high levels of male perpetrated violence against women, children and other men with blame often attributed to victims rather than perpetrators (Hayes & Abbot, 2016). The aberrant behaviours and attitudes of men (also referred to as toxic masculinity) has been central to the notion of a so-called contemporary ‘crisis in masculinity’ with violence and risk taking behaviours (alcohol, substance abuse, sexual risk taking) embedded in male culture. While previous explanations of the ‘modern day crisis’ among men can be largely attributed to South Africa’s history of violent and traumatic struggles of domination over place, ideology and bodies, there is a paucity of work theorising this crisis from a socio-historical and psychodynamic trauma paradigm. In this vein, this paper delves into key periods of our history (referred to as ‘chosen traumas’) that have had persistent disruptive influences on particularly, black masculinity, which have collectively contributed to the modern day crisis. Our argument relies on the idea that unresolved historical traumas have a transgenerational ‘haunting’ effect on contemporary identities (Gordon, 1997; Layton, 2019). Focusing on black men who were subjected to a violent and repressive past, we have argued that ghosts of the pre-Apartheid to post-Apartheid modern day South Africa continue to have cumulative impacts on the black male psyche. It is suggested that these past traumas, together with contemporary representations of black masculinity, have led to a deep sense of unresolved shame, the dynamics of which we have attempted to illuminate using psychodynamic and masculinity theory. The paper concludes with some recommendations on dealing with unresolved traumas and violence

Hegemonic masculinity and risky sexual behaviours in KwaZulu-Natal, South Africa.

HEARD, 2021.This study assessed the relationship between hegemonic masculinity and HIV risky behaviours among men in UMgungundlovu district, Kwazulu-Natal, South Africa. Methodology: The data was collected through a cross-sectional survey where 10,000 households were approached using a structured questionnaire, but only 3,895 men were considered for this study due to data completeness. Both descriptive and regression analyses were employed in data analysis using Stata 16. Results: The largest group of participants were aged 20-24 years (23%), had incomplete education (50%), no income (60%), always lived in the community (62.5%), were not away from home (91.7%), and were separated but still legally married (85.4%). In the regression analysis, only sex after drinking (β=0.54, P=0.025) and non-use of condoms (β=-0.37, P=0.005; β=-0.48, P=0.004) were significantly associated with masculinity norms. Conclusion: Hegemonic masculinity is associated with risky behaviours, incredibly sex after drinking and non-condom use, and safe male circumcision is a modifier to this relationship

Body image and antiretroviral therapy adherence among people living with HIV: a protocol for a systematic review and meta-analysis.

HEARD, 2021.Introduction Adherence to antiretroviral therapy (ART) remains a key challenge to achieving the fast-track goal of ending the HIV epidemic by 2030. To provide a more comprehensive indication of whether interventions designed to promote ART adherence might benefit from targeting body image perceptions, we aim to conduct a systematic review to synthesise existing evidence on the association between body image and ART adherence. Methods and analysis A systematic review of peer-reviewed observational studies and randomised controlled trials that have investigated the association between body image and adherence to ART will be performed. JSTOR, PsycARTICLES, PsycINFO, PubMed, ScienceDirect and Web of Science databases will be searched from 1 January 2000 to 31 March 2021. Eligible records will consider body image as either an independent variable or a mediator, whereas ART adherence will be assessed as an outcome variable. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and study quality will be assessed using relevant tools developed by the National Institute of Health. If sufficient data are available, a meta-analysis will be conducted. Effect size estimates will be aggregated using a random effects meta-analysis approach. Publication bias and its impact will be evaluated through the use of a funnel plot and the trim-and-fill method. The Grading of Recommendations Assessment, Development and Evaluation approach will be used to report on the overall quality of evidence

Factors associated with the take-up of voluntary medical male circumcision amongst learners in rural KwaZulu-Natal.

CAPRISA, 2017.Abstract available in pdf

Early resumption of sex following voluntary medical male circumcision amongst school-going males.

CAPRISA, 2016.Abstract available in pdf

HIV focused sexual risk‑reduction interventions targeting adolescent boys and young men in Sub‑Saharan Africa : a scoping review

DATA AVAILABILITY: All data relevant to the study are included in the article or uploaded as supplementary information. Any further data required are available on request from the corresponding author.Adolescent girls and young women’s exceptionalism with HIV interventions has left adolescent boys and young men (ABYM) trailing behind, thus becoming a marginalized and underserved population. The scoping review aimed to provide an overview of interventions that have targeted sexual risk behaviors in ABYM in Sub-Saharan Africa (SSA) over the previous 21 years with critical insights on ‘what works’ in preventing the sexual transmission of HIV. A scoping review guided by Arksey and O’Malley’s (in Int J Soc Res Methodol 8(1):19–32, 16) framework and the 2015 Johanna Briggs Institute’s guidelines was conducted. A search of literature published between 2000 and 2020 was reviewed and twenty nine interventions from nine Sub Saharan African countries that met the eligibility criteria were reviewed. The review provides evidence on the successes and the limitations of sexual risk behavior interventions for ABYM in SSA. There is clear and consistent evidence that interventions reduce sexual risk behaviors in adolescent boys and young men. Their efciency seems to grow with the length and intensity of the intervention. Positive efects were generally observed in condom use and on measures of HIV knowledge, attitudes and sexual behaviors as well as uptake of HIV tests and voluntary male circumcision. This review shows that sexual-risk interventions engaging men and boys in SSA are promising and warrant further rigorous development in terms of conceptualization, design and evaluation.The National Research Foundation (NRF) of South Africa and Swedish International Development Agency. Open access funding provided by University of KwaZulu Natal.http://link.springer.com/journal/10461Nursing Scienc

Offering Self-administered Oral HIV Testing as a Choice to Truck Drivers in Kenya: Predictors of Uptake and Need for Guidance While Self-testing

We assessed predictors of choosing self-administered oral HIV testing in the clinic with supervision versus the standard provider-administered blood test when offered the choice among 149 Kenyan truck drivers, described the types of guidance participants needed during self-testing and predictors of needing guidance. Overall, 56.38% of participants chose the self-test, 23.49% the provider-administered test, and 20.13% refused testing. In the adjusted regression models, each additional unit on the fatalism and self-efficacy scales was associated with 0.97 (p = 0.003) and 0.83 (p = 0.008) times lower odds of choosing the self-test, respectively. Overall, 52.38% of self-testers did so correctly without questions, 47.61% asked questions, and 13.10% required unsolicited correction from the provider. Each additional unit on the fatalism scale was associated with 1.07 times higher odds of asking for guidance when self-testing (p\0.001). Self-administered oral HIV testing seems to be acceptable and feasible among Kenyan truck drivers, especially if given the opportunity to ask questions

Investigating the interrelations between systems of support in 13 to 18 year old adolescents: a network analysis of resilience promoting system in a high and middle-income country.

HEARD, 2021.Adolescents’ ability to function well under adversity relies on a network of interrelated support systems. This study investigated how consecutive age groups differ in the interactions between their support systems. A secondary data analysis of cross-sectional studies that assessed individual, caregiver, and contextual resources using the Child and Youth Resilience Measure (Ungar & Liebenberg, 2005) in 13- to 18-year-olds in Canada (N = 2,311) and South Africa (N = 3,039) was conducted applying network analysis. Individual and contextual systems generally showed the highest interconnectivity. While the interconnectivity between the individual and caregiver system declined in the Canadian sample, a u-shaped pattern was found for South Africa. The findings give first insights into cross-cultural and context-dependent patterns of interconnectivity between fundamental resource systems during adolescence

The impact on HIV testing over 6 months when free oral HIV self-test kits were available to truck drivers in Kenya: a randomized controlled trial.

HEARD, 2021.Background: Studies suggest that offering HIV self-testing (HIVST) increases short-term HIV testing rates, but few have looked at long-term outcomes. Methods: We conducted a randomized controlled trial (RIDIE 55847d64a454f) on the impact of offering free oral HIVST to 305 truck drivers recruited from two clinics in Kenya. We previously reported that those offered HIVST were more likely to accept testing. Here we report on the 6-month follow-up during which intervention participants could pick-up HIVST kits from eight clinics. Results: There was no difference in HIV testing during 6-month follow-up between participants in the intervention and the standard of care (SOC) arms (OR = 1.0, p = 0.877). The most common reasons given for not testing were lack of time (69.6%), low risk (27.2%), fear of knowing HIV status (20.8%), and had tested recently (8.0%). The null association was not modified by having tested at baseline (interaction p = 0.613), baseline risk behaviors (number of partners in past 6 months, interaction p = 0.881, had transactional sex in past 6 months, interaction p = 0.599), nor having spent at least half of the past 30 nights away from home for work (interaction p = 0.304). Most participants indicated a preference for the characteristics associated with the SOC [preference for blood-based tests (69.4%), provider-administered testing (74.6%) testing in a clinic (70.1%)]. However, those in the intervention arm were more likely to prefer an oral swab test than those in the SOC (36.6 vs. 24.6%, p = 0.029). Conclusions: Offering HIVST kits to truck drivers through a clinic network had little impact on testing rates over the 6-month follow-up when participants had to return to the clinic to access HIVST. Clinic-based distribution of HIVST kits may not address some major barriers to testing, such as lack of time to go to a clinic, fear of knowing one’s status and low risk perception. Preferred HIV testing attributes were consistent with the SOC for most participants, but oral swab preference was higher among those in the intervention arm, who had seen the oral HIVST and had the opportunity to try it. This suggests that preferences may change with exposure to different testing modalities

Costing analysis of an SMS-based intervention to promote HIV self-testing amongst truckers and sex workers in Kenya

Objective HIV testing rates in many sub-Saharan African countries have remained suboptimal, and there is an urgent need to explore strategic yet cost-effective approaches to increase the uptake of HIV testing, especially among high-risk populations. Methods A costing analysis was conducted for a randomized controlled trial (RCT) with male truckers and female sex workers (FSWs) registered in the electronic health record system (EHRS) of the North Star Alliance, which offers healthcare services at major transit hubs in Southern and East Africa. The RCT selected a sample of truckers and FSWs who were irregular HIV testers, according to the EHRS, and evaluated the effect of SMSs promoting the availability of HIV self-testing (HIVST) kits in Kenyan clinics (intervention program) versus a general SMS reminding clients to test for HIV (enhanced and standard program) on HIV testing rates. In this paper, we calculated costs from a provider perspective using a mixed-methods approach to identify, measure, and value the resources utilized within the intervention and standard programs. The results of the analysis reflect the cost per client tested. Results The cost of offering HIVST was calculated to be double that of routine facility-based testing (USD 10.13 versus USD 5.01 per client tested), primarily due to the high price of the self-test kit. In the two study arms that only offered provider-administered HIV testing in the clinic, only 1% of truckers and 6% of FSWs tested during the study period, while in the intervention arm, which also offered HST, approximately 4% of truckers and 11% of FSWs tested. These lower than expected outcomes resulted in relatively high cost per client estimates for all three study arms. Within the intervention arm, 65% of truckers and 72% of FSWs who tested chose the HIVST option. However, within the intervention arm, the cost per additional client tested was lower for FSWs than for truckers, at USD 0.15 per additional client tested versus USD 0.58 per additional client tested, driven primarily by the higher response rates. Conclusion Whilst the availability of HIVST increased HIV testing among both truckers and FSWs, the cost of providing HIVST is higher than that of a routine health facility-based test, driven primarily by the price of the HIV self-test kit. Future research needs to identify strategies which increase demand for HIVST, and determine whether these strategies and the subsequent increased demand for HIVST are cost-effective in relation to the conventional facility based testing currently available