Transactional Sex and the Pursuit of Modernity

This paper explores meanings and understandings of sexual exchange for material gain in an urban township of Durban, South Africa. The analysis argues against the tendency to assume too readily that all forms of sexual exchange are oriented towards subsistence, and not consumption. This paper also argues that sexual exchange is the means used by women in this study to pursue images and ideals largely created by the media and globalisation. It is revealed that transactional sex is perceived as ‘normal’ leading many women to accept men’s multiple partners and to put themselves as risk of contracting HIV/AIDS (despite having knowledge of the pandemic). Finally, the paper highlights women’s power and agency whereby women are asserting themselves in order to exploit sexual relationships in the interests of new ‘needs’ – the commodities of modernity

Demonizing women in the era of AIDS: an analysis of the gendered construction of HIV/AIDS in KwaZulu-Natal.

Thesis (Ph.D.)-University of Natal, Durban, 1999.As the second decade of AIDS draws to a close, researchers and others involved in the AIDS effort have come to appreciate that complex interactions between social, cultural, biological and economic forces are involved in shaping the epidemiological course of the disease. Nevertheless, the process by which these variables interact and affect each other remains poorly understood, with many of the shaping forces yet to be fully explored. In South Africa, the sociocultural matrix in which the AIDS epidemic is embedded and its role in shaping the interpretation and experience of AIDS have not been fully analyzed. This thesis represents an attempt to elucidate the finer nuances of some commonly-held local beliefs, perceptions, symbolic representations, ethnomedical explanatory models and mythologies associated with AIDS. These associations are viewed as directly informing the way in which Zulu-speaking people are experiencing and responding to HIV/AIDS in KwaZulu Natal, currently home to 1/3 of the country's estimated 3 million HIV infected people. In particular, the focus is on the gender patterning of AIDS, with ethnographic data drawn from extensive field experience at St Wendolin's Mission, a peri-urban settlement in the Marianhill district of Durban. The shared perception of women as naturally 'dirty', as sexually 'out of control' and suspected of using witchcraft in new ways, are identified and discussed as key conceptual strands contributing to the sociocultural construction of HIV/AIDS in that community. It is argued that these notions are metaphorically joining and combining in ways that 'gender' the AIDS epidemic and simultaneously 'demonize' women. The central tenet of this thesis is that HIV/AIDS is fundamentally associated with women as a female caused and transmitted disease that can and does affect men. The author argues that the gendered construction of AIDS in St Wendolin's is a reflection of patriarchal resistance to women's changing roles and expectations that represent an overstepping of culturally defined moral boundaries. Deeply embedded ways of thinking associated with notions of gender are viewed as germane to the disempowerment of women that ultimately impedes the fight against HIV/AIDS. The thesis concludes with a discussion on the opportunity which the current AIDS epidemic presents for wider sociocultural transformation, and how this might be achieved through an AIDS 'education for liberation' based on the philosophies of Paulo Freire

Youth, HIV/AIDS and the importance of sexual culture and context

Twenty years of the sub-Saharan HIV/AIDS epidemic has impressed upon us the extent to which this disease is far more than a public health challenge. As it ravishes fragile economics, decreases life expectancies, increases women's burdens, generates orphans and decimates the dreams and futures of millions of people, HIV/AIDS has become nothing less than the most ominous development challenge facing the African continent. Contemplation of the sheer magnitude of the social repercussions brought in the wake of HIV/AIDS incurs the risk of crippling our senses and blocking the imagination needed for addressing this crisis. Indeed, the personal impact is sharpened rather than mitigated by the realization that this disease is, after all, almost entirely preventable. The poignancy of this simple but painful truth was clearly articulated in 1991 when President Museveni of Uganda declared to his parliament: 'They are telling us that a thin piece of rubber stands between us and the future of our continent!' (Museveni 1997). Still today, more than a decade after the time of that statement, many hopes for Africa are vested in that thin piece of rubber. Primary prevention through behaviour change involving safer-sex practices is still the most viable and potentially effective option for halting the spread of HIV/AIDS in these resource poor countries where affordable treatment is lacking (Davis and Weller, 1999; Donovan and Ross, 2000; Pequegnat and Stover, 2000). This paper focuses on the socio-cultural context in which the enactment of 'highrisk' youth sexual activity takes place. It is divided into two parts: the first examines the general body of research on HIV/AIDS and youth, with particular reference to South Africa; the second discusses some recent findings from ongoing ethnographic research at St Wendolin's, a peri-urban Zulu-speaking community in Durban, on aspects of sexual culture that enhance the spread of HIV/AIDS. Currently it is estimated that between 30-40% of the adult population of KwaZulu-Natal is HIV infected (Whiteside and Sunter 2000). As a whole, African communities in the greater metropolitan Durban area, and indeed throughout KwaZulu-Natal province, represent high seroprevalence epicentres for HIV/AIDS.</p

Antiretroviral therapy and changing patterns of HIV stigmatisation in Entebbe, Uganda

Antiretroviral therapy (ART) has the potential to change processes of HIV stigmatisation. In this article, changing processes of stigmatisation among a group of people living with HIV (PLWH) on ART in Wakiso District, Uganda, are analysed using qualitative data from a study of PLWH’s self-management of HIV on ART. There were 38 respondents (20 women, 18 men) who had been taking ART for at least 1 year. They were purposefully selected from government and non-government ART providers. Two in-depth interviews were held with each participant. Processes of reduced self-stigmatisation were clearly evident, caused by the recovery of their physical appearance and support from health workers. However most participants continued to conceal their status because they anticipated stigma; for example, they feared gossip, rejection and their status being used against them. Anticipated stigma was gendered: women expressed greater fear of enacted forms of stigma such as rejection by their partner; in contrast men’s fears focused on gossip, loss of dignity and self-stigmatisation. The evidence indicates that ART has not reduced underlying structural drivers of stigmatisation, notably gender identities and inequalities, and that interventions are still required to mitigate and tackle stigmatisation, such as counselling, peer-led education and support groups that can help PLWH reconstruct alternative and more positive identities

Risk factors for incident HIV infection among antenatal mothers in rural Eastern Cape, South Africa

The prevalence of HIV among antenatal clients in South Africa has remained at a very high rate of about 29% despite substantial decline in several sub-Saharan countries. There is a paucity of data on risk factors for incident HIV infection among antenatal mothers and women within the reproductive age bracket in local settings in the Eastern Cape, South Africa.To establish the risk factors for incident HIV infection among antenatal clients aged 1849 years attending public antenatal clinics in rural Eastern Cape, South Africa

Implementing microbicides in low-income countries.

The magnitude of the global human immunodeficiency virus (HIV) epidemic is determined by women from lower income countries, specifically sub-Saharan Africa. Microbicides offer women who are unable to negotiate safe sex practices a self-initiated HIV prevention method. Of note, is its potential to yield significant public health benefits even with relatively conservative efficacy, coverage and user adherence estimates, making microbicides an effective intervention to invest scarce healthcare resources. Existing healthcare delivery systems provide an excellent opportunity to identify women at highest risk for infection and to also provide an access point to initiate microbicide use. Innovative quality improvement approaches, which strengthen existing sexual reproductive health services and include HIV testing, and linkages to care and treatment services, provide an opportunity to lay the foundations for wide-scale provision of microbicides. The potential to enhance health outcomes in women and infants and potentially affect rates of new HIV infection may soon be realised

Trends in HIV prevalence in pregnant women in rural South Africa.

CAPRISA, 2015.Abstract available in pdf

Food Insecurity and Sexual Risk in an HIV Endemic Community in Uganda

Food insecurity has been linked to high-risk sexual behavior in sub-Saharan Africa, but there are limited data on these links among people living with HIV/AIDS, and on the mechanisms for how food insecurity predisposes individuals to risky sexual practices. We undertook a series of in-depth open-ended interviews with 41 individuals living with HIV/AIDS to understand the impact of food insecurity on sexual-risk behaviors. Participants were recruited from the Immune Suppression Clinic at the Mbarara University of Science and Technology in Mbarara, Uganda. Interviews were recorded, transcribed verbatim, translated, and coded following the strategy of grounded theory. Four major themes emerged from the interview data: the relationship between food insecurity and transactional sex for women; the impact of a husband’s death from HIV on worsening food insecurity among women and children; the impact of food insecurity on control over condom use, and the relationship between food insecurity and staying in violent/abusive relationships. Food insecurity led to increased sexual vulnerability among women. Women were often compelled to engage in transactional sex or remain in violent or abusive relationships due to their reliance on men in their communities to provide food for themselves and their children. There is an urgent need to prioritize food security programs for women living with HIV/AIDS and address broader gender-based inequities that are propelling women to engage in risky sexual behaviors based on hunger. Such interventions will play an important role in improving the health and well-being of people living with HIV/AIDS, and preventing HIV transmission

Medical Pluralism Predicts Non-ART Use among Parents in Need of ART: A Community Survey in KwaZulu-Natal, South Africa

Despite documented common use of traditional healers and efforts to scale up antiretroviral treatment (ART) in sub-Saharan Africa, evidence on whether medical pluralism predicts ART use is inconclusive and restricted to clinic settings. This study quantitatively assesses whether medical pluralism predicts ART use among parents in need of ART in South Africa. 2,477 parents or primary caregivers of children were interviewed in HIV-endemic communities of KwaZulu-Natal. Analysis used multiple logistic regression on a subsample of 435 respondents in need of ART, who reported either medical pluralism (24.6 %) or exclusive public healthcare use (75.4 %). Of 435 parents needing ART, 60.7 % reported ART use. Medical pluralism emerged as a persistent negative predictor of ART utilization among those needing it (AOR [95 % CI] = .556 [.344 - .899], p = .017). Use of traditional healthcare services by those who need ART may act as a barrier to treatment access. Effective intersectoral collaboration at community level is urgently needed