An ethnographic study of the everyday lives of young women living with HIV in Zambia

Although young women in sub-Saharan Africa are disproportionately affected by HIV, limited research has documented their lives with HIV. This thesis aimed to understand the impact of HIV on young women’s everyday lives in Lusaka, Zambia. I conducted a 12-month ethnography with seven middle-income young women living with HIV in 2017-18. Participant observation with the young women, their friends and families was conducted in their homes, recreational spaces, churches, health facilities, colleges and workplaces. Additional data were generated through participatory workshops, diaries and visual collages. The young women had previously participated in a qualitative study in 2014- 15. Data from the latter study were included for secondary analysis. Analyses were inductive, theory-driven and iterative. Methodological critique assessed how collage methods effectively enabled self-reflection among participants in their representations of their lives with HIV. This thesis also prompted critical reflections on ethics-in-practice in conducting research with these participants, and identified areas of ethical tension, including the negotiated researcher-participant relationship and protecting participants’ HIV status. Theoretical findings showed how young women enacted agency through employing strategies to navigate their lives, including secrecy and limiting disclosure. This enabled them to cope with a stigmatising environment and the tight restrictions that were sometimes imposed around disclosure, sexual relationships and treatment adherence. Temporal analyses explored the impact of HIV on the participants’ lives across time, showing how their everyday and biographical experiences were interlinked with the historical availability of ART. My findings provide evidence of these young women’s resilience, offsetting a historical focus on their vulnerability. I propose applying Reynolds Whytes’ term “biogeneration” to capture how young people’s lives are entwined lives to their biosocial-historical environment. I question overly-simplistic narratives urging routine HIV-status disclosure, and endorse support groups for young people living with HIV to provide critical safe spaces to share their experiences with their peers

Non-Surgical Regional Therapy for Osteoarthritis: An Update and Review of the Literature

Osteoarthritis (OA) is the most common joint condition worldwide. It can lead to chronic debilitating symptoms that can be definitively managed with surgical techniques at times. More frequently however, either due to age, extent of disease or patient choice, non-surgical approaches are preferred. They include topical therapies such as thermotherapy, ultrasound, laser treatment, non-steroidal anti-inflammatory drugs (NSAIDs) and capsaicin cream. Injections are another technique often implemented. These consist of intra-articular (IA) corticosteroid or hyaluronan injections, trigger point injections and subcutaneous sodium salicylate. Acupuncture and various types of external support are also widely used. This chapter examines the latest evidence and summarises the role of the various regional treatments available for use in the management of OA

Pervasive and standalone computing: The perceptual effects of variable multimedia quality.

The introduction of multimedia on pervasive and mobile communication devices raises a number of perceptual quality issues, however, limited work has been done examining the 3-way interaction between use of equipment, quality of perception and quality of service. Our work measures levels of informational transfer (objective) and user satisfaction (subjective)when users are presented with multimedia video clips at three different frame rates, using four different display devices, simulating variation in participant mobility. Our results will show that variation in frame-rate does not impact a user’s level of information assimilation, however, does impact a users’ perception of multimedia video ‘quality’. Additionally, increased visual immersion can be used to increase transfer of video information, but can negatively affect the users’ perception of ‘quality’. Finally, we illustrate the significant affect of clip-content on the transfer of video, audio and textual information, placing into doubt the use of purely objective quality definitions when considering multimedia presentations

Navigating 'ethics in practice': An ethnographic case study with young women living with HIV in Zambia.

While 'procedural ethics' provides essential frameworks for governing global health research, reflecting on 'ethics in practice' offers important insights into addressing ethically important moments that arise in everyday research. Particularly for ethnographic research, renowned for it's fluid and spontaneous nature, engaging with 'ethics in practice' has the potential to enhance research practice within global health. We provide a case study for such reflexivity, exploring 'ethics in practice' of ethnographic research with middle-income young women living with HIV in Lusaka, Zambia. We explore the ethical issues arising from the layered interaction of the population (young women), the disease under investigation (HIV), the method of study (ethnographic), and the setting (Zambia, a lower middle income country). We describe how we navigated five key practical ethical tensions that arose, namely the psycho-emotional benefits of the research, the negotiated researcher-participant relationship, protecting participants' HIV status, confidentiality and data ownership, and researcher obligations after the end of the research. We exemplify reflexive engagement with 'ethics in practice' and suggest that engaging with ethics in this way can make important contributions towards developing more adequate ethical guidelines and research practice in global public health

Coming of age with HIV: a temporal understanding of young women's experiences in Zambia.

Young perinatally-infected women living with HIV in Zambia grew up alongside antiretroviral therapy (ART) roll-out and expanding prevention programmes. We used Bonnington's temporal framework to understand how HIV impacted the experiences of these women over time. Data were drawn from two sequential studies with a cohort of young women living with HIV: a qualitative study in 2014-16 and an ethnographic study in 2017-18. Data from workshops, in-depth interviews, participant observation and diaries were analysed thematically, guided by three temporalities within the framework: everyday, biographical and epochal time. In everyday time, repetitive daily treatment-taking reminded young women of their HIV status, affecting relationships and leading to secrecy with ART. In biographical time, past events including HIV disclosure, experiences of illness, and loss shaped present experiences and future aspirations. Lastly, in epochal time, the women's HIV infection and their survival were intimately interlinked with the history of ART availability. The epochal temporal understanding leads us to extend Reynolds Whyte's notion of "biogeneration" to conceptualise these women, whose experiences of living with HIV are enmeshed with their biosocial environment. Support groups for young women living with HIV should help them to process biographical events, as well as supporting their everyday needs

Randomised Double-Blind Trial of Combination Antibiotic Therapy in Rheumatoid Arthritis

Objective. A combination of intravenous clindamycin and oral tetracycline has been used for many years as a treatment for active rheumatoid arthritis (RA), despite the absence of good evidence for its efficacy. A single-blind pilot study of this therapy suggested that a double-blind placebo-controlled trial was warranted. Methods. Patients with active RA were randomised in a 2 : 1 ratio to receive active treatment or placebo for 25 weeks. The active treatment consisted of intravenous clindamycin in a reducing regime, and oral tetracycline twice daily three times a week. 50 patients were to be recruited. The primary outcome measure was the proportion of patients achieving an ACR20 response. Results. An interim statistical analysis was performed after 20 patients had completed the study. Two patients in the active group achieved an ACR20 response, with none in the placebo group (NS). There was a better ESR20 response in the placebo group (P = .02). There were no other significant differences between the groups. The results indicated that it was unlikely that a significant difference in ACR20 response would emerge if the remaining 30 patients were recruited. The trial was therefore halted. Conclusion. This antibiotic regime is unlikely to be a valuable therapy for active rheumatoid arthritis

Secrets and Silence: Agency of Young Women Managing HIV Disclosure.

Drawing on a 12-month ethnography with young women living with HIV in Zambia, we explore their everyday strategies to avoid unintentional disclosure of their HIV status. Young women practiced secrecy with sexual partners, through hiding their antiretroviral therapy and using veiled language around HIV. Whilst remaining silent about their HIV status enabled them to maintain identities beyond HIV, this secrecy triggered feelings of guilt and anxiety, suggesting that their agency was "bounded" by the context of persistent stigma. These strategies to hide their HIV status question public health narratives urging disclosure, and support disclosure-counseling approaches that champions choice

Between division and connection: a qualitative study of the impact of COVID-19 restrictions on social relationships in the United Kingdom.

Background: The first national COVID-19 lockdown in the United Kingdom between March to July 2020 resulted in sudden and unprecedented disruptions to daily life. This study sought to understand the impact of COVID-19 non-pharmaceutical interventions (NPIs), such as social distancing and quarantine, on people's lived experiences, focusing on social connections and relationships. Methods: Data were generated through 20 in-depth online and telephone interviews, conducted between May and July 2020, and analysed using thematic analysis informed by an ecological framework. Results: Findings show that the use of NPIs impacted social relationships and sociality at every level, disrupting participant's sense of self; relationships with their partners, household members, neighbours, and communities; and polarising social and political views. However, experiences of personal meaning-making and reflection, and greater social connectedness, solidarity, and compassion - despite physical distance - were also common. Conclusions: Participant's lived experiences of the first UK lockdown underscore the interconnectedness of relationships at the individual, community and societal level and point towards the important role of trust, social cohesion, and connectedness in coping with pandemic stress and adversity. Where infectious disease prevention measures rupture sociality, support for social connection at every relational level is likely to help build resilience in light of ongoing COVID-19 restrictions