Class, resistance, and the psychologization of development in South Africa

This paper focuses on the psychologization of development in South Africa, one of the most unequal countries in the world, through a critical analysis of a discussion on a national radio programme about the meaning of Mandela Day. We demonstrate how speakers draw on common sense notions of race, class, and party politics that (re)produce subject positions from within a rights-based interpretive repertoire that emphasizes structural reform and class resistance, and an agency interpretive repertoire that emphasizes individualism, responsibility, and volunteerism. We further demonstrate how the agency subject position serves to stifle and resist the rights subject position by drawing on common sense 'psychological truths' about what it means to be a good citizen

Community participation and food security in a developing context: a critical health psychology perspective

M.A. University of the Witwatersrand, Faculty of Humanities (Research Psychology), 2012The primary aim of the study was to critically analyse how concepts such as community and participation are represented in relation to food gardens against the back drop of corporate social initiatives and public private partnerships. Using a variety of data sources; interviews, and internet documents, this study looked at two case studies of community food gardens in separate schools in Gauteng, South Africa. Both schools were part of a food garden intervention implemented by two separate organisations. The collected data allowed for a comprehensive analysis of the concepts that underpin food security interventions. The data was analysed using thematic content analysis and drew on critical realism and recent writing in critical health psychology. The results showed that the main topics under discussion include challenging notions of community and participation, empowerment, individualism, education and partnerships. Development approaches draw on these concepts to promote community based interventions that effectively position individual members as responsible for their community’s food insecurity. Such concepts reflect a psychologised way of thinking about health which has become prevalent in development. Critically exploring these concepts highlights how psychologising food insecurity has the effect of ignoring the structural cause of the problem

Tuberculosis patients at the human-animal interface: Potential zooanthroponotic and zoonotic transmission

Background Human-to-animal transmission of M. tuberculosis (Mtb) is reported in South Africa but there is a paucity of epidemiological data. The aim of this One Health manuscript is to describe zooanthroponotic exposure of domestic animals to TB patients, virtually all of whom had laboratory confirmed pulmonary Mtb disease. Methods This cross-sectional study was nested within two TB contact tracing studies and collected data from 2017 to 2019. TB index patients and their households in three provinces of South Africa were recruited. A questionnaire was administered to households, assessing type and number of animals owned, degree of exposure of animals to humans, and veterinary consultations. For this analysis, we compared descriptive variables by animal-keeping status (animal-keeping vs non-animal keeping households), calculated the chi square and respective p-values. Results We visited 1766 households with at least one confirmed case of TB, 33% (587/1766) had livestock or companion animals. Of non-animal-owning households, 2% (27/1161) cared for other community members' livestock. Few (16%, 92/587) households kept animals in their dwelling overnight, while 45% (266/587) kept animals outside the home, but within 10 m of where people slept and ate. Most (81%, 478/587) of people in animal-owning households were willing for their animal/s to have a TB skin test, but <1% (5/587) of animals had been skin-tested; 4% (24/587) of animal-owning households had a veterinary consultation in the past six months, and 5% (31/587) reported one of their animals dying from natural causes in the prior six months. Conclusion Our survey suggests that a high proportion of patients with TB live in settings facilitating close contact with domestic animal species with known susceptibility to Mtb. There is a substantial exposure of household animals to patients with TB and therefore risk of both transmission to, and spillback from animals to humans

Prevalence and risk factors for latent tuberculosis infection among household contacts of index cases in two South African provinces: Analysis of baseline data from a cluster-randomised trial.

INTRODUCTION: Household contacts of patients with active pulmonary tuberculosis (TB) often have latent TB infection, and are at risk of progression to disease. We set out to investigate whether index TB case HIV status was linked to a higher probability of latent TB infection among household contacts. MATERIALS AND METHODS: Data were collected prospectively from participants in the intervention arm of a household cluster-randomised trial in two South Africa provinces (Mangaung, Free State, and Capricorn, Limpopo). In intervention group households, TB contacts underwent HIV testing and tuberculin skin testing (TST). TST induration was estimated at two cut-offs (≥5mm, ≥10mm). Multilevel Bayesian regression models estimated posterior distributions of the percentage of household contacts with TST induration ≥5mm and ≥10mm by age group, and compared the odds of latent TB infection by key risk factors including HIV status index case age and study province. RESULTS: A total of 2,985 household contacts of 924 index cases were assessed, with most 2,725 (91.3%) undergoing TST. HIV prevalence in household contacts was 14% and 10% in Mangaung and Capricorn respectively. Overall, 16.8% (458/2,725) had TST induration of ≥5mm and 13.1% (359/2,725) ≥10mm. In Mangaung, children aged 0-4 years had a high TST positivity prevalence compared to their peers in Capricorn (22.0% vs. 7.6%, and 20.5% vs. 2.3%, using TST thresholds of ≥5mm and ≥10mm respectively). Compared to contacts from Capricorn, household contacts living in Mangaung were more likely to have TST induration ≥5mm (odds ratio [OR]: 3.08, 95% credibility interval [CI]: 2.13-4.58) and ≥10mm (OR: 4.52, 95% CI: 3.03-6.97). There was a 90% and 92% posterior probability that the odds of TST induration ≥5mm (OR: 0.79, 95% CI: 0.56-1.14) and ≥10mm (OR: 0.77, 95% CI: 0.53-1.10) respectively were lower in household contacts of HIV-positive compared to HIV-negative index cases. CONCLUSIONS: High TST induration positivity, especially among young children and people living in Mangaung indicates considerable TB transmission despite high antiretroviral therapy coverage. Household contact of HIV-positive index TB cases were less likely to have evidence of latent TB infection than contacts of HIV-negative index cases

Intensified household contact tracing, prevention and treatment support versus enhanced standard of care for contacts of tuberculosis cases in South Africa: study protocol for a household cluster-randomised trial.

BACKGROUND: Household contact tracing of index TB cases has been advocated as a key part of TB control for many years, but has not been widely implemented in many low-resource setting because of the current dearth of high quality evidence for effectiveness. Innovative strategies for earlier, more effective treatment are particularly important in contexts with hyper-endemic levels of HIV, where levels of TB infection remain extremely high. METHODS: We present the design of a household cluster-randomised controlled trial of interventions aimed at improving TB-free survival and reducing childhood prevalence of Mycobacterium tuberculosis infection among household contacts of index TB cases diagnosed in two provinces of South Africa. Households of index TB cases will be randomly allocated in a 1:1 ratio to receive either an intensified home screening and linkage for TB and HIV intervention, or enhanced standard of care. The primary outcome will compare between groups the TB-free survival of household contacts over 15 months. All participants, or their next-of-kin, will provide written informed consent to participate. DISCUSSION: Evidence from randomised trials is required to identify cost-effective approaches to TB case-finding that can be applied at scale in sub-Saharan Africa. TRIAL REGISTRATION: ISRCTN16006202 (01/02/2017: retrospectively registered) and NHREC4399 (11/04/2016: prospectively registered). Protocol version: 4.0 (date: 18th January 2018)

Sex work and young women : a cross sectional study to understand the overlap of age and sex work as a central tenet to epidemic control in South Africa

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Yield of facility-based targeted universal testing for tuberculosis with Xpert and mycobacterial culture in high-risk groups attending primary care facilities in South Africa

DATA SHARING : Individual participant data that underlie the results reported in this article, after de-identification, the data dictionary, study protocol, statistical analysis plan, and analytic code will be made available to investigators whose proposed use of the data has been approved by an independent review committee to achieve aims in the approved proposal. Proposals should be submitted to N. A. M. ([email protected]). To gain access, data requestors will need to sign a data access agreement.BACKGROUND : We report the yield of targeted universal tuberculosis (TB) testing of clinic attendees in high-risk groups. METHODS : Clinic attendees in primary healthcare facilities in South Africa with one of the following risk factors underwent sputum testing for TB: human immunodeficiency virus (HIV), contact with a TB patient in the past year, and having had TB in the past 2 years. A single sample was collected for Xpert-Ultra (Xpert) and culture. We report the proportion positive for Mycobacterium tuberculosis. Data were analyzed descriptively. The unadjusted clinical and demographic factors’ relative risk of TB detected by culture or Xpert were calculated and concordance between Xpert and culture is described. RESULTS : A total of 30 513 participants had a TB test result. Median age was 39 years, and 11 553 (38%) were men. The majority (n=21734, 71%) had HIV, 12 492 (41%) reported close contact with a TB patient, and 1573 (5%) reported prior TB. Overall, 8.3% were positive for M. tuberculosis by culture and/or Xpert compared with 6.0% with trace-positive results excluded. In asymptomatic participants, the yield was 6.7% and 10.1% in symptomatic participants (with trace-positives excluded). Only 10% of trace-positive results were culture-positive. We found that 55% of clinic attendees with a sputum result positive for M. tuberculosis did not have a positive TB symptom screen. CONCLUSIONS : A high proportion of clinic attendees with specific risk factors (HIV, close TB contact, history of TB) test positive for M. tuberculosis when universal testing is implemented.The Bill & Melinda Gates Foundation, the National Institutes of Health, all laboratory testing was paid for by the Government of South Africa.https://academic.oup.com/cidam2024Family MedicineSDG-03:Good heatlh and well-bein

Estimating the contribution of key populations towards HIV transmission in South Africa

INTRODUCTION: In generalized epidemic settings, there is insufficient understanding of how the unmet HIV prevention and treatment needs of key populations (KPs), such as female sex workers (FSWs) and men who have sex with men (MSM), contribute to HIV transmission. In such settings, it is typically assumed that HIV transmission is driven by the general population. We estimated the contribution of commercial sex, sex between men, and other heterosexual partnerships to HIV transmission in South Africa (SA). METHODS: We developed the "Key-Pop Model"; a dynamic transmission model of HIV among FSWs, their clients, MSM, and the broader population in SA. The model was parameterized and calibrated using demographic, behavioural and epidemiological data from national household surveys and KP surveys. We estimated the contribution of commercial sex, sex between men and sex among heterosexual partnerships of different sub-groups to HIV transmission over 2010 to 2019. We also estimated the efficiency (HIV infections averted per person-year of intervention) and prevented fraction (% IA) over 10-years from scaling-up ART (to 81% coverage) in different sub-populations from 2020. RESULTS: Sex between FSWs and their paying clients, and between clients with their non-paying partners contributed 6.9% (95% credibility interval 4.5% to 9.3%) and 41.9% (35.1% to 53.2%) of new HIV infections in SA over 2010 to 2019 respectively. Sex between low-risk groups contributed 59.7% (47.6% to 68.5%), sex between men contributed 5.3% (2.3% to 14.1%) and sex between MSM and their female partners contributed 3.7% (1.6% to 9.8%). Going forward, the largest population-level impact on HIV transmission can be achieved from scaling up ART to clients of FSWs (% IA = 18.2% (14.0% to 24.4%) or low-risk individuals (% IA = 20.6% (14.7 to 27.5) over 2020 to 2030), with ART scale-up among KPs being most efficient. CONCLUSIONS: Clients of FSWs play a fundamental role in HIV transmission in SA. Addressing the HIV prevention and treatment needs of KPs in generalized HIV epidemics is central to a comprehensive HIV response

Association of smoking opinions and risk perception with smoking status in Serbia adults

Background Overall, Serbian adults are aware of the association of smoking with malignant diseases. However, it is not known whether adult smokers perceive this a risk for future concern. The study objective is to understand how smoking related opinions and risk perception in Serbian adults is associated with smoking status in order to support planning of targeted interventions. Methods Secondary analysis of data drawn from a 2014 cross sectional, National Survey on Lifestyles of Citizens in Serbia. Multivariate logistic regression was used to determine the association of smoking opinions and risk perception with smoking status. Results A total sample of 5385 adults aged 18-64 years were analysed with a smoking prevalence of 39.8%. Tobacco use ranked 15 th of 17 listed problems in Serbia by its perceived importance. Opinions on tobacco use as a problem significantly differs by smoking status (p< 0.001, χ2=90.04). Among those (75.5%) who report tobacco use as rather important or an important problem, 44.5%, are non-smokers, 36.5% are current smokers and 19.1% ex-smokers. There is also a significant difference (p< 0.05, χ2=329.22) in risk perception according to smoking status, 66.5% of adults perceived smoking one or more packs of cigarettes per day to be great risk, of which 48.9%, are non-smokers 31.7% are smokers and 19.4% are ex-smokers. Those who think tobacco is an important problem compared with people who think it is not a problem (OR 1.6, p< 0.001) and those who perceive smoking as not risky (OR,7.0, p< 0.001) compared with those who think it is a great risk, have higher odds of being smokers. Conclusions Despite high prevalence, smoking is not recognized as important problem in society. Among current smokers, risk perception is low. Findings call for interventions aimed at changing risk perception and opinions on importance of tobacco control