Negative stereotypes examined through the HIV and AIDS discourse: qualitative findings from white young people in Johannesburg, South Africa

Previous studies reporting perceptions of HIV and AIDS by white youth in South Africa suggest both explicit and implicit racial stereotypes and negative attitudes. This paper contributes to the literature on the discourse of racial stereotypes found in discussions about HIV and AIDS. The study was conducted in the suburb of Edenvale, north-east of Johannesburg, South Africa. Three focus group discussions were held with mixed-sex, white middle-class participants aged 16 to 24. Key findings show stereotypes related to cultural knowledge and group character of black youth. Participants spoke negatively of ignorance, illiteracy, traditionalism, backwardness and lack of civilisation among black youth. Black youth were negatively represented as relying on ancestors and traditional healers for guidance. Participants reasoned that black young males were sexually irresponsible and promiscuous, and were spreading HIV intentionally. Thus it is imperative that contemporary HIV prevention interventions in South Africa address anddispel stereotypes reproducing racist discourses

Why do we have sex? Reflections from a Stepping Stones participatory action research with youth LGBTI in Johannesburg

Research on youth homosexuality is predominantly deficit model orientated. This research principally focuses on the impact of being different, low self-worth, distress, stigma, discrimination, HIV and so on.  Data gathered through a series of Stepping Stones workshops conducted at a local University in Gauteng provided us with an opportunity to explore young lesbian, gay and bisexual men and women’s engagement with sex. The aim of this study was to understanding the relevance of Stepping Stones for the LGB community, inform about circumstances surrounding why LGB youth engage in sex and offer a comparison with research from heterosexual youth. The authors facilitated nine workshop sessions with twelve lesbian, gay and bisexual men and women aged 18-25 at the University using Stepping Stones. Data analysed was drawn from the session entitled ‘Why we behave as we do’.  We used a thematic analytic approach to analyse the data. Some of the motivations for sex were in fact about the participants; they wanted to have sex.  Off course others were about the partner; sex was engaged in to please the other. This study concludes that the reasons lesbian, gay and bisexual youth engage in sex may not be unique and thus they too need to be included in mainstream sexuality and safer sex interventions

Top or Bottom? Varsity youth talk about gay sexuality in a Stepping Stones Workshop: Implications for sexual health

This paper discusses the constructs of sexuality amongst a group of LGBTI university students during a Stepping Stones workshop aimed at exploring their engagement with sexual and reproductive health rights issues as it affects them. These constructs include notions of binary identities of being gay, such as being a ‘top’ versus being a ‘bottom’, that are then applied to sexual practices and behaviour that have serious implications for sexual health and bodily integrity. We discuss the intersections of gender identity, sexuality, sexual health and sexual rights, arguing that such constructs are not only limiting in their demarcations of sexual boundaries in relationships and for intimacy but also that attempts to engage sexual health promotion must take into account the intersecting identities of gender and sexuality that are tied to sexual behaviour

Ethnicity and Response to Drug Therapy

Hypercholesterolemia is a complex disorder presenting in different forms, including the familial form (FH), with varying underlying aetiology, and contributing substantially to coronary artery disease. Particularly, the FH underlies monogenic changes in genes involved in cholesterol synthesis and transport, including the low density lipoprotein receptor, proprotein convertase sublitisin/kexin type 9 and apolipoprotein B. However, hyperlipidemia is largely a complex interaction of changes in multiple genes with environmental factors, such as diet, overweight and obesity that are controllable by adopting healthy eating habits and exercise, which may vary by ethnicity. Diet alone is often not adequate to achieve the desired lipid lowering effect in individuals harbouring very high cholesterol levels, necessitating the use of lipid lowering medication or other forms of therapy. Antilipidemic drugs fall into (a) bile acid sequestrants (b) cholesterol absorption inhibitors, (c) 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, (d) fibric acid derivatives (e) proprotein convertase subtilisin/kexin type 9 inhibitors, (f) miscellaneous agents and (g) drug combinations. Mutations in their various metabolizing enzymes, particularly the cytochrome P450 family, often lead to partially/non-functional, or even rapid metabolizing phenotypes, triggering great variations in the way individuals respond to drug therapy, which in turn depends on ethnicity. This may produce unexpected outcomes such as therapeutic failure, adverse side effects and toxicity in individuals of different ethnic origin. Hence, in-depth information of the impact of ethnicity on these relationships has the huge potential of achieving optimal quality use of drugs as well as improving the efficacy and safety of antilipidemic therapeutic agents

Impact of Stepping Stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial

Objective To assess the impact of Stepping Stones, a HIV prevention programme, on incidence of HIV and herpes simplex type 2 (HSV-2) and sexual behaviour

An investigation of fingerstick blood collection for pointof- care HIV-1 viral load monitoring in South Africa

Background: Viral load (VL) quantification is an important tool in determining newly developed drug resistance or problems with adherence to antiretroviral therapy (ART) in HIV-positive patients. VL monitoring is becoming the standard of care in many resource-limited settings. Testing in resource-limited settings may require sampling by fingerstick because of general shortages of skilled phlebotomists and the expense of venepuncture supplies and problems with their distribution.Objective: To assess the feasibility and ease of collecting 150 μL capillary blood needed for the use of a novel collection device following a classic fingerstick puncture.Methods: Patients were recruited by the study nurse upon arrival for routine ART monitoring at the Themba Lethu Clinic in Johannesburg, South Africa. Each step of the fingerstick and blood collection protocol was observed, and their completion or omission was recorded.Results: One hundred and three patients consented to the study, of whom three were excluded owing to the presence of callouses. From a total of 100 patients who consented and were enrolled, 98% of collection attempts were successful and 86% of participants required only one fingerstick to successfully collect 150 μL capillary blood. Study nurse adherence to the fingerstick protocol revealed omissions in several steps that may lower the success rate of capillary blood collection and reduce the performance of a subsequent VL assay.Conclusion: The findings of this study support the feasibility of collecting 150 μL of capillary blood via fingerstick for point-of-care HIV-1 VL testing in a resource-limited setting

Changes in socioeconomic determinants of health in a copper mine development area, northwestern Zambia

In 2011, an industrial copper mine was developed in northwestern Zambia. A health impact assessment was conducted to anticipate and address potential health impacts. To monitor these impacts, three community-based surveys were conducted in the area (2011, 2015 and 2019). We analysed these data to determine how household socioeconomic indicators - considered determinants of health - have changed in the area over time. In mine-impacted communities, between 2011 (pre-construction) and 2019, significant changes were observed for: (i) average household size (-0.6 members); (ii) proportion of mothers that have not completed primary school (+20.4%); (iii) ownership of economic assets (e.g. phones +29.3%; televisions +15.6%); (iv) access to safe drinking water (+27.4%); and (v) improved housing structures (e.g. finished roof +58.6%). When comparing changes between 2015 and 2019 in impacted communities to nearby comparison communities, there was (i) an increased proportion of mothers that had not completed primary school in comparison communities vs. no change in impacted communities; and (ii) increased ownership of economic assets in impacted vs. comparison communities in 2019. This study found generally positive changes in the socioeconomic development of impacted compared to comparison communities, with the most pronounced improvements in the early phases of mine development

Experience and lessons from health impact assessment guiding prevention and control of HIV/AIDS in a copper mine project, northwestern Zambia

To avoid or mitigate potential project-related adverse health effects, the Trident copper project in Kalumbila, northwestern Zambia, commissioned a health impact assessment. HIV was identified a priority health issue based on the local vulnerability to HIV transmission and experience from other mining projects in Africa. Hence, an HIV/AIDS management plan was developed, including community and workplace interventions, with HIV testing and counselling (HTC) being one of the key components. We present trends in HTC data over a 4-year period.; In 13 communities affected by the Trident project, HTC was implemented from 2012 onwards, using rapid diagnostic tests, accompanied by pre- and post-test counselling through trained personnel. In addition, HTC was initiated in the project workforce in 2013, coinciding with the launch of the mine development. HTC uptake and HIV positivity rates were assessed in the study population and linked to demographic factors using regression analysis.; In total, 11,638 community members and 5564 workers have taken up HTC with an increase over time. The HIV positivity rate in the community was 3.0% in 2012 and 3.4% in 2015, while positivity rate in the workforce was 5.2% in 2013 and 4.3% in 2015. Females showed a significantly higher odds of having a positive test result than males (odds ratio (OR) = 1.96, 95% confidence interval (CI): 1.55-2.50 among women in the community and OR = 2.90, 95% CI: 1.74-4.84 among women in the workforce). HTC users in the 35-49 years age group were most affected by HIV, with an average positivity rate of 6.6% in the community sample and 7.9% in the workforce sample. These study groups had 4.50 and 4.95 higher odds of being positive, respectively, compared to their younger counterparts (15-24 years).; While HTC uptake increased five-fold in the community and almost three-fold in the workplace, the HIV positivity rates were insignificantly higher in 2015 compared to 2012. Our data can be used alongside other surveillance data to track HIV transmission in this specific context. Guided by the health impact assessment, the HIV prevention and control programme was readily adapted to the current setting through the identification of socioeconomic and environmental determinants of health

Studying Sexuality: LGBTI experiences in institutions of Higher Education in Southern Africa

Although there are several studies internationally on gender and sexual orientation diversity, these are limited in the Southern African Development Community (SADC). This special issue contains articles written from different Institutions of Higher Education (IHE) in the SADC region on experiences of LGBTI individuals covering sexual health, teaching and training, advocacy and interventions. The aim of publishing this research is to disseminate information for broader advocacy to destabilise hetero- and cis-normativity. The study sites included rural and metropolitan-based institutions and diverse research designs were used. Most of the research findings presented here indicate that the institutions of higher education in SADC are still heteronormative and LGBTI staff and students are marginalized, prejudiced and discriminated against. Some studies report that there are activities in a few institutions harnessed in order to create conducive teaching and learning environments for and about sexual orientation and gender identity in the SADC.College of Human Science

Monitoring of selected health indicators in children living in a copper mine development area in northwestern Zambia

The epidemiology of malaria, anaemia and malnutrition in children is potentially altered in mining development areas. In a copper extraction project in northwestern Zambia, a health impact assessment (HIA) was commissioned to predict, manage and monitor health impacts. Two cross-sectional surveys were conducted: at baseline prior to project development (2011) and at four years into development (2015). Prevalence of Plasmodium falciparum, anaemia and stunting were assessed in under-five-year-old children, while hookworm infection was assessed in children aged 9-14 years in communities impacted and comparison communities not impacted by the project. P. falciparum prevalence was significantly higher in 2015 compared to 2011 in both impacted and comparison communities (odds ratio (OR) = 2.51 and OR = 6.97, respectively). Stunting was significantly lower in 2015 in impacted communities only (OR = 0.63). Anaemia was slightly lower in 2015 compared to baseline in both impacted and comparison communities. Resettlement due to the project and migration background (i.e., moving into the area within the past five years) were generally associated with better health outcomes in 2015. We conclude that repeated cross-sectional surveys to monitor health in communities impacted by projects should become an integral part of HIA to deepen the understanding of changing patterns of health and support implementation of setting-specific public health measures