Living with a spoiled identity : HIV positive women talk of stigma

Word processed copy.|Includes bibliographical references.The purpose of this study is to begin to explore how women experience and deal with AIDS stigma under conditions where they have little support. In-depth, narrative interviews were conducted with ten HIV -positive women, living in a poor, black township in Cape Town. The study used both Social Constructionist and Psychoanalytic theory to understand the impact that their """"spoiled identity"""" had on the emotional lives of these women. The study elicited women's narratives as they talked about the circumstances surrounding their diagnosis, their subsequent interaction with their family and community, and their experiences of living with a spoiled identity. The analysis suggested that the women drew on negative social discourses around HIV, which were then internalized, to become part of the self. However, the narratives also indicated the women's resistance to their stigmatised identity

Towards a psychology of sexual health

Increased attention has been made in recent years to issues of sexual and reproductive health in relation to broader social and political environments and human rights issues. The World Health Organization (WHO, 2015) has indicated that we cannot consider sexual and reproductive health concerns such as HIV and other sexually transmitted diseases, sexual violence, sexual problems, unwanted pregnancies and unsafe abortions, without considering discrimination and inequality. Many individuals around the world may be actively discriminated against and even abused on the basis of their sexual and gender identity, who they choose to have sex with and their sexual practices. Within this framework, sexual health is not to be understood only in terms of the absence of sexual disease or dysfunction, but rather more holistically in terms of physical as well as psychological and social well-being. Sexual health is not just about disease, but also identity and relationships. As the WHO (2015) states, ‘For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled’ (p. 5). This inclusive definition of sexual health demands an imaginative sexual health psychology that theorises the individual as embedded within their psychosocial, sociocultural and geopolitical contexts. This inclusive definition also demarcates the rather impoverished attempt to develop a sexual health psychology to date. Much of the existing work on sexual health psychology has for the most part aligned with funding opportunities which address the proximal determinants of sexual ill-health. Such approaches align themselves with the medical profession and focus on behavioural determinants of unsafe sex and the transmission of sexual infections, the determinants and psychological consequences of sexual violence, and understanding the causes and psychological treatments of what are termed ‘sexual dysfunctions’ (e.g. Miller and Green, 2002). These are all important areas of work, but their overall focus on the proximal determinants of sexual ill-health elides other, and potentially more important determinants of sexual health. Moreover, a biomedical focus on sexual health alone and a tendency to only use the individual as a unit of analysis and theory amplifies and interpellates notions of individual responsibility and culpability. It can diminish and obscure social and other structural determinants of sex (e.g. Campbell, 2003 and Tomlinson et al., 2010 in relation to HIV) and lead to the medicalisation of sexual difficulties (Moynihan, 2003; Tiefer, 2006). Such partial understandings of sexual health can severely delimit the ways we can imagine and develop sexual health interventions (Marks et al., 2018)

Challenges faced by parents of children diagnosed with autism spectrum disorder

Few studies address the daily challenges faced by parents of children diagnosed with autism spectrum disorder. This article reports on a qualitative interview study with 20 parents exploring their experiences, challenges faced, and what has helped them to cope. A thematic analysis of the data identified five core categories: Dealing with challenging behaviour; dealing with judgements from others; lack of support; impact upon the family; coping and the importance of appropriate support. The findings emphasize where the parents themselves believe they still require additional support. It raises key strategies and resources that parents have found helpful.Peer reviewe

Predictors of negative beliefs toward the sexual rights and perceived sexual healthcare needs of people with physical disabilities in South Africa

Background: Although sexuality is a ubiquitous human need, recent empirical research has shown that people without disabilities attribute fewer sexual rights and perceive sexual healthcare to benefit fewer people with disabilities, compared to non-disabled people. Within a global context, such misperceptions have tangible, deleterious consequences for people with disabilities (e.g., exclusion from sexual healthcare), creating an urgent need for effective strategies to change misperceptions. Methods: To lay the groundwork for developing such strategies, we examined predictors of the recognition of sexual rights of people with physical disabilities within the South African context, derived from three key social psychological literatures (prejudice, social dominance orientation and intergroup contact), as well as the relationship between sexual rights and beliefs about sexual healthcare. Data were obtained through a cross-sectional survey, given to non-disabled South Africans (N = 1989). Results: Findings indicated that lack of recognition of the sexual rights for physically disabled people predicted less positive beliefs about the benefits of sexual healthcare. In turn, high levels of prejudice (both cognitive and affective) toward disabled sexuality predicted less recognition of their sexual rights, while prejudice (both forms) was predicted by prior contact with disabled people and possessing a social dominance orientation (cognitive prejudice only). Evidence was also obtained for an indirect relationship of contact and social dominance orientation on sexual healthcare beliefs through prejudice, although these effects were extremely small. Conclusion: Results are discussed in terms of their implications for rehabilitation, as well as national-level strategies to tackle negative perceptions of disabled sexuality, particularly in contexts affected by HIV.Implications for rehabilitation Findings demonstrate an empirical link between prejudice toward disabled sexuality, lack of recognition of sexual rights and viewing sexual healthcare of less benefit for disabled people. Consequently, there is need for increased attention to these dimensions within the rehabilitative context. Contact with disabled people, including dedicated interventions, is unlikely to meaningfully impact beliefs about the benefits of sexual healthcare

‘Understanding’ as a practical issue in sexual health education for people with intellectual disabilities: a study using two qualitative methods

Objective: Sexual health education is important in addressing the health and social inequalities faced by people with intellectual disabilities. However, provision of health-related advice and education to people with various types and degrees of linguistic and learning difficulties involves addressing complex issues of language and comprehension. This paper reports an exploratory study using two qualitative methods to examine the delivery of sexual health education to people with intellectual disabilities. Methods: Four video-recordings of sexual health education sessions were collected. Conversation analysis was used to examine in detail how such education occurs as a series of interactions between educators and learners. Interviews with four educators were carried out and analyzed using thematic analysis. Results: The analysis shows how educators anticipate problems of comprehension and how they respond when there is evidence that a person does not understand the activity or the educational message. This occurs particularly when verbal prompts involve long sentences and abstract concepts. We show a characteristic pattern which arises in these situations, in which both educator and learner jointly produce a superficially correct response. Conclusions: While interviews allows us some insight into contextual issues, strategy, and aspects of sexual health education which occur outside of the actual teaching sessions, analysis of actual interactions can show us patterns which occur in interactions between educators and learners when comprehension is in question. Addressing how sexual health education is delivered in practice and in detail provides valuable lessons about how such education can be improved

Challenges to providing HIV prevention education to youth with disabilities in South Africa

Purpose: In South Africa, little is known how HIV prevention education is implemented in schools for learners with disabilities. This article reports on findings from a study exploring the extent to which HIV education is reached to people with disabilities in South Africa, and the challenges faced by educators providing HIV prevention education to learners with disabilities. Method: A survey questionnaire completed by 34 schools for learners with special education needs in the Western Cape province of South Africa. Additional complimentary data were collected through interviews with a total of 21 members of staff at schools for learners with disabilities. Results: Respondents recognise the importance of providing HIV prevention education for people with disabilities. Staff reports some challenges in providing HIV prevention education: barriers to communication; discomfort about issues of sexuality and disability; disagreements among staff about what is appropriate content for sexual health education; and fears of promoting sexual activity. Conclusions: There is a need for HIV prevention education to be specifically customized to the needs of the specific population. A general programme, which is included as part of a general curriculum and generally tailored to “mainstream” schools, would need to be adapted according to specific needs and disabling barriers faced

Impairment, socialization and embodiment: The sexual oppression of people with physical disabilities

People with disabilities face multiple forms of social exclusion, discrimination, and oppression, including in the domain of sex and sexuality. From a critical psychoanalytic viewpoint, social responses to persons with impairments are strongly unconsciously mediated, and often dominated by projections based on archaic anxieties about dependency, vulnerability, and shame. Where disability meets sexuality, these defenses may be more prominent still, resulting, for one example, in the prejudiced myth that people with disabilities are disinterested in, or not capable of, sex. Using this theoretical stance, this paper examines how the developmental role of family and societal influences on the social constructions of sexuality and disability are internalized, resisted, and negotiated by two South Africans with physical disabilities. Data are drawn from interview material elicited via photovoice methodology. The interview narratives and photographic images are used to explore how sexual oppression may be internalized, creating intra-psychic barriers to inclusion for this already structurally disadvantaged group

Experience of sexual self-esteem among men living with HIV

Much of the focus on sexual health for people living with HIV has been on promoting safe sex behaviours. However, also important for sexual health is a positive sexual self-esteem. This article reports on an interpretative phenomenological analysis of interviews with seven men about the impact that having HIV has had on their sense of sexual self. Five overarching themes were identified: the ‘destruction’ of a sexual self; feeling sexually hazardous; sexual inhibition; reclaiming a sexual self and finding a place through sero-sorting. With HIV now being a chronic illness, interventions are required to support people to lead sexually satisfying lives

(Re)presenting the self: Questions raised by a photovoice project with people with physical disabilities in South Africa

Photovoice is presented here as an emancipatory, participatory research method with the potential to put minority subjects in charge of their own representation. Drawing on research with disabled people conducted in South Africa, we argue that the meaning of images is often hostage to interpretations which reify untruths about the subject. We consider how photovoice projects may give rise to images that perpetuate the subjugation of their subjects, but could also facilitate an emancipatory politics of self-representation through photography, constituting a challenge and not only the discursive regimes and ideologies which underlie dominant aesthetics

The meaning of participation : reflections on our study

CITATION: Hunt, X., et al. 2021. The meaning of participation : reflections on our study. In: Hunt X., Braathen S.H., Chiwaula M., Carew M.T., Rohleder P., Swartz L. (eds). Physical disability and sexuality. Palgrave Macmillan, Cham. doi:10.1007/978-3-030-55567-2_10.The original publication is available at https://link.springer.comPublication of this chapter was funded by the Stellenbosch University Open Access FundIn Chapter 1 we provided a discussion of participatory research as a method for doing research, and provided an outline of what we did in the research project upon which this book is based. In this final chapter, we reflect back on our experiences of doing a participatory research project of this kind.https://link.springer.com/chapter/10.1007/978-3-030-55567-2_10Publisher's versio