Constructing loss : exploring the traumatic effects of bereavement due to HIV/AIDS and tuberculosis on aid workers in South Africa

This thesis aimed to investigate, first, the potentially traumatic effects of AIDS-related bereavement on HIV/AIDS aid workers in South Africa; second, the resources that aid workers utilise in order to cope with their work; and third, differences in the experiences of local versus international aid workers. HIV/AIDS work is associated with various stresses and burnout is commonly observed among HIV/AIDS caregivers. Care of HIV/AIDS aid workers, however, has been largely overlooked; research has typically focused on the experiences of professional health workers, and often outside of an African setting. This present study, therefore, addressed these limitations with the use of participant observation ethnography and ethnographic interviewing. A period of one year was spent with an organisation in South Africa that provides care for vulnerable children in need and affected by HIV/AIDS. Openended semi-structured interviews were conducted with 63 male and female local and international staff and volunteers. The interviews were analysed using discourse analysis (DA), a methodology novel within HIV/AIDS and trauma research and particularly suitable for investigating language, social context and interaction, and identities, which are factors found to be important in HIV/AIDS work. Participants’ discourses were analysed to identify how they construct their identities, concepts such as HIV/AIDS and tuberculosis, events they experienced, and how they made sense of these phenomena. The main finding of this study was that contemporary HIV/AIDS aid work involves new challenges that have surpassed AIDS-related bereavement as the most prominent concern. The main challenges reported by participants involved the inability to control HIV/AIDS treatment and consequently inability to prevent, or control, AIDS-related death as a result of patient non-compliance. Participants further constructed HIV contraction as controllable and, therefore, avoidable, and used this micro discourse on control to counter HIV-related stigma, particularly stigma they experienced as HIV/AIDS aid workers. This rhetorical technique, however, rather maintains the macro discourse on HIV-related stigma by maintaining the blame component of the disease. Two identity constructions emerged in participants’ discourses. First, the characteristics inherent in the child identity suggested that loss is not merely a matter of death but also sadness for and on behalf of children for their various losses. Second, the caregiver identity prescribed how ‘proper’ and ‘genuine’ HIV/AIDS caregivers are expected to behave. The prescriptive nature of this identity can explain burnout among HIV/AIDS caregivers. The rewards of caregiving, however, can act as a buffer against difficult or traumatic experiences inherent in HIV/AIDS work. Managerial support and global belief systems that allow finding meaning were further identified as important coping resources for HIV/AIDS aid workers. Finally, differences between local and international participants, in terms of how they conceptualise phenomena and consequently have different needs, emphasise the role of culture in the experiences of HIV/AIDS aid workers. In the thesis I further discuss these findings in light of theories of social psychology, such as the Just World hypothesis, Cognitive Dissonance, and Identity Control Theory and Self-Categorization Theory. I conclude that although AIDS-related death no longer is a prominent issue, care of HIV/AIDS aid workers should not be overlooked. Contemporary HIV/AIDS work simply involves new challenges and traumas, and it is important that such work is continuously researched to identify evolving needs

Status inconsistency and return to work among foreign-born and native Swedes

We investigated potential differences in status inconsistency and time to return to work (RTW) from sickness absence between foreign-born and native Swedes, whether inconsistency was associated with RTW, and if this association was stronger for foreign-borns than natives. Significantly fewer native than foreign-born Swedes reported negative status inconsistency, but RTW did not differ between the groups and inconsistency was not associated with RTW. A positive selection of individuals to the Swedish labour market might help explain the findings. This first study of status inconcistency and RTW requires follow-ups in different settings of labour markets and insurance regulations

If they have a girlfriend, they have five girlfriends': Accountability and sexism in volunteer workers' talk about HIV/AIDS in a South African health setting

Significant challenges remain in tackling the global HIV/AIDS epidemic. Effective action requires both appropriate policy at a global level and informed practice on the local level. Here we report how workers in a project in Johannesburg, South Africa make sense of HIV transmission. Discourse analysis of data from interviews with 63 participants shows that project workers routinely attribute transmission to men's sexual relationships with multiple female partners. This explanation is so pervasive that it renders invisible other routes to transmission. Absence of consideration of other routes to infection potentially restricts front-line practice, so hindering local attempts to tackle HIV/AIDS.div_PaSpub4310pu

Evidence-based ethical problem solving to guide practise in psychology research

oai:journals.psychopen.eu:article/101Looking back to the World War II activities, undertaken in the name of research, there is little room for doubt as to why we have Ethics Committees (ECs; or Institutional Review Boards, IRBs, as they are referred to in the U.S.) and various ethical codes of conduct. On one hand, no contemporary scientist would deny the need for a peer review process to ensure ethical treatment and protection of human research subjects, especially in psychology research. On the other hand, anecdotal evidence of ECs becoming an impediment to scientists and their research is mounting up (Ceci & Bruck, 2009; Fiske, 2009; Sieber, 2009; Tully, Ninis, Booy, & Viner, 2000); albeit empirical data on the issue is lacking (Ceci & Bruck, 2009; Fiske, 2009). There appears, however, to be a general sense in the academic world that this impediment sometimes arises as a result of EC members' lack of awareness or understanding of the particular research topic under review and its associated literature and methodologies, including what may constitute contemporary best practise in the area. This may then give rise to competing ethical concerns, between EC members and their department colleagues. Members of psychology ECs are not, and could not possibly be, experts on all psychological topics and methodologies

The Battle Over Control

In this discourse analytic article, I discuss the shifting challenges of HIV/AIDS caregiving, as highlighted in previous research, as well as the similarities between past and present challenges as illustrated by the discourses of HIV/AIDS caregivers at a nonprofit organization in South Africa. Using data from interviews with staff members and volunteers, I illustrate how both past and contemporary challenges in HIV/AIDS caregiving relate to an inability to exercise control. Participants’ discourses revealed a contrast whereby, on one hand, they conveyed a sense of being in control over HIV, while, contradictorily, their accounts contained instances of lack or loss of control. I discuss the implications of barriers to control in HIV/AIDS caregiving and the role of communication and interaction research. I conclude by endorsing ongoing, regular assessments of the needs of those undertaking such work in order to identify their evolving needs in light of evolving challenges

Researching Aid Workers' Constructions of HIV / AIDS in South Africa using Interview-based Discourse Analysis

This case study discusses the design and use of research interviews in conducting a discourse analytic study of the experiences of HIV / AIDS aid workers in South Africa. For many years, research interviews have been a commonly used method of collecting qualitative data. Recently interviews have come to be seen less as a means for the interviewer to elicit information from the interviewee and instead as conversational encounters that are jointly constructed by the interviewer and interviewee. Even on this changing view, however, the use of interviews to collect qualitative data is a contested issue within discourse analytic research. Some writers argue that research interviews constitute a form of interaction that is markedly different from other forms of interaction, while other writers argue that research interviews can be treated as reasonably resembling interactions found elsewhere if the interviewer designs and conducts interviews that allow for appropriate interactional involvement of interviewees. Here we discuss how the interviewer established working relationships with the participants before conducting the interviews. We examine how the design of this project allowed interviews to participate meaningfully in the interview interactions as reflected in the data that were jointly produced. We conclude by discussing the advantages of this project design for exploring the experiences of the participants in this case.div_PaSinpress4661inpres

Revictimization and recovery from sexual assault: implications for health professionals.

Twenty-seven adult females’ responses from an online qualitative questionnaire were analyzed to explore their views on being recovered from an experience of sexual assault, and identify aspects of their postassault health service encounters that facilitated or impeded their recovery process. Being recovered involved accepting the experience, being freed from negative states, regaining control and trust, and receiving help from and being believed by others. Participants predominantly reported negative experiences with health services. Factors perceived as impeding the recovery process include health professionals’ inexperience in dealing with survivors of sexual assault, adhering to rape myths and stereotypes, and disrespectful or inconsiderate treatment of survivors. We argue that these postassault negative experiences revictimized survivors. Addressing these factors may reduce revictimization, facilitate recovery, and decrease assaulted women’s long-term use of health services.</jats:p

Adolescent health care in a multi-cultural area: a qualitative study from adolescents’ perspective

Only few studies have investigated adolescents’ own views of health care in relation to socio-economic contexts. This study evaluated the Adolescent Health Service in Angered, a socio-economically disadvantaged, multi-cultural area in Gothenburg, Sweden, to identify factors that may facilitate or impede access to and visits at such services. Data were collected through focus groups with 11 female and 12 male adolescents and thematically analysed according to young peoples’ conceptions of adolescent health services, their needs and experiences thereof, and factors that could facilitate or impede their use of such services. By enhancing competence, concern and respect amongst staff and ensuring acceptable practical arrangements, sufficient information, familiarisation and involvement of adolescents and parents, services can provide accessible and acceptable health care for young people, thus contributing to fulfilment of adolescents’ right to health