Alternative explanations about HIV and AIDS: re-examining distrust among young adults in Cape Town, South Africa

Alternative beliefs about HIV – such as the man-made origins of the virus or the existence of a cure – can undermine trust in and engagement with HIV prevention and treatment initiatives. It is therefore crucial to study the reasons why these beliefs are plausible to some individuals, and how we might better address them in future prevention and treatment campaigns. This study contributes to understanding these beliefs by examining the explanations provided by African respondents in Khayelitsha Township for the plausibility of alternative beliefs about HIV and AIDS. Drawn from a sub-selection of over 2900 respondents to the Cape Area Panel Study, ten focus group discussions (n=47) were held with African men and women from the township of Khayelitsha. Previous studies maintain that the experience of apartheid, of former President Mbeki’s AIDS denialism, and of the unsettling transformations of globalisation have negatively influenced the South African public’s trust in biomedical claims. This paper argues that in addition to these explanations, individuals express distrust about HIV science because certain aspects of these scientific explanations do not ‘add-up’, particularly when considered in light of their everyday observations and experiences. These disjunctures in information do not simply reflect a lack of HIV knowledge or rejection of scientific principles. Rather, in drawing on past and present experiences, individuals demonstrate their commitment to “street-level epistemologies of trust”, an informal manner of empirically engaging with science’s rationale. HIV prevention campaigns should draw on experiential aspects of HIV and AIDS to lend credibility to scientific claims and recognize that some doubts about science are a form of skeptical engagement rather than an outright rejection

Alternative beliefs about HIV/AIDS: re‐examining distrust among young adults in Cape Town, South Africa

Alternative beliefs about HIV – such as the man‐made origins of the virus or the secret existence of a cure ‐ can undermine trust in, and engagement with HIV prevention and treatment initiatives. These effects make understanding such beliefs an important component of responding to HIV/AIDS in South Africa. Echoing Robins’ observation that the current era allows for “the possibility of critical reflection on the ways in which contestations over scientific truth unfold under particular historical conditions” (2009a), this thesis seeks to reconsider dominant explanations for alternative beliefs about HIV/AIDS in South Africa. Previous studies maintain that the experiences of apartheid, the transition to democracy, and the early years of the new government have had permanent implications for the public’s trust in biomedical claims. In this thesis I argue that in addition to these explanations, individuals express distrust about HIV science because certain aspects of these scientific explanations do not ‘add‐up’, particularly when considered in light of their everyday observations and experiences. These disjunctures in information do not simply reflect a lack of HIV knowledge or rejection of scientific principles. Rather, in drawing on past and present experiences, individuals demonstrate their commitment to “street‐level epistemologies of trust” (Hardin 1992), an informal manner of empirically engaging with science’s rationale. Employing the Public Understandings of Science (PUS) framework to analyze these beliefs, this study conceptualizes trust and mistrust of scientific and official claims about HIV along a spectrum. Study participants endorse a range of alternative beliefs and knowledge about HIV/AIDS. They cite experiential and observational reasons to justify why they trust some authority figures and not others. In their role as trusted sources of information about HIV, peer educators with the Treatment Action Campaign draw on various “rhetorics of persuasion” (Robins 2009b) in order to lend practical plausibility to their claims. Ultimately, this study argues that respondents’ distrust of HIV science should be seen less as a rejection of scientific principles and more as a form of skeptical engagement with certain aspects of these scientific claims

How Do Gender Norms Affect Our Risk of HIV?

Youth carry a diverse set of beliefs on HIV risk and responsibility. Prevention and education about sexual health must address gender stereotypes and inequities that are related to HIV.York’s Knowledge Mobilization Unit provides services and funding for faculty, graduate students, and community organizations seeking to maximize the impact of academic research and expertise on public policy, social programming, and professional practice. It is supported by SSHRC and CIHR grants, and by the Office of the Vice-President Research & Innovation. [email protected] www.researchimpact.c

More than just talk: the framing of transactional sex and its implications for vulnerability to HIV in Lesotho, Madagascar and South Africa

Background 'Transactional sex' was regarded by the mid-1990s as an important determinant of HIV transmission, particularly in sub-Saharan Africa. Little attention has been paid to what the terms used to denote transactional sex suggest about how it is understood. This study provides a nuanced set of descriptions of the meaning of transactional sex in three settings. Furthermore, we discuss how discourses around transactional sex suggest linkages to processes of globalization and hold implications for vulnerability to HIV. Methods The analysis in this article is based on three case studies conducted as part of a multi-country research project that investigated linkages between economic globalization and HIV. In this analysis, we contextualize and contrast the 'talk' about transactional sex through the following research methods in three study sites: descriptions revealed through semi-structured interviews with garment workers in Lesotho; focus groups with young women and men in Antananarivo, Madagascar; and focus groups and in-depth interviews with young women and men in Mbekweni, South Africa. Results Participants' talk about transactional sex reveals two themes: (1) 'The politics of differentiation' reflects how participants used language to demarcate identities, and distance themselves from contextually-based marginalized identities; and (2) 'Gender, agency and power' describes how participants frame gendered-power within the context of transactional sex practices, and reflects on the limitations to women's power as sexual agents in these exchanges. Talk about transactional sex in our study settings supports the assertion that emerging transactional sexual practices are linked with processes of globalization tied to consumerism. Conclusions By focusing on 'talk' about transactional sex, we locate definitions of transactional sex, and how terms used to describe transactional sex are morally framed for people within their local context. We take advantage of an opportunity to comparatively explore such talk across three different study sites, and contribute to a better understanding of both emerging sexual practices and their implications for HIV vulnerability. Our work underlines that transactional sex needs to be reflected as it is perceived: something very different from, but of at least equal concern to, formal sex work in the efforts to curb HIV transmission

Peer educators’ responses to mistrust and confusion about HIV and AIDS science in Khayelitsha, South Africa

Peer educators are on the front lines of communication between sources of scientific authority about HIV and AIDS and target populations. This study focuses on a group of peer educators from the Treatment Action Campaign working in Khayelitsha, South Africa (n=20), highlighting perceptions of their treatment literacy activities and the challenges faced in these encounters. In order to maintain clients’ trust in themselves and their information about HIV, they employ various “rhetorics of persuasion”, including accurate mobilisation of biomedical facts, personal testimonies, and figurative language such as parables and metaphors. These tactics build on community members’ everyday observations and experiences and draw from peer educators’ own credibility and trustworthiness as TAC members, and as members of the community. This paper draws attention to the ways in which peer educators’ personal agency and judgement are brought to the task of peer education, as well as the implications for future programmes using treatment literacy to advocate on behalf of biomedical facts about HIV and AIDS

Alternative explanations about HIV and AIDS: re-examining distrust among young adults in Cape Town, South Africa

Alternative beliefs about HIV - such as the man-made origins of the virus or the existence of a cure - can undermine trust in and engagement with HIV prevention and treatment initiatives. It is therefore crucial to study the reasons why these beliefs are plausible to some individuals, and how we might better address them in future prevention and treatment campaigns. This study contributes to understanding these beliefs by examining the explanations provided by African respondents in Khayelitsha Township for the plausibility of alternative beliefs about HIV and AIDS. Drawn from a sub-selection of over 2900 respondents to the Cape Area Panel Study, ten focus group discussions (n=47) were held with African men and women from the township of Khayelitsha. Previous studies maintain that the experience of apartheid, of former President Mbeki's AIDS denialism, and of the unsettling transformations of globalisation have negatively influenced the South African public's trust in biomedical claims. This paper argues that in addition to these explanations, individuals express distrust about HIV science because certain aspects of these scientific explanations do not 'add-up', particularly when considered in light of their everyday observations and experiences. These disjunctures in information do not simply reflect a lack of HIV knowledge or rejection of scientific principles. Rather, in drawing on past and present experiences, individuals demonstrate their commitment to "street-level epistemologies of trust", an informal manner of empirically engaging with science's rationale. HIV prevention campaigns should draw on experiential aspects of HIV and AIDS to lend credibility to scientific claims and recognize that some doubts about science are a form of skeptical engagement rather than an outright rejection

Women in the driver's seat: an exploratory study of perceptions and experiences of female truck drivers and their employers in South Africa

The road freight industry is essential to Southern African economies, and South Africa, the largest economy and port of entry and exit for the majority of goods coming and going to the region, has a shortage of trained, quality truck drivers. This study investigates the extent towhich employers are hiring female drivers in response to this skilled-labour shortage and brings to light the experiences of both employers and female truck drivers in South Africa's road freight industry. Although there is a dearth of literature on the experiences of women in skilled blue-collar work in South Africa, previous studies from the developed world have established certain expectations for the integration of women into traditionally male-dominated fields. the results of this study are discussed in relation to these expectations. Findings suggest that women are increasingly targeted for employment, beyond the requirements of affirmative action legislation, due to the perception that female drivers are safer, more conscientious, less likely to endanger public safety and company property, and less likely to engage in risky forms of behaviour including those associated with exposure to HIV/AIDS. This has led some employers to conclude that the female drivers they employ are not only equal but superior to their male colleagues.While female drivers note challenges in gaining entry and acceptance in the industry, they also report a near-unanimously positive experience with colleagues and supervisors. This study furthers our understanding of changing gender dynamics in South Africa as well as the secondary impacts of HIV/AIDS on southern African countries. The future of female employment in South Africa's road freight industry holds both opportunities and challenges

Taking culture seriously in biomedical HIV prevention trials: a meta-synthesis of qualitative studies

This is an Accepted Manuscript of an article published by Taylor & Francis in the American Journal of Bioethics in 2016, available at http://www.tandfonline.com/doi/full/10.1586/14760584.2016.1118349From publisher: A substantial gap exists between widespread acknowledgement of the importance of incorporating cultural sensitivity in biomedical HIV prevention trials and empirical evidence to guide the operationalization of cultural sensitivity in these trials. We conducted a systematic literature search and qualitative meta-synthesis to explore how culture is conceptualized and operationalized in global biomedical HIV prevention trials. Across 29 studies, the majority (n = 17) were conducted in resource-limited settings. We identified four overarching themes: (1) semantic cultural sensitivity – challenges in communicating scientific terminology into local vernaculars; (2) instrumental cultural sensitivity – understanding historical experiences to guide tailoring of trial activities; (3) budgetary, logistical, and personnel implications of operationalizing cultural sensitivity; and (4) culture as an asset. Future investigations should address how sociocultural considerations are operationalized across the spectrum of trial preparedness, implementation, and dissemination in particular sociocultural contexts, including intervention studies and evaluations of the effectiveness of methods used to operationalize culturally sensitive practices.PA Newman is principal investigator on studies funded by the Canadian Institutes of Health Research (THA-118570), and receives funding from the Canada Research Chairs Program

‘Why would you promote something that is less percent safer than a condom?’: Perspectives on partially effective HIV prevention technologies among key populations in South Africa

New biomedical prevention technologies (NPTs) for HIV, including oral Pre-Exposure Prophylaxis, and vaginal and rectal microbicides and HIV vaccines in development, may contribute substantially to controlling the HIV epidemic. However, their effectiveness is contingent on product acceptability and adherence. We explored perceptions and understanding of partially effective NPTs with key populations in South African townships. From October 2013 to February 2014, we conducted six focus groups and 18 individual interviews with Xhosa-speaking adolescents (n = 14), adult men who have sex with men (MSM) (n = 15), and adult heterosexual men (n = 9) and women (n = 10), and eight key informant (KI) interviews with healthcare workers. Interviews/focus groups were transcribed and reviewed using a thematic approach and framework analysis. Overall, participants and KIs indicated scepticism about NPTs that were not 100% efficacious. Some participants equated not being 100% effective with not being completely safe, and thus not appropriate for dissemination. KIs expressed concerns that promoting partially effective NPTs would encourage substitution of a more effective with a less effective method or encourage risk compensation. Educational and social marketing interventions that address the benefits and appropriate use of partially effective NPTs, including education and support tailored for frontline service providers, are needed to prepare for successful NPT implementation in South Africa

Is the pre-natal period a missed opportunity for communicating with parents about immunizations? Evidence from a longitudinal qualitative study in Victoria, British Columbia

Background Growing evidence shows that many parents begin the decision-making process about infant vaccination during pregnancy and these decisions – once established – may be resistant to change. Despite this, many interventions targeting vaccination are focused on communicating with parents after their baby is born. This suggests that the prenatal period may constitute a missed opportunity for communicating with expectant parents about infant vaccination. Methods Using a longitudinal qualitative design, we conducted two interviews (prepartum and postpartum) with women (n = 19) to explore the optimal timing of vaccination information. The data were analyzed thematically, and examined across all sets of pre- and post-partum interviews as well as within each individual participant to draw out salient themes. Results Most participants formed their intentions to vaccinate before the baby was born and indicated that they would welcome information about vaccination from their maternity care providers. However, few individuals recalled their maternity care providers initiating vaccination-related conversations with them. Conclusion The prenatal period is an important time to begin conversations with expectant parents about vaccinating their infants, particularly if these conversations are initiated by trusted maternity care providers. More information is needed on how maternity care providers can be better supported to have these conversations with their patients.Other UBCNon UBCReviewedFacultyResearcherOthe