\u27There are a lot of new people in town: but they are here for soccer, not for business\u27 a qualitative inquiry into the impact of the 2010 soccer world cup on sex work in South Africa

Background: Sports mega-events have expanded in size, popularity and cost. Fuelled by media speculation and moral panics, myths proliferate about the increase in trafficking into forced prostitution as well as sex work in the run-up to such events. This qualitative enquiry explores the perceptions of male, female and transgender sex workers of the 2010 Soccer World Cup held in South Africa, and the impact it had on their work and private lives. Methods: A multi-method study design was employed. Data consisted of 14 Focus Group Discussions, 53 sex worker diaries, and responses to two questions in surveys with 1059 male, female and transgender sex workers in three cities. Results: Overall, a minority of participants noted changes to the sex sector due to the World Cup and nothing emerged on the feared increases in trafficking into forced prostitution. Participants who observed changes in their work mainly described differences, both positive and negative, in working conditions, income and client relations, as well as police harassment. The accounts of changes were heterogeneous - often conflicting in the same research site and across sites. Conclusions: No major shifts occurred in sex work during the World Cup, and only a few inconsequential changes were noted. Sports mega-events provide strategic opportunities to expand health and human rights programmes to sex workers. The 2010 World Cup missed that opportunity

Enhancing global control of alcohol to reduce unsafe sex and HIV in sub-Saharan Africa

Sub-Saharan Africa carries a massive dual burden of HIV and alcohol disease, and these pandemics are inextricably linked. Physiological and behavioural research indicates that alcohol independently affects decision-making concerning sex, and skills for negotiating condoms and their correct use. More than 20 studies in Africa have reported higher occurrence of HIV among people with problem drinking; a finding strongly consistent across studies and similar among women and men. Conflation of HIV and alcohol disease in these setting is not surprising given patterns of heavy-episodic drinking and that drinking contexts are often coterminous with opportunities for sexual encounters. HIV and alcohol also share common ground with sexual violence. Both perpetrators and victims of sexual violence have a high likelihood of having drunk alcohol prior to the incident, as with most forms of violence and injury in sub-Saharan Africa. Reducing alcohol harms necessitates multi-level interventions and should be considered a key component of structural interventions to alleviate the burden of HIV and sexual violence. Brief interventions for people with problem drinking (an important component of primary health care), must incorporate specific discussion of links between alcohol and unsafe sex, and consequences thereof. Interventions to reduce alcohol harm among HIV-infected persons are also an important element in positive-prevention initiatives. Most importantly, implementation of known effective interventions could alleviate a large portion of the alcohol-attributable burden of disease, including its effects on unsafe sex, unintended pregnancy and HIV transmission

At the Heart of the Problem: Health in Johannesburg\u27s Inner-City

Urban life in the twenty-first century is marked by numerous stresses and shocks, resulting from rapid urbanisation, frequent migration and crowding, massive unemployment, climate change, physical disasters, and disease outbreaks, among other challenges. This reality – according to the ‘100 Resilient Cities’ initiative of the Rockefeller Foundation – is why the concept of resilience is critical to a sustainable future: cities must learn to “survive and thrive, regardless of the challenge” [1]. In cities in the global South that face a heavy HIV burden, this health crisis is often inseparable from a wider set of interlinked social challenges, ranging from acute economic inequality to chronic political mismanagement and failed states. What ‘resilience’ means in such contexts is hard to imagine, but at the very least, as UNAIDS’ Michel Sidibé puts it, “people must be at the centre of the response” [2]

Sex work and the 2010 FIFA World Cup: time for public health imperatives to prevail

<p>Abstract</p> <p>Background</p> <p>Sex work is receiving increased attention in southern Africa. In the context of South Africa's intense preparation for hosting the 2010 FIFA World Cup, anxiety over HIV transmission in the context of sex work has sparked debate on the most appropriate legal response to this industry.</p> <p>Discussion</p> <p>Drawing on existing literature, the authors highlight the increased vulnerability of sex workers in the context of the HIV pandemic in southern Africa. They argue that laws that criminalise sex work not only compound sex workers' individual risk for HIV, but also compromise broader public health goals. International sporting events are thought to increase demand for paid sex and, particularly in countries with hyper-endemic HIV such as South Africa, likely to foster increased HIV transmission through unprotected sex.</p> <p>Summary</p> <p>The 2010 FIFA World Cup presents a strategic opportunity for South Africa to respond to the challenges that the sex industry poses in a strategic and rights-based manner. Public health goals and growing evidence on HIV prevention suggest that sex work is best approached in a context where it is decriminalised and where sex workers are empowered. In short, the authors argue for a moratorium on the enforcement of laws that persecute and victimise sex workers during the World Cup period.</p

Qualitative assessment of South African healthcare worker perspectives on an instrument-free rapid CD4 test

Background: Accurate measurement of CD4 cell counts remains an important tenet of clinical care for people living with HIV. We assessed an instrument-free point-of-care CD4 test (VISITECT® CD4) based on a lateral flow principle, which gives visual results after 40 min. The test involves five steps and categorises CD4 counts as above or below 350 cells/μL. As one component of a performance evaluation of the test, this qualitative study explored the views of healthcare workers in a large women and children’s hospital on the acceptability and feasibility of the test. Methods: Perspectives on the VISITECT® CD4 test were elicited through in-depth interviews with eight healthcare workers involved in the performance evaluation at an antenatal care facility in Johannesburg, South Africa. Audio recordings were transcribed in full and analysed thematically. Results: Healthcare providers recognised the on-going relevance of CD4 testing. All eight perceived the VISITECT® CD4 test to be predominantly user-friendly, although some felt that the need for precision and optimal concentration in performing test procedures made it more challenging to use. The greatest strength of the test was perceived to be its quick turn-around of results. There were mixed views on the semi-quantitative nature of the test results and how best to integrate this test into existing health services. Participants believed that patients in this setting would likely accept the test, given their general familiarity with other point-of-care tests. Conclusions: Overall, the VISITECT® CD4 test was acceptable to healthcare workers and those interviewed were supportive of scale-up and implementation in other antenatal care settings. Both health workers and patients will need to be oriented to the semi-quantitative nature of the test and how to interpret the results of test

Community empowerment and involvement of female sex workers in targeted sexual and reproductive health interventions in Africa: A systematic review

Background: Female sex workers (FSWs) experience high levels of sexual and reproductive health (SRH) morbidity, violence and discrimination. Successful SRH interventions for FSWs in India and elsewhere have long prioritised community mobilisation and structural interventions, yet little is known about similar approaches in African settings. We systematically reviewed community empowerment processes within FSW SRH projects in Africa, and assessed them using a framework developed by Ashodaya, an Indian sex worker organisation.Methods: In November 2012 we searched Medline and Web of Science for studies of FSW health services in Africa, and consulted experts and websites of international organisations. Titles and abstracts were screened to identify studies describing relevant services, using a broad definition of empowerment. Data were extracted on service-delivery models and degree of FSW involvement, and analysed with reference to a four-stage framework developed by Ashodaya. This conceptualises community empowerment as progressing from (1) initial engagement with the sex worker community, to (2) community involvement in targeted activities, to (3) ownership, and finally, (4) sustainability of action beyond the community.Results: Of 5413 articles screened, 129 were included, describing 42 projects. Targeted services in FSW 'hotspots' were generally isolated and limited in coverage and scope, mostly offering only free condoms and STI treatment. Many services were provided as part of research activities and offered via a clinic with associated community outreach. Empowerment processes were usually limited to peer-education (stage 2 of framework). Community mobilisation as an activity in its own right was rarely documented and while most projects successfully engaged communities, few progressed to involvement, community ownership or sustainability. Only a few interventions had evolved to facilitate collective action through formal democratic structures (stage 3). These reported improved sexual negotiating power and community solidarity, and positive behavioural and clinical outcomes. Sustainability of many projects was weakened by disunity within transient communities, variable commitment of programmers, low human resource capacity and general resource limitations.Conclusions: Most FSW SRH projects in Africa implemented participatory processes consistent with only the earliest stages of community empowerment, although isolated projects demonstrate proof of concept for successful empowerment interventions in African settings

Impacts of climate change on health and wellbeing in South Africa

Supplementary Materials: File S1, Protocol for systematic review of Climate Change research in South Africa.Given its associated burden of disease, climate change in South Africa could be reframed as predominately a health issue, one necessitating an urgent health-sector response. The growing impact of climate change has major implications for South Africa, especially for the numerous vulnerable groups in the country. We systematically reviewed the literature by searching PubMed and Web of Science. Of the 820 papers screened, 34 were identified that assessed the impacts of climate change on health in the country. Most papers covered effects of heat on health or on infectious diseases (20/34; 59%). We found that extreme weather events are the most noticeable effects to date, especially droughts in theWestern Cape, but rises in vector-borne diseases are gaining prominence. Climate aberration is also linked in myriad ways with outbreaks of food and waterborne diseases, and possibly with the recent Listeria epidemic. The potential impacts of climate change on mental health may compound the multiple social stressors that already beset the populace. Climate change heightens the pre-existing vulnerabilities of women, fishing communities, rural subsistence farmers and those living in informal settlements. Further gender disparities, eco-migration and social disruptions may undermine the prevention—but also treatment—of HIV. Our findings suggest that focused research and effective use of surveillance data are required to monitor climate change’s impacts; traditional strengths of the country’s health sector. The health sector, hitherto a fringe player, should assume a greater leadership role in promoting policies that protect the public’s health, address inequities and advance the country’s commitments to climate change accords.http://www.mdpi.com/journal/ijerpham2018Geography, Geoinformatics and Meteorolog

Increasing global temperatures threaten gains in maternal and newborn health in Africa: A review of impacts and an adaptation framework.

Anatomical, physiologic, and socio-cultural changes during pregnancy and childbirth increase vulnerability of women and newborns to high ambient temperatures. Extreme heat can overwhelm thermoregulatory mechanisms in pregnant women, especially during labor, cause dehydration and endocrine dysfunction, and compromise placental function. Clinical sequelae include hypertensive disorders, gestational diabetes, preterm birth, and stillbirth. High ambient temperatures increase rates of infections, and affect health worker performance and healthcare seeking. Rising temperatures with climate change and limited resources heighten concerns. We propose an adaptation framework containing four prongs. First, behavioral changes such as reducing workloads during pregnancy and using low-cost water sprays. Second, health system interventions encompassing Early Warning Systems centered around existing community-based outreach; heat-health indicator tracking; water supplementation and monitoring for heat-related conditions during labor. Building modifications, passive and active cooling systems, and nature-based solutions can reduce temperatures in facilities. Lastly, structural interventions and climate financing are critical. The overall package of interventions, ideally selected following cost-effectiveness and thermal modeling trade-offs, needs to be co-designed and co-delivered with affected communities, and take advantage of existing maternal and child health platforms. Robust-applied research will set the stage for programs across Africa that target pregnant women. Adequate research and climate financing are now urgent

COVID-19 in Africa: care and protection for frontline healthcare workers

Medical staff caring for COVID-19 patients face mental stress, physical exhaustion, separation from families, stigma, and the pain of losing patients and colleagues. Many of them have acquired SARS-CoV-2 and some have died. In Africa, where the pandemic is escalating, there are major gaps in response capacity, especially in human resources and protective equipment. We examine these challenges and propose interventions to protect healthcare workers on the continent, drawing on articles identified on Medline (Pubmed) in a search on 24 March 2020. Global jostling means that supplies of personal protective equipment are limited in Africa. Even low-cost interventions such as facemasks for patients with a cough and water supplies for handwashing may be challenging, as is ‘physical distancing’ in overcrowded primary health care clinics. Without adequate protection, COVID-19 mortality may be high among healthcare workers and their family in Africa given limited critical care beds and difficulties in transporting ill healthcare workers from rural to urban care centres. Much can be done to protect healthcare workers, however. The continent has learnt invaluable lessons from Ebola and HIV control. HIV counselors and community healthcare workers are key resources, and could promote social distancing and related interventions, dispel myths, support healthcare workers, perform symptom screening and trace contacts. Staff motivation and retention may be enhanced through carefully managed risk ‘allowances’ or compensation. International support with personnel and protective equipment, especially from China, could turn the pandemic’s trajectory in Africa around. Telemedicine holds promise as it rationalises human resources and reduces patient contact and thus infection risks. Importantly, healthcare workers, using their authoritative voice, can promote effective COVID-19 policies and prioritization of their safety. Prioritizing healthcare workers for SARS-CoV-2 testing, hospital beds and targeted research, as well as ensuring that public figures and the population acknowledge the commitment of healthcare workers may help to maintain morale. Clearly there are multiple ways that international support and national commitment could help safeguard healthcare workers in Africa, essential for limiting the pandemic’s potentially devastating heath, socio-economic and security impacts on the continen