New approaches, new activities and new outcomes in international conferences on HIV/AIDS in Africa – Report of the 3rd African Conference on the social aspects of HIV/AIDS, Dakar, 10 - 14 October 2005

Africa's HIV/AIDS situation remains cause for concern. The impact of HIV is considerable and threatens the survival and development of African societies. Although much has been attempted, the results still leave much to be desired. AIDS is an epidemic that needs to be addressed with much creativity and spirit of initiative. It is against this background that the 3rd African conference on the social aspects of HIV/AIDS brought innovations in the way international conferences are designed, activities implemented and results obtained. The innovations concerned the approach to international conferences and take into account reconceptualising HIV/AIDS so as to encourage holistic approaches and better visibility of vulnerable groups.The activities of the conference were organised in such a way as to get people living with HIV/AIDS (PLWHA), grassroots communities and marginalised groups to play a focal role.The conference offered an opportunity for developing cultural activities that would translate the African cultural concepts that had been identified as important in the HIV situation and response analysis. Interaction at the conference created an opportunity to analyse the various dimensions of the political, cultural and economic determinants. The conference offered food for thought around response construction while singling out the themes of urgency and acceleration of response, synergy construction, and coordination and conception of political responses. Keywords: conference, policies, HIV/AIDS, cultural aspects, responses, determinants Journal of Social Aspects of HIV/AIDS Vol. 3 (2) August 2006: 424-44

Condom Access in South African Schools: Law, Policy, and Practice

Juliana Han and Michael L. Bennish discuss their experience developing a policy on condom distribution for Mpilonhle, a South African nongovernmental organization involved in HIV prevention in schools

HIV risk perception and behavior among medically and traditionally circumcised males in South Africa

Abstract Background In South Africa, voluntary medical male circumcision (VMMC) has recently been implemented as a strategy for reducing the risk of heterosexual HIV acquisition among men. However, there is some concern that VMMC may lead to low risk perception and more risky sexual behavior. This study investigated HIV risk perception and risk behaviors among men who have undergone either VMMC or traditional male circumcision (TMC) compared to those that had not been circumcised. Methods Data collected from the 2012 South African national population-based household survey for males aged 15 years and older were analyzed using bivariate and multivariate multinomial logistic regression, and relative risk ratios (RRRs) with 95 % confidence interval (CI) were used to assess factors associated with each type of circumcision relative no circumcision. Results Of the 11,086 males that indicated that they were circumcised or not, 19.5 % (95 % CI: 17.9–21.4) were medically circumcised, 27.2 % (95 % CI: 24.7–29.8) were traditionally circumcised and 53.3 % (95 % CI: 50.9–55.6) were not circumcised. In the final multivariate models, relative to uncircumcised males, males who reported VMMC were significantly more likely to have had more than two sexual partners (RRR = 1.67, p = 0.009), and males who reported TMC were significantly less likely to be low risk alcohol users (RRR = 0.72, p < 0.001). Conclusion There is a need to strengthen and improve the quality of the counselling component of VMMC with the focus on education about the real and present risk for HIV infection associated with multiple sexual partners and alcohol abuse following circumcision

Social constructions of gender roles, gender-based violence and HIV/AIDS in two communities of the Western Cape, South Africa

The links between gender roles, gender-based violence and HIV/AIDS risk are complex and culturally specific. In this qualitative study we investigated how women and men in two black communities in the Western Cape, South Africa, constructed their gender identities and roles, how they understood gender-based violence, and what they believed about the links between gender relations and HIV risk. First we conducted 16 key informant interviews with members of relevant stakeholder organisations. Then we held eight focus group discussions with community members in single-sex groups. Key findings included the perception that although traditional gender roles were still very much in evidence, shifts in power between men and women were occurring. Also, gender-based violence was regarded as a major problem throughout communities, and was seen to be fuelled by unemployment, poverty and alcohol abuse. HIV/AIDS was regarded as particularly a problem of African communities, with strong themes of stigma, discrimination, and especially ‘othering' evident. Developing effective HIV/AIDS interventions in these communities will require tackling the overlapping as well as divergent constructions of gender, gender violence and HIV which emerged in the study. Keywords: gender roles, gender-based violence, HIV/AIDS, South Africa. RÉSUMÉ Les liens entre les rôles de genre, la violence contre les femmes et le risque du VIH/SIDA sont complexes et culturellement particuliers. Dans cette étude qualitative, nous avons examiné: comment des hommes et des femmes ont construit des identités et les rôles de genre dans deux communautés noires du Cap de l'Ouest, en Afrique du Sud, comment ont-ils compris la violence contre les femmes et ce qu'ils croyaient des liens entre les relations de sexes et le risque du VIH. Dans un premier temps, nous avons mené 16 entretiens principaux d'informateurs auprès des membres des organismes dépositaires. Ensuite, nous avons eu huit discussions des groupes de foyer avec des membres de la communauté en deux groupes différents, un pour les femmes un autre pour les hommes. Les résultats de recherche ont inclus la perception que: même si les rôles de genre traditionnels restent toujours évidents, il y a aussi le déplacement de pouvoir entre les hommes et les femmes. De plus, la violence contre les femmes était vue comme un problème majeur à travers les communautés et d'être aggravée par le chômage, la pauvreté et l'abus d'alcool. Le VIH/SIDA était considéré particulièrement comme un problème des communautés africaines avec des thèmes fortes de stigmatisation, de discrimination et surtout le ‘othering' évidents. Le développement des interventions efficaces du VIH/SIDA dans ces communautés va exiger une maîtrise des constructions de genre qui se recouvrent partiellement et qui sont divergentes également, la violence contre les femmes et le VIH qui ont apparu dans cette étude. Mot clés: les rôles de genre, la violence contre les femmes, le VIH/SIDA, l'Afrique du Sud

Report and policy brief: 2nd Annual Conference on Social Aspects of HIV/AIDS Research, Cape Town, 9 - 12 May 2004

This report and policy brief summarises the overarching principles, key findings and suggested policy options that emerged from rapporteur reports of conference proceedings of the 2nd Annual Conference on Social Aspects of HIV/AIDS Research, Cape Town, 9 - 12 May 2004. SAHARA-J (2004) 1(2): 62-77 Keywords: SAHARA Network, Conference proceedings, Policy brief, HIV, AIDS, Sub-Saharan Africa, reseach, Social aspects. RÉSUMÉ Ce dossier de rapport et de politique présente un compte-rendu des principes dominants, des conclusions principales et des options d'une politique proposée qui font partie des communications présentées de la 2è Conférence Annuelle de Recherche sur les Aspects Sociaux du VIH/SIDA, le Cap, 9 - 12 mai 2004. SAHARA-J (2004) 1(2): 62-77 Mots clés: Réseau du SAHARA, démarches de conférence, dossier de politique, HIV/AIDS, Afrique Secondaire-Saharan, reseach, aspects sociaux

Culture Matters in Communicating the Global Response to COVID-19.

Current communication messages in the COVID-19 pandemic tend to focus more on individual risks than community risks resulting from existing inequities. Culture is central to an effective community-engaged public health communication to reduce collective risks. In this commentary, we discuss the importance of culture in unpacking messages that may be the same globally (physical/social distancing) yet different across cultures and communities (individualist versus collectivist). Structural inequity continues to fuel the disproportionate impact of COVID-19 on black and brown communities nationally and globally. PEN-3 offers a cultural framework for a community-engaged global communication response to COVID-19

Randomized community-level HIV prevention intervention trial for men who drink in South African alcohol-serving venues

South African alcohol-serving establishments (i.e., shebeens) offer unique opportunities to reduce HIV risks among men who drink. Purpose: To test an individual- and a social structural-level HIV prevention intervention for men who drink in shebeens. Methods: Twelve matched pairs of township neighbourhoods were randomized to receive either (i) an HIV prevention intervention (guided by Social Action Theory) to reduce sexual risk and increase risk reduction communication in social networks, or (ii) an attention-matched control intervention that focused on the prevention of relationship violence. At the individual level, the interventions delivered skills building workshops focused on sexual risk reduction. At the social structural level, the intervention aimed to increase conversations about safer sex among men in the shebeens, distributed small media and implemented community educational events. Individual-level outcomes were assessed by following the workshop cohorts for 1 year (N = 984), and community-level outcomes were examined through cross-sectional community surveys conducted for 1 year in the shebeens (N = 9,678). Results: Men in the HIV prevention workshops demonstrated greater condom use, more HIV prevention-oriented conversations and greater perceptions of safer sex norms than men in the comparison workshops. Changes at the community level demonstrated significant differences in condom use, although the pattern was not consistent over time. Conclusions: Multi-level interventions that target men who drink in South African shebeens may help reduce risks for HIV and other sexually transmitted infections.Web of Scienc

The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas

Abstract Stigma is a well-documented barrier to health seeking behavior, engagement in care and adherence to treatment across a range of health conditions globally. In order to halt the stigmatization process and mitigate the harmful consequences of health-related stigma (i.e. stigma associated with health conditions), it is critical to have an explicit theoretical framework to guide intervention development, measurement, research, and policy. Existing stigma frameworks typically focus on one health condition in isolation and often concentrate on the psychological pathways occurring among individuals. This tendency has encouraged a siloed approach to research on health-related stigmas, focusing on individuals, impeding both comparisons across stigmatized conditions and research on innovations to reduce health-related stigma and improve health outcomes. We propose the Health Stigma and Discrimination Framework, which is a global, crosscutting framework based on theory, research, and practice, and demonstrate its application to a range of health conditions, including leprosy, epilepsy, mental health, cancer, HIV, and obesity/overweight. We also discuss how stigma related to race, gender, sexual orientation, class, and occupation intersects with health-related stigmas, and examine how the framework can be used to enhance research, programming, and policy efforts. Research and interventions inspired by a common framework will enable the field to identify similarities and differences in stigma processes across diseases and will amplify our collective ability to respond effectively and at-scale to a major driver of poor health outcomes globally

Pathways from witnessing community violence to mental health problems among South African adolescents

The intersection of violence exposure and mental health problems is a public health crisis for South African (SA) adolescents. Understanding the impact of community violence on adolescent mental health can inform future interventions. Objectives. To assess pathways between community violence exposure and internalising and externalising problems in SA adolescents receiving mental healthcare, and the roles of parent and peer relationships in these associations. Methods. Participants (N=120 parent-adolescent pairs) were recruited from four mental health clinics in Western Cape Province to participate in a pilot test of a family-based HIV prevention study. Adolescents reported on their exposure to community violence, parental attachment, peer support of risk behaviour, and mental health. Parents reported on adolescents' internalising and externalising mental health problems. Participants received transport money (ZAR30 = USD3) and a shopping voucher or cash (ZAR50 = USD5) for their time. Results. Adolescents were 12 - 18 years old (mean (standard deviation) 14.39 (1.82) years), 53% were male, and 67% and 33% reported black African and mixed-race ethnicity, respectively. Parents were 94% female and reported an average monthly income of ZAR3 973 (USD397)