"Bring a Picture, Song, or Poem": Expression Sessions as a Participatory Methodology

Partizipative Forschungsansätze, bei denen die Teilnehmer*innen im Mittelpunkt der Forschung stehen, haben sich als erfolgreich erwiesen, um deren Engagement und Äußerungsbereitschaft zu unterstützen. In diesem Artikel beschreiben wir unsere Erfahrungen mit einer neuartigen, hybriden partizipatorischen Methodik, den Expression Sessions (ES), mit Heranwachsenden. Wir erläutern insbesondere, wie wir ES konzeptualisiert und operationalisiert haben und diskutieren die Nützlichkeit dieses Ansatzes. Im Verlauf unserer Studie wurden 24 Fokusgruppendiskussionen mit 144 Jugendlichen zwischen 12 bis 17 Jahren durchgeführt. Wir haben festgestellt, dass durch die ES die aktive Teilnahme gefördert, offene und aussagekräftige Äußerungen erleichtert und die gemeinsame Reflexion verbessert wurden. Durch den ES-Ansatz hatten die Teilnehmer*innen die Freiheit, die ihnen am sinnvollsten erscheinenden Ausdrucksweisen zu wählen, was die Reflexion und Diskussion von Themen auf neue, sinnvolle Weise erleichterte. In diesem Artikel stellen wir daher eine alternative, partizipative Methodik vor, die von qualitativen Forscher*innen und bei unterschiedlichen Untersuchungsgruppen leicht angewendet werden kann.Participatory research approaches in which participants are placed at the center of the research have been successfully used to facilitate research engagement and open expression. In this article we describe our experiences of using a novel, hybrid participatory methodology called expression sessions (ES) with adolescents. We specifically explain how the ES method was conceptualized and operationalized and offer reflections on the usefulness of this approach. Our study was implemented through 24 focus group discussions with 144 adolescent participants aged 12-17 years old. We found the ES method valuable to encourage active participation, facilitate open and meaningful expressions, and enhance collaborative reflection. Through the ES approach participants had the freedom to choose their most proficient ways of expression, which facilitated reflection and discussion of issues in new meaningful ways. In this article thus we present an alternative, participatory methodology that can easily be adopted by qualitative researchers and with diverse samples

An empirical study of standards of prevention in South African HIV vaccine trials: Norms, perspectives and practices.

Doctor of Philosophy in Psychology. University of KwaZulu-Natal, Pietermaritzburg, 2015.and sponsors are required to help HIV vaccine trial participants remain HIVuninfected by ensuring access to HIV risk-reduction interventions, termed the standard of prevention. Ethics guidelines for biomedical HIV prevention trials make a range of recommendations on the standard of prevention, including that participants should be provided with ‘state-of-the-art’ prevention interventions; what should be declared in protocols and informed consent documents; and about how decisions should be made. Recommendations in these guidelines have been intensely debated, and argued to be infeasible and impractical. This qualitative study aimed to identify standard of prevention decision-making and implementation practices at five South African trial sites, explore whether practices meet guideline recommendations, and discuss implications for practices and ethics guidelines. Stakeholders’ perspectives on key recommendations in ethics guidelines were also explored. Practices were examined through a review of site documents and interviews with key research stakeholders. Despite concerns in the literature that guidelines establish ideals that cannot be achieved in practice, this study found high concordance between practices and guideline recommendations. In some instances, site practices exceeded recommendations in guidelines. Practices deviated most from guidelines with regard to ‘negotiating’ standards of prevention packages, the description of prevention plans in protocols and informed consent forms, and the ethical review of monitoring plans. The ‘state-of-the-art’ recommendation was argued as being ‘in the eye of the beholder’ and considered too vague, too absolute and as requiring localisation. The requirement for stakeholder consultation on the evolving standard of prevention was also questioned in terms of who would constitute relevant stakeholders, the difficulties with achieving consensus, and the nature of the consultation process. Stakeholders endorsed ethics requirements that new tools be added to the prevention package when they are scientifically validated and approved by regulatory authorities. In addition, they argued that public health sector availability of the intervention and the phase of the trial also be considered. Funding restrictions, power inequalities, provider promotion of interventions and cultural dynamics, among other complexities were identified as influencing standards of prevention decision-making and/or implementation. Recommendations are made for strengthened practices and improvements to guidelines so that they address empirically identified complexities

Stereotype activation and university access programmes : preparing students with one hand and holding them back with the other?

Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2008.A generally untested assumption within the stereotype threat literature is that it is only those individuals who are highly identified with a domain who will be susceptible to stereotype threat. Further, many of the studies on stereotype threat have been confined to artificial laboratory settings and have been conducted on American samples. The current study aimed to develop a measure of domain-identification in order to test this central assumption of stereotype threat theory on a sample of students in a humanities access programme in a South African university. Results indicate that the experience of stereotype threat varies with respect to the combination of 1) the degree of domain-identification, and 2) the degree to which students are aware of negative domain-relevant stereotypes. That is, students who were highly domain-identified and were highly or moderately aware of negative stereotypes performed worse than highly domain-identified individuals who had low levels of awareness of others negative stereotypes about their in-group

Child consent in South African law: Implications for researchers, service providers and policy-makers

A letter providing updated information on an orginal article published in 2010

The dynamics of sexual risk amongst South African youth in age-disparate relationships

IntroductionSouth Africa has the highest burden of HIV in the world with over 8 million people living with HIV. Young women and girls account for a quarter of new HIV infections while making up only 10% of the population. A key driver of HIV incidence is transactional and survival sex between adolescent girls or young women and older men (the latter referred to as ‘sugar-daddies’ or ‘blessers’). This paper expands on the existing literature on age-disparate and intergenerational relationships to provide social and behavioural interpretations of how young men, commonly omitted from studies on this topic, and women in concurrent relationships with both their peers and older partners perceive and navigate sexual risk.MethodWe conducted a qualitative study in a rural setting of uMgungundlovu District, KwaZulu-Natal Province, with purposively selected male and female participants aged 18–24 years old in age-disparate relationships. Semi-structured in-depth interviews (IDI) were conducted and analysed using interpretative phenomenological analysis (IPA) to explore existing information, motivations, and behavioural practices around relationships and sexual risk.ResultsThe themes and related sub-themes found through IPA included the following: (1) navigating dating: narratives that show a strong preference for being in an age-disparate relationship; the challenges that young people face when choosing an older person as a side partner; and social media applications seen as creating opportunities to meet side partners; and (2) the distribution of love and trust in a multi-party sexual network: condom (mis)use differentiates between straights—those in a serious relationship—and sides; and the power of eye-test seroguessing, the praxis of testing people visually for HIV in nullifying existing knowledge about sexual and reproductive health risk.DiscussionThis research offers an understanding of how schemas of non-condom use are organised. We observed that while condom-less sex is often viewed as essential to building social capital in a serious relationship, it is not the only factor that determines sexual relationship power. Eye-test seroguessing not only develops consortium (trust, reciprocity, and solidarity), but it fulfils the psycho-social need to belong to a network of serious relationships. Moreover, it is critical to the enactment of masculinities because it consolidates femininity to keep men happy, i.e., by being passive in the sexual encounter, women constrain their self-efficacy to act contrary to the conventions of reputable women. Therefore, it is plausible that in the serosorting that occurs prior to unprotected sexual acts, the power of eye-test seroguessing limits the ability to engage in safe sexual practices

Child consent in South African law: Implications for researchers, service providers and policy-makers

Children under 18 are legal minors who, in South African law, are not fully capable of acting independently without assistance from parents/legal guardians. However, in recognition of the evolving capacity of children, there are exceptional circumstances where the law has granted minors the capacity to act independently. We describe legal norms for child consent to health-related interventions in South Africa, and argue that the South African parliament has taken an inconsistent approach to: the capacity of children to consent; the persons able to consent when children do not have capacity; and restrictions on the autonomy of children or their proxies to consent. In addition, the rationale for the differing age limitations, capacity requirements and public policy restrictions has not been specified. These inconsistencies make it difficult for stakeholders interacting with children to ensure that they act lawfully

Taking HIV testing to families: designing a family-based intervention to facilitate HIV testing, disclosure and intergenerational communication

Introduction: Facility-based HIV testing does not capture many adults and children who are at risk of HIV in South Africa. This underscores the need to provide targeted, age-appropriate HIV testing for children, adolescents and adults who are not accessing health facilities. While home based counseling and testing has been succesfully delivered in multiple settings, it also often fails to engage adolescents. To date, the full potential for testing entire families and linking them to treatment has not been evaluated. Methods: The steps to expand a successful home-based counseling and testing model to a family-based counseling and testing approach in a high HIV prevalence context in rural South Africa are described. The primary aim of this family-based model is to increase uptake of HIV testing and linkage to care for all family members, through promoting family cohesion and intergenerational communication, increasing HIV disclosure in the family, and improving antiretroviral treatment uptake, adherence and retention. We discuss the three-phased research approach that led to the development of the family-based counseling and testing intervention. Results: The family-based intervention is designed with a maximum of five sessions, depending on the configuration of the family (young, mixed and older families). There is an optional additional session for high-risk or vulnerable family situations. These sessions encourage HIV testing of adults, children and adolescents and disclosure of HIV status. Families with adolescents receive an intensive training session on intergenerational communication, identified as the key causal pathway to improve testing, linkage to care, disclosure and reduced stigma for this group. The rationale for the focus on intergenerational communication is described in relation to our formative work as well as previous literature, and potential challenges with pilot testing the intervention are explored. Conclusion: This paper maps the process for adapting a novel and largely successful home-based counseling and testing intervention for use with families. Expanding the successful home-based counseling and testing model to capture children, adolescents and men could have significant impact if the pilot is successful and scaled-up

Amendments to the Sexual Offences Act dealing with consensual underage sex: Implications for doctors and researchers

In terms of the Sexual Offences and Related Matters Amendment Act, consensual sex or sexual activity with children aged 12 - 15 was a crime, and as such had to be reported to the police. This was challenged in court in the Teddy Bear case, which held that it was unconstitutional and caused more harm than good. In June 2015, the Amendment Act was accepted by both the National Assembly and the National Council of Provinces, and came into operation on the 3 July 2015. This article looks at the amendments to sections 15 and 16 of the Act and what the reporting obligations for medical professionals and researchers are in light of the amendments, as well as the duty to provide medical services and advice to adolescents

Payment of trial participants can be ethically sound: Moving past a flat-rate

The South African Medicines Control Council (MCC) policy that trial participants be paid a flat-rate of R150 per visit in clinical trials has been criticised in the press1,2; its affordability by non-industry funded trials questioned3; that it is an excessive or inappropriate reward4; or that it neglects critical factors like the design or nature of the study.3, 4 It might also be argued that this amount will act as an “undue inducement” for participants to enrol. In our view the principal problem with the MCC policy is that it violates justice in that participants are paid the same amount but do not do the same things or make the same financial sacrifices.5 It has been argued that it would be more appropriate to have a broad contextualised policy6 and that participants should be paid for their time and expenses.4 However, these recommendations have not been specified in the South African literature. To take these recommendations forward we apply two theoretical models of payment (Wage Payment and Reimbursement models) to operationalise payments for time, inconvenience and expenses (TIE). We recommend that participants be paid for their time at a rate similar to national unskilled labour rates, with increments for inconvenient procedures (set nationally), and that they be refunded their direct expenses. This is operationally complex but ethically sound. Our recommendations for stakeholders include that the NHREC assume control of payment norms and endorses payment for TIE. A new payment approach will struggle to overcome the legacy of a flat rate because of community expectations and researchers who have enjoyed a simple administrative procedure