Sexual practices and the cultural meanings of rural people in Zimbabwe in the era of the Human Immunodefiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) epidemic : a social constructionist perspective.

Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2011.Notwithstanding a myriad of interventions put in place over three decades to combat the HIV/AIDS pandemic, the incidence and prevalence are still unacceptably high in southern Africa. There is a need to broaden the HIV/AIDS research agenda by exploring the nuanced socio-cultural contexts within which mundane social and sexual encounters occur. The thesis explored the sexual practices and cultural meanings of seventy rural Zimbabwean men and women using a social constructionist approach informed by the voice-relational methodology. Findings of the study show that the construction of meaning around HIV/AIDS is subjective and influenced by social contestations around space, gender, type of relationship as well as the social sanctions or support mechanisms available at a particular moment. Some of the cultural factors that facilitate the spread of HIV include gender roles that disapprove of sexual concurrency for women but tolerate this practice among men. The study also highlighted the vulnerability of young women, in secretive relationships, to sexual violence perpetrated by their male partners, lack of social support for women who participate in socially disapproved practices including pre-marital sex, and involvement in commercial sexual activities. Prevention efforts should be located in people’s experiences and interpretation of their lifeworlds, paying particular attention to the language people use to construct meaning around the HIV/AIDS epidemic. The interventions must navigate structural, spatial, personal, and familial contestations for relevance and effectiveness

HIV and fertility change in rural Zimbabwe

Fertility transition and HIV epidemics are currently running parallel in some sub-Saharan African populations. Interactions between the two at the individual and population levels could accentuate or moderate the resulting demographic trends. We review a number of mechanisms through which an HIV epidemic and responses to it can affect birth rates, through the biological and behavioural proximate determinants. Uninfected as well as infected people can be affected and many of the changes could have unintended consequences for fertility at the individual level. Results from a small-scale in-depth study in two rural areas of Zimbabwe are reviewed. These indicate that the local HIV epidemic has begun to influence the proximate determinants of fertility. If observed trends persist, a modest acceleration in the recent decline in birth rates seems plausible

The prevalence of self-reported vision difficulty in economically disadvantaged regions of South Africa

Background: Vision impairment, resulting in vision difficulties, is a leading cause of disability, and hence one of the key barriers for people to access education and employment, which may force them into poverty. Objectives: The objective of this study was to determine the prevalence of self-reported vision difficulties as an indicator of vision impairment in economically disadvantaged regions in South Africa, and to examine the relationship between self-reported vision difficulties and socio-economic markers of poverty, namely, income, education and health service needs. Methods: A cross-sectional study was conducted in economically disadvantaged districts to collect data from households on poverty and health, including vision difficulty. As visual acuity measurements were not conducted, the researchers used the term vision difficulty as an indicator of vision impairment. Data were collected from 27 districts (74 901 respondents). Logistic regression analysis and chi-square tests were used to determine bivariate relationships between variables and self-reported vision difficulty. Kernel density estimators were used for age, categorised by self-reported and not reported vision difficulty. Results: Prevalence of self-reported vision difficulty was 11.2% (95% CI, 8.7% – 13.7%). More women (12.7%) compared to men (9.5%) self-reported vision difficulty (p < 0.01). Self-reported vision difficulty was higher (14.2%) for respondents that do not spend any money. A statistically significant relationship was found between the highest level of education and self-reporting of vision difficulty; as completed highest level of education increased, self-reporting of vision difficulty became lower (p < 0.01). A significantly higher prevalence of self-reported vision difficulty was found in respondents who are employed (p < 0.01), 17% (95% CI: 12.8% – 21.1%). Conclusion: The evidence from this study suggests associations between socio-economic factors and vision difficulties that have a two-fold relationship (some factors such as education, and access to eye health services are associated with vision difficulty whilst vision difficulty may trap people in their current poverty or deepen their poverty status). The results are thus indicative of the need for further research in South Africa

Is there evidence for behaviour change in response to AIDS in rural Zimbabwe?

This article reports on evidence for behaviour change in response to AIDS among women in two rural areas of Manicaland Province, Zimbabwe. It examines self-reported data on two overlapping areas of behaviour: (1) actions taken to avoid HIV-1 infection; and (2) fertility practices. The latter were used to assess the validity of the former, given that self-reported behaviour data are notoriously problematic. It is concluded that while self-reported behaviour change is exaggerated, the true level of change has nonetheless been significant and includes delayed onset of sexual relations, increased use of condoms and, possibly, increased monogamy. Reported actions taken to avoid HIV-1 infection and differentials in fertility practices were correlated with data on demographic, social and psychological factors. Differentials in fertility practices were associated with heightened risk perception--particularly when based on personal acquaintance with AIDS patients--but not with greater knowledge of HIV-1/AIDS. Results from the study suggest that effective behaviour change in Manicaland is facilitated by greater knowledge, experience and personal risk perception but obstructed by low female autonomy, marital status and economic status, and by male labour migration and alcohol consumption. Gaps in knowledge included misconceptions about the distinction between HIV-1 and AIDS, the influence of STDs, perinatal transmission, and incorrect modes of transmission. Better knowledge was associated with education, religion, travel and media exposure. Personal risk perception was quite high (42%) and correlated with non-marriage, media exposure and contact with medical services. Few respondents knew close relatives with HIV/AIDS (4%) but nearly a quarter of those who felt in danger of infection said this was because friends and relatives were dying of AIDS. Many reported credible behavioural responses, some of which would only be effective given their partner's co-operation. Intensified behaviour interventions are needed which should include peer-education initiatives targeting men and individuals without access to modern media. The epidemic may accelerate fertility decline in rural Zimbabwe through behavioural as well as biological change.HIV/AIDS KABP behaviour change fertility Zimbabwe