Soft systems methodology as a potential approach to understanding non-motorised transport users in South Africa

Non-Motorised Transport (NMT) in South Africa is currently not completely integrated into transport and spatial planning as a formal mode of transport. This is evident when observing the current condition and utilisation of South Africa?s NMT infrastructure. Pedestrians are frequently observed walking on the roads instead of on the newly built pedestrian walkways directly next to them. It is not uncommon in South Africa to find evidence of pedestrians who break through brick walls and cross highways illegally instead of using the pedestrian bridges provided. These examples demonstrate that the behaviour and needs of NMT users in South Africa are not understood and provided for by built environment planning and design practitioners (BEPDPs). The aim of this paper is to show the potential of using systems thinking and more particularly Soft Systems Methodology (SSM) as a practical and beneficial instrument that will guide BEPDPs with the ongoing learning process of understanding NMT users and their specific needs. An introduction to relevant systems thinking philosophies and methodologies are provided, followed by a discussion on the background, development and use of SSM in practice. This paper advocates the necessity of considering NMT as a mode of transport with the emphasis on the need for culture-oriented planning that can contribute to integrated innovative context sensitive mobility solutions and the promotion of green mobility. In achieving this, SSM is shown to provide useful tools for BEPDPs to seek understanding of the behaviour and needs of NMT users within the broader contexts of the mobility requirements of communities and to then provide fit-for-purpose NMT infrastructure and facilities.Paper presented at the 35th Annual Southern African Transport Conference 4-7 July 2016 "Transport ? a catalyst for socio-economic growth and development opportunities to improve quality of life", CSIR International Convention Centre, Pretoria, South Africa.The Minister of Transport, South AfricaTransportation Research Board of the US

Age-Related Differences in Socio-demographic and Behavioral Determinants of HIV Testing and Counseling in HPTN 043/NIMH Project Accept

Youth represent a large proportion of new HIV infections worldwide, yet their utilization of HIV testing and counseling (HTC) remains low. Using the post-intervention, cross-sectional, population-based household survey done in 2011 as part of HPTN 043/NIMH Project Accept, a cluster-randomized trial of community mobilization and mobile HTC in South Africa (Soweto and KwaZulu Natal), Zimbabwe, Tanzania and Thailand, we evaluated age-related differences among socio-demographic and behavioral determinants of HTC in study participants by study arm, site, and gender. A multivariate logistic regression model was developed using complete individual data from 13,755 participants with recent HIV testing (prior 12 months) as the outcome. Youth (18–24 years) was not predictive of recent HTC, except for high-risk youth with multiple concurrent partners, who were less likely (aOR 0.75; 95% CI 0.61–0.92) to have recently been tested than youth reporting a single partner. Importantly, the intervention was successful in reaching men with site specific success ranging from aOR 1.27 (95% CI 1.05–1.53) in South Africa to aOR 2.30 in Thailand (95% CI 1.85–2.84). Finally, across a diverse range of settings, higher education (aOR 1.67; 95% CI 1.42, 1.96), higher socio-economic status (aOR 1.21; 95% CI 1.08–1.36), and marriage (aOR 1.55; 95% CI 1.37–1.75) were all predictive of recent HTC, which did not significantly vary across study arm, site, gender or age category (18–24 vs. 25–32 years)

Effect of community-based voluntary counselling and testing on HIV incidence and social and behavioural outcomes (NIMH Project Accept; HPTN 043): a cluster-randomised trial

Background Although several interventions have shown reduced HIV incidence in clinical trials, the community-level effect of effective interventions on the epidemic when scaled up is unknown. We investigated whether a multicomponent, multilevel social and behavioural prevention strategy could reduce HIV incidence, increase HIV testing, reduce HIV risk behaviour, and change social and behavioural norms. Methods For this phase 3 cluster-randomised controlled trial, 34 communities in four sites in Africa and 14 communities in Thailand were randomly allocated in matched pairs to receive 36 months of community-based voluntary counselling and testing for HIV (intervention group) or standard counselling and testing alone (control group) between January, 2001, and December, 2011. The intervention was designed to make testing more accessible in communities, engage communities through outreach, and provide support services after testing. Randomisation was done by a computer-generated code and was not masked. Data were collected at baseline and after intervention by cross-sectional random surveys of community residents aged 18-32 years. The primary outcome was HIV incidence and was estimated with a cross-sectional multi-assay algorithm and antiretroviral drug screening assay. Thailand was excluded from incidence analyses because of low HIV prevalence. Findings The estimated incidence of HIV in the intervention group was 1.52% versus 1.81% in the control group with an estimated reduction in HIV incidence of 13.9%. HIV incidence was significantly reduced in women older than 24 years), but not in other age or sex subgroups. Community-based voluntary counselling and testing increased testing rates by 25% overall by 45% in men and 15% in women. No overall effect on sexual risk behaviour was recorded. Social norms regarding HIV testing were improved by 6% in communities in the intervention group. Interpretation These results are sufficiently robust, especially when taking into consideration the combined results of modest reductions in HIV incidence combined with increases in HIV testing and reductions in HIV risk behaviour, to recommend the Project Accept approach as an integral part of all interventions (including treatment as prevention) to reduce HIV transmission at the community level.