Risky sexual behaviour among men : HIV surveillance and risk reduction among men who have multiple, female sexual partners in Cape Town, South Africa

Includes abstract.Includes bibliographical references.Second generation HIV surveillance surveys that collect biological and behavioural data from populations of interest is urgently needed to demonstrate accountability to domestic and international HIV funders, monitor trends in HIV and risk behaviours over time, and provide evidence of the effectiveness of HIV prevention efforts

Court support workers speak out: Upholding children's rights in the criminal justice system

The prevalence of sexual offences against children in South Africa continues to be among the highest in the world. The quality and accuracy of a child's testimony is often pivotal to whether cases are prosecuted, and whether justice is done. Child witness programmes assist child victims of sexual abuse to prepare to give consistent, coherent and accurate testimony, and also attempt to ensure that the rights of the child are upheld as enshrined in the various laws, legislative frameworks, directives and instructions that have been introduced since 1994. We draw on information from two studies that sought the perspectives of court support workers to explore whether a child rights-based approach is followed in the criminal justice system (CJS) for child victims of sexual abuse. Findings suggest varying degrees of protection, assistance and support for child victims of sexual abuse during participation in the CJS. The findings revealed that the rights of children to equality, dignity and not to be treated or punished in a cruel, inhuman or degrading way were undermined in many instances. Finally, recommendations are given on ways to mitigate the harsh effects that adversarial court systems have on children's rights.DHE

Decisions to care for HIV/AIDS orphans

Bibliography: leaves 151-161.There is substantial evidence to indicate that South Africa is facing the prospect of a large number of children, now and in the future, who will be orphaned as a result of the HIV/AIDS pandemic. In all likelihood, these children would have experienced psychological trauma through the illness and death of people close to them, and the social isolation that accompanies HIV-infection and AIDS-related illness and death. The ideal would be for as many of these children as possible to experience some type of family life in which to grow and mature into responsible adults. The aim of the present study was to explore a range of factors that might influence prospective carers' decisions to care for children orphaned by HIV/AIDS. These include features of prospective carers; features of the orphaned child; and forms of assistance that may be required. By means of a postal survey, the present study explored existing adoptive and foster parents' (N=17S) willingness to care for an HIV/AIDS orphan. Results show that close to 69% of respondents indicated a willingness to care for an HIV/AIDS orphan. Although some differences were noted depending on the HIV status of the child and whether the respondent was an adoptive or foster parent, on the whole they also indicated a preferred willingness to care for an HIV-negative female child, up to the age of 6 years old, of the same culture and from the same family as themselves, and without surviving relatives or siblings. Free medical care and schooling for the child were the suggested forms of assistance required. The Theory of Planned Behaviour (Ajzen, 1991), explored in the present study, did predict intentions to care for either an HIV-negative or HIV-positive orphan. However, certain components of the models did not have good predictive ability calling into question the usefulness of the model as a means to explain and predict intention to care for an HIV/AIDS orphan. Implications of the study provide recommendations for persons involved with children orphaned by HIV/AIDS

Intimate Partner Violence, Relationship Power Inequity and the Role of Sexual and Social Risk Factors in the Production of Violence among Young Women Who Have Multiple Sexual Partners in a Peri-Urban Setting in South Africa

This paper aims to assess the extent and correlates of intimate partner violence (IPV), explore relationship power inequity and the role of sexual and social risk factors in the production of violence among young women aged 16-24 reporting more than one partner in the past three months in a peri-urban setting in the Western Cape, South Africa. Recent estimates suggest that every six hours a woman is killed by an intimate partner in South Africa, making IPV a leading public health problem in the country. While there is mounting evidence that levels of IPV are high in peri-urban settings in South Africa, not much is known about how it manifests among women who engage in concomitantly high HIV risk behaviours such as multiple sexual partnering, transactional sex and age mixing. We know even less about how such women negotiate power and control if exposed to violence in such sexual networks.Two hundred and fifty nine women with multiple sexual partners, residing in a predominantly Black peri-urban community in the Western Cape, South Africa, were recruited into a bio-behavioural survey using Respondent Driven Sampling (RDS). After the survey, focus group discussions and individual interviews were conducted among young women and men to understand the underlying factors informing their risk behaviours and experiences of violence.86% of the young women experienced IPV in the past 12 months. Sexual IPV was significantly correlated with sex with a man who was 5 years or older than the index female partner (OR 1.7, 95% CI 1.0-3.2) and transactional sex with most recent casual partner (OR 2.1, 95% CI 1.1-3.8). Predictably, women experienced high levels of relationship power inequity. However, they also identified areas in their controlling relationships where they shared decision making power.Levels of IPV among young women with multiple sexual partners were much higher than what is reported among women in the general population and shown to be associated with sexual risk taking. Interventions targeting IPV need to address sexual risk taking as it heightens vulnerability to violence

The wrong type of decline: Fluctuations in price and value of illegal substances in Cape Town

This article documents and contextualises fluctuations in the street-level prices and values of selected illegal substances over a 10-year period in Cape Town, South Africa, by drawing on recent empirical research and past reports. The contemporary prices are compared and contrasted with each other, as well as with those previously documented. We show that when adjusted for inflation, the value of these substances has decreased over the last decade, making them more affordable, even though their nominal prices have remained morestable. In beginning to provide explanations for these changes, we outline some of the mechanisms that shape the market and point to the primary structural drivers of substance use in the country

More than just talk: the framing of transactional sex and its implications for vulnerability to HIV in Lesotho, Madagascar and South Africa

Background 'Transactional sex' was regarded by the mid-1990s as an important determinant of HIV transmission, particularly in sub-Saharan Africa. Little attention has been paid to what the terms used to denote transactional sex suggest about how it is understood. This study provides a nuanced set of descriptions of the meaning of transactional sex in three settings. Furthermore, we discuss how discourses around transactional sex suggest linkages to processes of globalization and hold implications for vulnerability to HIV. Methods The analysis in this article is based on three case studies conducted as part of a multi-country research project that investigated linkages between economic globalization and HIV. In this analysis, we contextualize and contrast the 'talk' about transactional sex through the following research methods in three study sites: descriptions revealed through semi-structured interviews with garment workers in Lesotho; focus groups with young women and men in Antananarivo, Madagascar; and focus groups and in-depth interviews with young women and men in Mbekweni, South Africa. Results Participants' talk about transactional sex reveals two themes: (1) 'The politics of differentiation' reflects how participants used language to demarcate identities, and distance themselves from contextually-based marginalized identities; and (2) 'Gender, agency and power' describes how participants frame gendered-power within the context of transactional sex practices, and reflects on the limitations to women's power as sexual agents in these exchanges. Talk about transactional sex in our study settings supports the assertion that emerging transactional sexual practices are linked with processes of globalization tied to consumerism. Conclusions By focusing on 'talk' about transactional sex, we locate definitions of transactional sex, and how terms used to describe transactional sex are morally framed for people within their local context. We take advantage of an opportunity to comparatively explore such talk across three different study sites, and contribute to a better understanding of both emerging sexual practices and their implications for HIV vulnerability. Our work underlines that transactional sex needs to be reflected as it is perceived: something very different from, but of at least equal concern to, formal sex work in the efforts to curb HIV transmission

The construction of an idealised urban masculinity among men with concurrent sexual partners in a South African township

Background : The perspectives of heterosexual males who have large sexual networks comprising concurrent sexual partners and who engage in high-risk sexual behaviours are scarcely documented. Yet these perspectives are crucial to understanding the high HIV prevalence in South Africa where domestic violence, sexual assault and rape are alarmingly high, suggesting problematic gender dynamics. Objective : To explore the construction of masculinities and men's perceptions of women and their sexual relationships, among men with large sexual networks and concurrent partners. Design : This qualitative study was conducted in conjunction with a larger quantitative survey among men at high risk of HIV, using respondent-driven sampling to recruit participants, where long referral chains allowed us to reach far into social networks. Twenty in-depth, open-ended interviews with South African men who had multiple and concurrent sexual partners were conducted. A latent content analysis was used to explore the characteristics and dynamics of social and sexual relationships. Results : We found dominant masculine ideals characterised by overt economic power and multiple sexual partners. Reasons for large concurrent sexual networks were the perception that women were too empowered, could not be trusted, and lack of control over women. Existing masculine norms encourage concurrent sexual networks, ignoring the high risk of HIV transmission. Biological explanations and determinism further reinforced strong and negative perceptions of women and female sexuality, which helped polarise men's interpretation of gender constructions. Conclusions : Our results highlight the need to address sexuality and gender dynamics among men in growing, informal urban areas where HIV prevalence is strikingly high. Traditional structures that could work as focal entry points should be explored for effective HIV prevention aimed at normative change among hard-to-reach men in high-risk urban and largely informal contexts

Effects of PREPARE, a Multi-component, School-Based HIV and Intimate Partner Violence (IPV) Prevention Programme on Adolescent Sexual Risk Behaviour and IPV : Cluster Randomised Controlled Trial

Young South Africans, especially women, are at high risk of HIV. We evaluated the effects of PREPARE, a multi-component, school-based HIV prevention intervention to delay sexual debut, increase condom use and decrease intimate partner violence (IPV) among young adolescents. We conducted a cluster RCT among Grade eights in 42 high schools. The intervention comprised education sessions, a school health service and a school sexual violence prevention programme. Participants completed questionnaires at baseline, 6 and 12 months. Regression was undertaken to provide ORs or coefficients adjusted for clustering. Of 6244 sampled adolescents, 55.3 % participated. At 12 months there were no differences between intervention and control arms in sexual risk behaviours. Participants in the intervention arm were less likely to report IPV victimisation (35.1 vs. 40.9 %; OR 0.77, 95 % CI 0.61-0.99; t(40) = 2.14) suggesting the intervention shaped intimate partnerships into safer ones, potentially lowering the risk for HIV