Peer-reviewed publications, 2015

Publications (journal articles, book chapters, books) produced in 2015:

  • Becker E, Kuo C, Cluver L, Operario D, et al.  Measuring child awareness for adult symptomatic HIV using a verbal assessment tool: Concordance between adult-child dyads on adult HIV symptoms. Sex Transm Infect, 2015; 91(7): 528-33.

Objectives: This study assessed children’s awareness for adult HIV-associated symptoms and illnesses using a verbal assessment tool by analysing inter-rater reliability between adult –child dyads. This study also evaluated sociodemographic and household characteristics associated with child awareness of adult symptomatic HIV.

Methods: A cross-sectional survey using a representative community sample of adult – child dyads (N=2477 dyads) was conducted in KwaZulu-Natal, South Africa. Analyses focused on a subsample (n=673 adult – child dyads) who completed verbal assessment interviews for symptomatic HIV. We used an existing validated verbal autopsy approach, originally designed to determine AIDS-related deaths by adult proxy reporters. We adapted this approach for use by child proxy reporters for reporting on HIV-associated symptoms and illnesses among living adults. Analyses assessed whether children could reliably report on adult HIV-associated symptoms and illnesses and adult provisional HIV status.

Results:  Adult – child pairs concurred above the 65th percentile for 9 of the 10 HIV associated symptoms and illnesses with sensitivities ranging from 10% to 100% and specificities ranging from 20% to 100%. Concordant reporting between adult – child dyads for the adult’s provisional HIV status was 72% (sensitivity=68%, specificity=73%). Children were more likely to reliably match adult’s reports of provisional HIV status when they lived in households with more household members, and households with more robust socioeconomic indicators including access to potable water, food security and television.

Conclusions:  Children demonstrate awareness of HIV- associated symptoms and illnesses experienced by adults in their household. Children in households with greater socioeconomic resources and more household members were more likely to reliably report on the adult’s provisional HIV status.

Caregiver social support has been shown to be protective for caregiver mental health, parenting and child psychosocial outcomes. This is the first known analysis to quantitatively investigate the relationship between caregiver social support and adolescent psychosocial outcomes in HIV-endemic, resource–scarce Southern African communities. A cross-sectional household survey was conducted over 2009–2010 with 2,477 South African adolescents aged 10–17 and their adult caregivers (18 years or older) in one urban and one rural community in South Africa’s KwaZulu-Natal province. Adolescent adjustment was assessed using adult caregiver reports of the Strengths and Difficulties questionnaire (SDQ), which measures peer problems, hyperactivity, conduct problems, emotional symptoms and child prosocial behavior. Hierarchical linear regressions and multiple mediation analyses, using bootstrapping procedures, were conducted to assess for: (a) direct effects of more caregiver social support on better adolescent psychosocial wellbeing; and (b) indirect effects mediated by better parenting and caregiver mental health. Direct associations (p\.001), and indirect associations mediated through better parenting, were found for all adolescent outcomes. Findings reinforce the importance of social support components within parenting interventions but also point to scope for positive intervention on adolescent psychosocial wellbeing through the broader family social network.

  • Colvin CJ. Anthropologies In and of evidence making in global health research and policy. Medical Anthropology, 2015; 34(2):99-105.

[no abstract available]

The question of whether hormonal contraception, particularly depot medroxyprogesterone acetate, increases a woman’s risk of acquiring HIV has been debated since an association was first noted in 1991.1 Subsequent data from observational studies, secondary analyses of trials, and systematic reviews2–4 largely support the view that depot medroxyprogesterone acetate makes a moderate contribution to HIV risk. Efforts to synthesise existing evidence, however, have shown significant heterogeneity and serious, uncontrolled risk of confounding.

  • Colvin CJ, Swartz A. Extension agents or agents of change? Annals of Anthropological Practice, 2015; 39(1): 29-41.

Global public health discourse and practice around community health workers (CHWs) often invoke two distinct ideal types: the CHW as an “extension agent” of biomedical health services, bringing health services into community and household settings, and the CHW as a progressive “agent of change,” working with communities to mobilize socially and politically around health inequities and identify and tackle the social determinants of health. In this article, we examine the experience of postapartheid South Africa with CHWs and take a critical look at the degree to which these conventional models of CHWs account for how CHWs in South Africa have emerged, what kinds of work they have done, how they have organized themselves, and what impacts they have had. In the end, we argue that these two models miss much of what is interesting and important about the lives and work of CHWs in South Africa. We further make the case that both mainstream and progressive public health academics and activists tend too often to frame—and reify—CHWs as a much-anticipated solution to a variety of (much bigger) health system and political problems. We maintain, instead, that to adequately understand and support the work of CHWs, one must begin by situating community-based care work within a much broader analysis of these problems.

Since the 1994 International Conference on Population and Development, researchers and practitioners have engaged in a series of efforts to shift health programming with men from being gender-neutral to being more gender-sensitive and gender-transformative. Efforts in this latter category have been increasingly utilised, particularly in the last decade, and attempt to transform gender relations to be more equitable in the name of improved health outcomes for both women and men. We begin by assessing the conceptual progression of social science contributions to gender-transformative health programming with men. Next, we briefly assess the empirical evidence from gender-transformative health interventions with men. Finally, we examine some of the challenges and limitations of gender-transformative health programmes and make recommendations for future work in this thriving interdisciplinary area of study.

A recent clinical trial provided evidence that pre-exposure prophylaxis (PrEP) has the potential to prevent HIV infection among people who inject drugs (PWID). We examined willingness to use PrEP among HIV-negative PWID in Vancouver, Canada (n = 543) to inform PrEP implementation efforts. One third (35.4 %) expressed willingness to use PrEP, with adjusted models indicating that younger age, no regular employment, requiring help injecting, engaging in sex work, and reporting multiple recent sexual partners were positively associated with willingness to use PrEP. Although willingness to use PrEP was low, PrEP was acceptable to some PWID at heightened risk for HIV infection.

  • Folayan M, Odetoyinbo R, Harrison A. Differences in use of contraception by age, sex and HIV status of 10-19 year old adolescents in Nigeria.

Background: Sexual behaviour and sexual practices affect the risk for acquisition and transmission of HIV infection. This study tries to identify differences in sexual behaviour (condom use with non-marital partners, multiple sexual partnerships transactional sex and age mixing in sexual relationships), sexual practices (oral, anal and vagina sex), and forced sexual initiation based on sex and HIV status of adolescents in Nigeria.

Method: Face to face interviewer-administered questionnaires were used to collect information from a nationally representative sample of 10–19 years old adolescents residing in Nigeria. Data included information on age of sexual debut, sexual behaviour and sexual practices. Association between HIV status, sex, sexual behaviour and sexual practices, and predictors of use of condoms during the last vaginal sexual intercourse were determined.

Result: More self-reported HIV positive than HIV negative females had experienced forced sexual initiation (p = 0.008). Significantly more female than male adolescents had engaged in transactional sex (p < 0.001) and had sex with partners who were older than them by 10 years or more (p < 0.001). Vaginal (95.2%), oral (26.6%) and anal (7.8%) sex were practiced by male and females irrespective of HIV status. More females reported oral sex (p = 0.001). Being a female (p = 0.001), having genital itching in the last 12 months (p = 0.04)and having engaged in anal sex in the last 12 months (p = 0.009) reduced the odds of using a condom at last vaginal intercourse. Having a HIV positive or negative status did not significantly increase the odds of using a condom at last vaginal intercourse.

Conclusion: Differences in sexual behaviour and sexual practices of adolescents was observed based on sex and not on HIV status. History of forced sex initiation however differed by HIV status. Tailored interventions for male and female adolescents are required to reduce their risk of HIV infection. Tailored interventions are also required for adolescents living with HIV to improve their sexual and reproductive health.

Young women in southern Africa experience some of the highest incidence rates of HIV infection in the world. Across southern Africa, HIV prevalence among women increases rapidly between the teenage years and young adulthood. Adult HIV prevalence is 16.8 % in South Africa, 23 % in Botswana, 23 % in Lesotho, and 26.5 % in Swaziland. Existing research has illuminated some of the key social, behavioral, and structural factors associated with young women’s disproportionate HIV risk, including gendered social norms that advantage male power in sexual relationships and age disparities in relationships between younger women and older male partners. Important structural factors include the region’s history of labor migration and legacy of family disruption, and entrenched social and economic inequalities. New interventions are emerging to address these high levels of HIV risk in the key population of young women, including structural interventions, biomedical prevention such as PrEP, and combined HIV prevention approaches.

  • Hershow RB, Gannett K, Merrill J, Kaufman EB, Barkley C, DeCelles J, Harrison A. Using soccer to build confidence and increase HCT uptake among at-risk girls: A mixed-methods study of an HIV prevention programme in South Africa. Sport in Society, 2015; 18(8): 1009-22.

HIV prevalence is eight times higher in young South African women compared to men. Grassroot Soccer (GRS) developed SKILLZ Street (SS), a single-sex intervention using soccer to improve self-efficacy, HIV-related knowledge, and HIV counselling and testing (HCT) uptake among girls ages 12–16. Female community leaders—“coaches”—deliver ten 2-hour sessions bi-weekly. Attendance and HCT data were collected at 38 programmes across 5 GRS sites during 24 months in 2011–2012. 514 participants completed a 16-item pre/post questionnaire. Focus group discussions (FGDs) were conducted with participants (n=11 groups) and coaches (n=5 groups), and coded for analysis using NVivo. Of 1,953 participants offered HCT, 68.5% tested. Overall, significant pre/post improvement was observed (p<0.001). FGDs suggest participants: valued coach-participant relationship; improved self-efficacy, HIV-related knowledge, communication, and changed perception of soccer as a male-only sport; and increased awareness of testing’s importance. Results suggest SS helps at-risk girls access HCT and HIV-related knowledge while promoting self-confidence.

  • Matthews LT, Moore L, Milford C, Greener R, Mosery N, Rifkin R, Psaros C, Safren S, Harrison A, et al. “If I don’t use a condom… I would be stressed in my heart that I’ve done something wrong”. Routine prevention messages preclude safer conception counselling for HIV-infected men and women in South Africa. AIDS and Behaviour, 2015; 19: 1666.

Intended conception likely contributes to a significant proportion of new HIV infections in South Africa. Safer conception strategies require healthcare provider–client communication about fertility intentions, periconception risks, and options to modify those risks. We conducted in-depth interviews with 35 HIV-infected men and women accessing care in South Africa to explore barriers and promoters to patient–provider communication around fertility desires and intentions. Few participants had discussed personal fertility goals with providers. Discussions about pregnancy focused on maternal and child health, not sexual HIV transmission; no participants had received tailored safer conception advice. Although participants welcomed safer conception counseling, barriers to client-initiated discussions included narrowly focused prevention messages and perceptions that periconception transmission risk is not modifiable. Supporting providers to assess clients’ fertility intentions and offer appropriate advice, and public health campaigns that address sexual HIV transmission in the context of conception may improve awareness of and access to safer conception strategies.

  • Reynolds L. Category and kin in ‘crisis’: Representations of kinship, care and vulnerability in demographic and ethnographic research in KwaZulu-Natal, South Africa. Studies in Comparative International Development, 2015; 50)4): 539-60.

[no abstract available]

  • van der Elst EM, Gichuru E, Muraguri N, Musyoki H, Micheni M, Kombo B, Smith AD, Graham SM, Sanders EJ, Operario D. Strengthening healthcare providers’ skills to improve HIV services for MSM in Kenya. AIDS, 2015; 29)0 3): S237-40.

[no abstract available]

  • Viitanen A, Colvin CJ. Lessons learned: Program messaging in gender-transformative work with men and boys in South Africa. Global Health Action, 2015;8: 27860.

Background: Adherence to traditional notions of masculinity has been identified as an important driver in the perpetuation of numerous health and social problems, including gender-based violence and HIV. With the largest generalized HIV epidemic in the world and high rates of violence against women, the need for gender-transformative work in South Africa is broadly accepted in activist circles and at the national and community level. Because of the integral role men play in both of these epidemics, initiatives and strategies that engage men in promoting gender equality have emerged over the last decade and the evidence base supporting the effectiveness of masculinities-based interventions is growing. However, little research exists on men’s receptivity to the messages delivered in these programs.

Objective: This article examines the current practices among a set of gender-transformation initiatives in South Africa to see what lessons can be derived from them. We look at how South African men participating in these programs responded to three thematic messages frequently found in gender-transformative work: 1) the ‘costs of masculinity’ men pay for adherence to harmful gender constructs; 2) multiple forms of masculinity; and 3) the human rights framework and contested rights.

Design: This article synthesizes qualitative findings from in-depth interviews, focus group discussions, and ethnographic research with men participating in several gender- and health-intervention programs in South Africa. The data were collected between 2007 and 2011 and synthesized using some of the basic principles of meta-ethnography.

Results and conclusions: Overall, men were receptive to the three thematic messages reviewed; they were able to see them in the context of their own lives and the messages facilitated rich dialog among participants. However, some men were more ambivalent toward shifting gender notions and some even adamantly resisted engaging in discussions over gender equality. More research is needed to gauge the long-term impact of participation in interventions that target gender and health.

 

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